1. Implementing a Falls Prevention Programme in the Acute Hospital Setting
Ms Pauline Fordyce, Head of Quality & Safety
Ms Helen Ryan, Clinical Governance/Quality Manager
Ms Joan Naughton, CNS Gerontology Liaison
Beaumont Hospital
Dublin

2. Beaumont Hospital Level 4 Hospital National Specialities
Renal/Kidney Transplant Services
Neurosurgical Services
Tertiary Referral Hospital

3. RCSI Hospital Group Monaghan Cavan Dundalk Drogheda Beaumont Connolly
Rotunda

4. Beaumont Hospital Serve a population of 1,022,184
Showing a largest population increase of any of the HSE 4 regions since 2006
1997 only 5% of Dublin’s over 65 lived in our catchment
Increased significantly to 24% by 2011
85+ age group increased by 20%between 2006 to 2011
Beaumont Catchment increased by 60%

5. Supporting Structures for Falls Prevention
Quality and Safety enabling structures
Governance and Risk Committee of the Board
Clinical Governance Committee
Integrated Quality and Safety Committee; IQS Department (Patient and Staff Safety Model)
Directorate Model of Care; 7 Directorates
Local Directorate Clinical Governance Committee
Falls Group
SCA stats in 2012 for a 5 year period indicated that we were in the median range for the number of adverse clinical events reported per bed day with our Peer Group (hospitals that has a similar number of beds)

6. Where to start ???

7. Find a few friends !!

8. Who did we need around the table ?
Falls Group
Who did we need around the table ?
Nursing Representation
Medical Representation
Health & Social Care Representation
Integrated Quality & Safety Representation
Any others ??

9. Falls Group Terms of Reference Background Purpose
Roles and Responsibilities
Objectives and work plan
Reporting relationships/Governance arrangements

11. Knowing how we are doing !

12. Clinical Audit – Hospital Wide
Methodology
Audit tool
Timeframe
Audit Report

13. Study the results – What is the data telling us ?

14. 42% of Falls Risk Assessments were completed for patients aged 65 years or older on admission

15. Opportunity for Improvement
Review current policy -
Review evidence
Draft policy
Consultation
Agree final draft

16. Inpatient Falls Prevention Policy Framework
Falls Risk Assessment
Risk Of Falling Care Plan
Patient/Family/Carer Information Leaflet
SOP for the use of bedrails
Post Fall Management Pathway

17. STRATIFY Falls Risk Assessment
STRATIFY is a risk assessment tool developed to predict patients at high risk of falling with clinically useful sensitivity and specificity.

18. Risk of Falling Care Plan
Care Plan designed by the group
Individualised for each patient
Documented date of assessment and reassessment
Prompted alerting medical team of risk
Referral to HSCP
Identify the necessary interventions to be undertaken to ensure risk reduction.

19. Trying to make things better!!!

20. QI Methodology PDSA Cycle Act Plan Study Do Carry out the plan
Objective
Questions and
predictions (why)
Plan to carry out
the cycle (who,
what, where, when)
What changes
are to be made?
Next cycle?
Study Do
Complete the
analysis of the data
Compare data to
predictions
Summarize what
was learned
Carry out the plan
Document problems
and unexpected
observations
Begin analysis
of the data
Model For Improvement

22. Patient/Family/Carer Information leaflet

23. Bed rails NOT recommended
Use of Bedrails
MENTAL STATE
A) IMMOBILE
Patient is immobile (bed fast or hoist dependant)
B) LIMITED MOBILITY
Requires some assistance i.e people and mobility aid
C) INDEPENDENT
Patient can mobilise without help from staff
1)AGITATED/CONFUSED OR UNPREDICTABLE BE
HAVIOUR
Use Bedrails with care
Bed rails NOT recommended
2) DISORIENTATION E.G FLUCTUATING CONSCIOUS LEVELS
Bedrails may be used
3) ORIENTATED, ALERT AND ABLE TO SUMMON ASSISTANCE IF REQUIRED
4) PATIENT IS UNCONCIOUS
Ref : National Patient Safety Association (NPSA)

24. Post Fall Management

25. Inpatient Falls Prevention Policy
New policy agreed at Falls Group
Ratified by the Senior Management Team
Upload onto Q Pulse

26. Implementation Plan

27. Inpatient Falls Prevention Policy Implementation Plan - Education
Who ?
What ?
When ?
How ?
Where ?

28. Inpatient Falls Prevention Policy Implementation Plan - Education
Who ?
What ?
When ?
How ?
Where ?

29. Inpatient Falls Prevention Policy Implementation Plan - Education
Who ?
What ?
When ?
How ?
Where ?

30. Inpatient Falls Prevention Policy Implementation Plan - Education
Who ?
What ?
When ?
How ?
Where ?

31. Inpatient Falls Prevention Policy Implementation Plan - Education
Who ?
What ?
When ?
How ?
Where ?

32. Inpatient Falls Prevention Policy Implementation Plan - Education
Who ?
What ?
When ?
How ?
Where ?

33. Inpatient Falls Prevention Policy Implementation Plan - Communication
3000 staff !!
Over 25 ward areas!!!
2 sites !!!!
800+ patients!!!

34. Inpatient Falls Prevention Policy Implementation Plan - Communication
Ward walk around
Visibility of Falls Group
Meet with key staff
Circulate information
Receive feedback on
opportunities/challenges
Learning

35. Inpatient Falls Prevention Policy Implementation Plan - Communication
Awareness Campaign
Screensavers
Posters
Stand outside Staff
Restaurant/Quiz - Prizes
Newsletter
Intranet News
and Announcements

36. Monitoring & Evaluation
Quality Care-Metrics measure of the quality of nursing and midwifery clinical care processes aligned to evidenced based standards.

37. Monitoring & Evaluation
87%
2015
2013
42%
Falls Risk Assessments

38. Next Steps …….. Review Current Policy !! Learning
Quality Improvement Methodology
Collaboration