Falling Down is for Babies! Reducing Falls in Hospitalized Pts.

MCCG snapshot 637 beds Level 1 Trauma Center Serves 29 counties (> 750 k residents) 5000 employees; 1500 nurses Regional economic impact > $1 Billion Magnet designated 2005, 2009

MCCG Case for Action 2009 under-perform NDNQI benchmark 68% of the quarters in MS and CC units Actions taken not making a sustained difference…. – On line risk assessment – Fall CQIR – High risk interventions – 3Ps – Bed alarms high risk units

Cost of falls at MCCG: Injury intervention, discomfort, pain Scans, films, other diagnostics ↑ length of stay psychological effects lawsuits Decrease trust/ pt satisfaction ↓reimbursement- CMS “never” event- IQR

MCCG vs. NDNQI falls 1Q09-4Q09

2010: Ramping Up Who falls? When? How? Why? Re-energize Fall Committee Strict interpretation of “fall” Fall reduction as strategic goal Current EBP Fall research project Fall NSICs and prevention bundle

Continuing the work 2010 Monitoring and feedback Inter-disciplinary mandatory education Recognition and accountability Additional technology ↓ fall incidence 12% and injury incidence 18% – out-perform NDNQI 52% – 65% prevention strategies – We can do better……………

Bring on 2011 Continue to review and incorporate best practices Technology: bed alarms on all, pilots, minimal lift Integrate processes 100% daily review of falls with feedback Patient/ family partnership: contract, brochure:

Patient/ Family Partnership

More 2011 improvements Strategic goal again Engagement Falls = errors: 100% review Avoiding injury while assisting falls Modify Morse scale: under-scoring high risk pts. * UNDER-perform 49% 2009 ↑ 81% in 2010

Clinical Documentation of the Morse Screening pre-revision: Protocol Reference Link

Modified Morse Scale 2011

Basic fall prevention ALL patients: Bathroom light Education about falls Shift assessment De-clutter, belongings Bed low and locked “Call Before You Fall”

EBP High fall risk prevention strategies >50 modified Morse scale or nursing judgment Yellow for “caution”- signage, armband, non skid slippers Pt/ family partnership- education each shift, brochure, contract, “teach back” Bed and chair alarm, familiar voice All disciplines accountable

More high risk prevention Strategic side-rails Bedside change of shift report Use of minimal lift equipment and BSC Purposeful/ accompanied toileting Clinical Observer Safety Net Bed in special circumstances Patient Mobility algorithm

Where we’re at today Leading/ process indicators: Risk assessment accuracy Prevention strategies Staffing Effectiveness Lagging/ outcome indicators: Fall incidence, comparison to benchmark # fall injuries, comparison

Process/ Outcome Summary ↓ fall incidence 20% ↓ falls with injury rate by 43.4% ↑ by >100% identification of high fall risk patients

More high risk prevention Fall % use of preventative strategies where applicable. Baseline to current 3Q10-4Q11

Process Measures risk assessment

Staffing Effectiveness Indicator: falls vs. turnover

Fall incidence

% out-perform NDNQI benchmark

# falls with injury

Injury falls compare to benchmark

Pushing to ZERO preventable falls in 2012 Chair alarms and familiar voice on PAR Looking at more supplies: yellow blankets, self releasing belt, diversion apron Focus on mobility Monthly tracking of actual vs. goal Unit specific drill down and action plan Mid course RCA, process flows, identify projects per GHA HEN HAC

Lessons Learned and Key Enablers #1 Engage frontline to management to Board EBP and research should drive practice Make fall reduction an organizational priority Don’t forget the other disciplines Capitalize on the power of peers Don’t assume knowledge = application

Lessons Learned and Key Enablers #2 Falls are errors to be eliminated Monitoring outcomes is good, adding process measures is better E.H.R. allows knowledge based assessment/intervention Survey to ascertain perception and belief, i.e. restraints DON’T prevent falls

Lessons Learned and Key Enablers #3 Incorporate education and communication into everything Partner with patients and families but factor impulsiveness It’s just basic nursing care, so integrate HAPU/ minimal lift and falls with mobility and safety Try and try again- it may work this time!

Contact Information Meryl Montgomery, Nursing QI Coordinator “Keep the drum beat going… promote the joy of sharing!” (GHA HEN)