Respond Deliver & Enable IMPROVING DEMENTIA CARE - FALLS PREVENTION Julie Vale 26 th January 2010

Respond Deliver & Enable The Numbers 200,000 falls per year in acute, community and mental health units (NPSA, 2007) Nationwide 500 people suffer a # hip following a fall in hospital R,D&E = 1,821 falls in 2009 Average of 152/month

Respond Deliver & Enable The R,D&E story Two fatalities Jan – Mar 08 One pt fell times – no action taken One pt fell twice in the same night over bedrails Both patients had cognitive impairment Culture of normalisation to falls across the trust and division

Respond Deliver & Enable Assessment. On admission – within 24 hours After any ward moves. After any change in condition – e.g. patient becomes unwell or has a fall. Routinely on a weekly basis moving to every 72 hours Top tip: Beware underscoring

Respond Deliver & Enable Risk planning. Cohort at-risk patients. Bed position – visible and low. Footwear. No bed rails. Refer to OT and Physio – for falls assessment and planning. Keep area clean and tidy – remove obstacles. No commodes left by bed. Communication to team – highlighting risk. Document all actions and processes followed.

Respond Deliver & Enable Leadership intervention – test of change re development of falls checklist/bundle Targeted formal falls education Intentional round every hour for patients with falls risk score >20 Checklist with key quality questions Verbal feedback from staff, patients and carers Positive results with decrease in falls across directorate and Trust Intentional Rounding Checklist Intentional rounding provides the visible presence of nursing staff on the ward and patients and carers have commented on it improving their experience while in hospital: “ I feel safe” “ I didn’t realise I had dropped my call bell” “ Nurses are saying they have time to care”

Respond Deliver & Enable INTENTIONAL ROUNDING CHECKLIST Hospital No. …………………. Name: ………………………… DoB: ………………………….. Affix patient label here For patients with a falls risk score of 20 or if any degree of cognitive impairment please enter either ‘A’ = achieved or ‘V’ = variance in columns. Record reason for variance and action taken overleaf. This patient requires observation every hour …..... minutes. DATE: TIMES 1. CONTINENCE Do you need to go to the toilet? 2. PAIN Do you have any pain? 3. ORIENTATION – fully alert=FA; mildly confused/disorientated=MC; severe confusion/disorientation=SC; asleep=A 4. POSITION / COMFORT Are you comfortable? 5. DRINK / MOUTHCARE Would you like a drink? 6. CALL BELL WITHIN REACH If you need me, please press this button 7. BED RAILS DOWN 8. BED TO THE LOWEST POINT TO THE FLOOR and underbed light on at night 9. IS THERE ANYTHING ELSE I CAN DO FOR YOU BECAUSE I HAVE THE TIME? INITIALS Intentional Rounding Checklist

Respond Deliver & Enable Principles and Lessons Learned Round >20 or if any degree of cognitive impairment/confusion All questions need to be asked in order Patients need to be rounded every hour over 24 hour period If patient asleep over night, when they wake, restart the clock Don’t stop if they haven’t fallen! Draft training package and targeted education vital for success Its more than managing the falls risk … patients feel cared for Build in audit cycle for sustainability Clinical champions Be relentless in approach Respond, Deliver & Enable

Respond Deliver & Enable 10/1/09 admitted to RD&E from Hay House 13/1/09 admitted to medical ward Falls assessment score 23 17/1/09 transferred to another ward not reassessed 25/1/09 routine falls reassessed as 34 IR not commenced 2/2/09 routine falls reassessed as 33 IR not commenced 7/2/09 routine falls reassessed as 33 IR not commenced 14/2/09 routine falls reassessed as 33 IR not commenced 16/2/09 routine falls reassessed as 33 IR not commenced 24/2/09 routine falls reassessed as 33 IR not commenced 2/3/09 routine falls reassessed as 33 IR not commenced CRP 92 1/3/09 2/3/09 Fall b c d b Time____ Event Supporting Information Incident

Respond Deliver & Enable Results Total number of inpatient falls in 10 medical wards April 2008 to July 2009

Respond Deliver & Enable Kenn Ward – Slips, trips and falls

Respond Deliver & Enable Very High Risk Some patients risk cannot be adequately reduced despite all of the above actions. 1.Risk assess and document any actions. 2.Alert your Matron and Senior Matron if patients remain at very high risk. 3.Consider 1:1 special 4.Consider using hip protectors 5.Reassess and document change on a daily basis.