1. Rapid Fire Team Presentation
Edmonton Home Care

2. Who We Are
Alberta Health Services Continuing Care Services Home Care, Geriatric Consult Team Edmonton, Alberta, Canada
Home Living Program consists of Home Care, Day Programs, and several specialty programs
Home Living serves 32,725 unique clients annually in Edmonton Zone
Geriatric Consult Team was created in August, 2011, in part to provide assessment and treatment of clients who have a risk or history of falls
64 clients have been served as of February 29, 2012

3. Objective of Learning Series
Think critically about how the Geriatric Consult Team will achieve improvement in falls screening, falls prevention, and injury reduction
Learn strategies of sustainability and integrate into falls improvement plans within overall Home Living Falls Risk Management Strategy
Develop skills to sustain practice change for prevention of falls and injury reduction
Actively participate in data submission to SHN Falls Intervention and network with other teams in the national Falls Facilitated Learning Series (FFLS)

4. Working Team
Team Lead:
Deb Payne, Manager, Quality Initiatives and Program Support
Team Sponsor:
Dennie Hycha, Director, Home Living
Team Members:
Shelley MacGregor, Area Manager, Geriatric Consult Team
Erin Meikle, Professional Practice Leader, PT, Home Living
Jennifer Russill, PT Amarjit Mann, PT
Sandy MacLean, OT Sharon Weleschuk, OT
Kelly Frazer, TA Richard Flierl, TA
Sharon Storey, RN Winona Mondor, RN
Susan Haggerty, Pharmacist Lesley MacGregor, NP
Joshua Running, NP Laura Murray, Recreation Therapist

5. Changes tested to date Changes Implemented Result
Facilitators/Barriers
Community Care Access (CCA) completes 3 screening questions on intake to Home Living
Have you fallen in the past 90 days?
If so, how many times?
Does fear of falling limit your activities?
94% of clients referred had falls screening on intake.
Facilitators:
Script is provided to all CCA staff – approach is standardized
CCA staff were early adopters of Home Care Falls Strategy
Barriers:
None
Falls screening by Home Living Case Manager
Partially working.
Falls Strategy is now a provincial initiative
Strong leadership locally and provincially
Completion of Phase I resulted in creation of Geriatric Consult Team, moving more to client focus
Organization-wide transition from paper to electronic documentation system (Meditech)
High workload of Case Managers

6. Changes tested to date Changes Implemented Result
Facilitators/Barriers
Geriatric Consult Team Assessment Tool including SPLATT
SPLATT questionnaire provides details about circumstances around fall (Symptoms, Previous falls, Location, Activity, Time, and Trauma)
Partially working.
Facilitators:
Ease of administration of SPLATT
Background knowledge of Phase I to guide team
Knowledge and support from Falls Risk Management Implementation and Evaluation Committee
Standard of Care for client falls is currently being piloted
Barriers:
Evolving processes for Geriatric Consult Team to assess falls or falls risk once screening is positive; awaiting Standard of Care

7. Baseline Measures
A chart review of Geriatric Consult Team clients was conducted in September, 2011
Geriatric Consult Team adopted FFLS goals for study period
Actual
Goal from Team Charter
Percentage of Falls Causing Injury
30%
24%
(reduce by 20%)
Percentage of Clients with Complete Falls Risk Screening on Admission
90%
100%
Percentage with Documented Falls Prevention/Injury Reduction Plan
70%

8. Study Population Client Group
Home Living clients referred by Case Managers to Geriatric Consult Team
Study Period
September 1, 2011 to January 31, 2012
Clients assessed and admitted to Geriatric Consult Team 43

9. Study Results

10. Study Results

11. Study Results

12. Factors Affecting Monthly Data
Clients referred to Geriatric Consult Team are often already experiencing falls or have a significant risk of falls
Geriatric Consult Team has no influence over the number of clients who have experienced a fall causing injury on admission to the team
Assessments may be delayed due to:
Client availability
Team availability
Increase referrals to Geriatric Consult Team
Monthly reporting does not provide trend data, only episodic data

13. Ensuring Quality Data
Continue to visit new clients as soon as possible and include falls screening on initial visit
Aim to complete documentation about falls history and risks in a timely manner
Review reporting periods to mitigate effect of delayed assessment
Identify cases where external factors delayed falls screening
Periodic review with Geriatric Consult Team and peers to discuss processes to work towards relevant data collection and best practice
Create standardized template and database for reporting of Geriatric Consult Team clients’ falls

14. Geriatric Consult Team Feedback: Falls
18 out of 64 clients have experienced a fall while under the care of Geriatric Consult Team from inception to February
Geriatric Consult Team is aware of the need to collect data about number and circumstances of falls in addition to Home Living falls reporting system
Family members and Home Care Case Managers report high satisfaction with Geriatric Consult Team’s interventions
Geriatric Consult Team members appreciate the benefit of an interdisciplinary approach to falls

15. Plan, Do, Study, Act (PDSA) Cycle
Geriatric Consult Team evaluated its current comprehensive initial assessment tool to determine its usefulness in falls screening and evaluation
PDSA cycle determined that the assessment tool in combination with the screening questions and SPLATT was an adequate screening tool, but additional targeted assessments should be explored for further evaluation of falls and falls risk
Geriatric Consult Team is exploring documents available in Meditech to assist in interdisciplinary assessment of falls
Geriatric Consult Team is working in collaboration with Falls Risk Management Implementation and Evaluation Team to standardize interventions for clients at low and high risk for falls

16. Sustaining Falls Improvement: Barriers
Competing priorities in Alberta Health Services
Geriatric Consult Team is a new entity, therefore, its processes and assessment forms are evolving
Uncertainty amongst Geriatric Consult Team members as to how to proceed following falls screening

17. Sustaining Falls Improvement: Facilitators
Strong support of Alberta Health Services, Senior Management, and Falls Risk Management Implementation and Evaluation Committee
Involvement with Canadian Falls Prevention Curriculum has provided Canadian content and is evidence informed
Geriatric Consult Team is a small, interdisciplinary group of experienced professionals who can directly impact the multifactorial reasons clients fall
Geriatric Consult Team has the opportunity to create new processes without the change management challenges that occur in a larger organization

18. Sustaining Falls Improvement: Moving Forward
Ensure timely assessment of clients, completeness of falls screening and appropriate, interdisciplinary evaluation of falls
Fully implement Standard of Care for falls
Determine an evaluation tool for Geriatric Consult Team clients who acknowledge a history of falls
Develop database and tracking form for Geriatric Consult Team to record clients’ falls
Collaboration with Falls Risk Management Implementation and Evaluation Committee

19. Sustaining Falls Improvement: Key Insights
FFLS was beneficial in initiating discussion on a Standard of Care for falls
Participating in FFLS has reinforced that falls are a universal problem and Geriatric Consult Team has benefitted from other teams’ knowledge
Process needs to be straightforward and implemented by all team members
Initial Geriatric Consult Team’s success is facilitated by team members visiting clients frequently and responding in a timely manner
FFLS process has provided insight into Geriatric Consult Team’s role in Home Care at large

20. Sustaining Falls Improvement: Advice to Teams
Keep working team small
Focus on one problem at a time
Align with larger organizational goals and find supportive leaders in management
Learn from other teams’ success and challenges

21. 6 Month Post FFLS Sustainability Plans for Falls Improvement
Goal Description
Action
Person Responsible
Metrics
Targeted Completion
100% of clients will have falls screening completed on intake to Home Care
3 falls screening questions
Community Care Access
Monitor completion of screening through chart audits
Annual process evaluation
100% of Home Care clients will have falls risk screening by Case Manager on initial assessment
Completion of FROP- COM in Meditech
Home Living Case Managers
Meditech chart audits
Implement organization- wide Standards of Care for falls
Compile data based on pilot project to develop Standards of Care
Falls Risk Management Implementation and Evaluation Committee
TBD
April 2012
Develop Standard of Care for referral to Geriatric Consult Team based on risk stratification
Determine criteria for high-risk clients that will indicate referral to Geriatric Consult Team; establish process for screening and assessment
Geriatric Consult Team, Falls Risk Management Implementation and Evaluation Committee, Program Support Manager
Fall 2012

22. 6 Month Post FFLS Sustainability Plans for Falls Improvement
Goal Description
Action
Person Responsible
Metrics
Targeted Completion
Geriatric Consult Team to determine effective falls assessment tool
Review assessments available in Meditech
Geriatric Consult Team and Meditech support personnel
Qualitative review by Geriatric Consult Team
April 2012
100% of clients will be screened for falls risk by Geriatric Consult Team on initial assessment
Repeat 3 falls screening questions and administer SPLATT
Geriatric Consult Team
Meditech and chart audits
Quarterly data collection; annual process evaluation
100% of Geriatric Consult Team clients will have falls prevention/ injury reduction plans
Establish plans when creating problem list based on assessment
Reliably record falls of Geriatric Consult Team clients
Establish tracking form for Geriatric Consult Team clients re: falls
Database to monitor frequency of falls post- assessment
April 2012; quarterly data collection

23. Contact Information
Deb Payne, MScHP
Manager, Quality Initiatives and Program Support
Phone: (780)
Jennifer Russill, BScPT
Physical Therapist, Geriatric Consult Team
Phone: (780)