1. Fall Risk Reduction Program Building Compliance and Sustainability Southlake Regional Health Centre, Newmarket, Ontario

2. Background Acute-Care Hospital with 400+ beds Newmarket, Ontario Complex medical rehab (10 beds) and complex continuing care (24 beds) unit being studied Interdisciplinary team in place with nursing, PT, OT, SLP, Recreation Therapist, and Discharge Planner. MDs available. Patients needing long-term rehab and those awaiting placement in LTC

3. Project Aim Southlake will reduce the rate of falls by 10% to a rate of 7.1% and reduce the severity of injury by 50% by implementing all evidence-based care components as able by December 31, 2008. We will establish benchmarks for this patient population. We want staff to comply with the program expectations We want our program to be sustainable

4. Team Members Sharon Desormeaux – unit manager Susan King – unit nurse educator Barbara Lloyd – Falls Program Leader Jan Courts – unit champion – long term nurse on unit Wendy Andrews and Rebecca Spence – nurses on studied unit Annie Hayward – discharge planner in emergency Lynn Bonk – Occupational Therapist on Orthopaedic unit

5. Changes Tested  Huddle Concept – method of communicating with staff  System for Gathering of Falls Data- from each nurse tracking individually to having unit champion to assist/reinforce and pass on to unit manager  Falls assessment, identifiers and interventions reminders

6. Other Changes Tested Environmental assessment of patients rooms – clutter, brakes on equipment, Mobility sheets – establish safe method of transfer/gait 4 Ps – Pain, positioning, potty and possessions

7. Measures  chart audits to measure assessments done  environmental assessments to measure identifiers in place - environmental assessments to assess bed in lowest position, room free of clutter, brakes on equipment  patient interviews to determine if 4 Ps performed by staff  staff report that there is an increased awareness of falls management on the unit and more attention to this

8. Comparison of Falls Rates/1000 Pt days

9. Comparison of Falls Rates/1000 patient days pre and post program implementation on CMR

10. Falls Rate per 1000 patient days

11. Lessons Learned Advice to other teams: choose your time for change when staff will be most receptive Have a unit champion- who will keep initiative as priority and constant resource Unit reminders helpful Key Insights: Change is extremely hard to manage Staying on task difficult with other priorities even for improvement team Ongoing measurement and assessment vital to demonstrate successes and failures and provide impetus for ongoing change :

12. Next Steps - implementation of post fall assessments- this will give more insight into falls risk population on the unit and also current issues/systems affecting falls rate/injuries -Information gained from post fall assessment may also help to direct future PDSAs -Expanding support of unit champion to other units within hospital as able -Consider set up of falls risk room or various ‘stations’ for staff for improved education and interest

13. Ongoing Steps Ongoing reminders and reinforcement needed to keep momentum of change going- help sustain what we have Work with front-line staff on unit to better determine needs of patients and staff for optimal outcomes- meetings, falls analysis Ongoing implementation of PDSA cycles and engage the staff in successful outcomes Staff need to work as a team and ‘own it’- continue to provide visual feedback

14. Challenges  Staff busy, meetings difficult to attend  Staff perception that they are doing things ‘right’ and this is only creating more ‘work’  Difficult connecting and communicating with evening staff  Huge volumes of paperwork in general so new documents brought forward not well received  Pressing demands on management to fit in with other responsibilities, including accreditation  Ensuring follow through of change concepts

15. Challenges Handled  Hold bi-weekly meetings when unit champion available to discuss progress and make plans for next change concept  Post falls rate to demonstrate successes achieved  Celebration in November as only 2 falls during month  At least one member of management available at unit falls meeting to support, encourage and plan appropriate PDSAs (unit manager, nurse educator and falls leader)  Minimizing any documentation for nurses– unit champion auditing and supporting follow through of change