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Leading Better Value
CareReducing falls and serious harm from falls by 5% in 12 months
by Intentional Hourly Rounding in the Acute Geriatric Evaluation and
Management (AGEM) unit Mid North Coast Local Health District
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ACUTE
GERIATRIC
EVALUATION &
MANAGEMENT
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EVIDENCE BASED INTERVENTIONS
• FALLS ASSESSMENTS ORTHOSTATIC BP
• RISK ASSESSMENTS BEDSIDE MDT MEETINGS
• COGNITION ASSESSMENT SAFE MOBILISATION
• DELIRIUM SCREEN
• MEDICATION REVIEW
• ENVIRONMENTAL MANAGEMENT
• INTENTIONAL HOURLY ROUNDING
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26 26 26
21 21
12
9 9
0 00
5
10
15
20
25
30
Fre
qu
en
cy #
Pareto Chart of Evidenced Based Interventions
for Falls Prevention used across 26 AGEM patients
Evidenced Based Intervention for Falls Prevention
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STORY BOARD OF OUR JOURNEY
Just some
of our
hardworking
team in
action
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Brain storming – a great way to start
The team put their heads together to mud map the day out to:
• Identify periods of time when patient care activity might
not be occurring.
• Determine when activities are already in place.
• When rounding could be included with other activities.
• Identify staff ’s issues and concerns with the new initiative.
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Operational Definition(s)- the transformation of a
concept into something concrete, observable and measurable.
• Initial agreement – purposeful hourly rounding with each patient, and /or their carer on the
AGEM.
• Adapted from hourly to crucial points throughout each shift and by all the multi
disciplinary team.
• Three crucial points identified for each shift based around staff activity w patients and data
produced around common times of falls. At these points in time staff were to round with
intention w focus on the fundamentals of care, the patient’s specific care needs
identified risks and goals eg scheduled toileting.
• To aid this we utilized and adapted the CECs guidelines of what are called the 3 Ps –the
patient’s position, environment and personal needs and 3 Ds – discomfort/pain,
documentation and devices.
• Rounding was to be documented at each at point of activity,
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Operational Definition(s)- the transformation of a
concept into something concrete, observable and measurable.
THE 3 Ps and 3 Ds
• Personal Needs Discomfort
• Position Devices
• Patient Environment Documentation
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Fishbone (Cause & Effect) Diagram
Why do patients fall in our Unit?
Manual Handling
Time constraints
Clinical Handover is time consuming
Getting the team together to plan implementation
Consistency
Already Do it
Education
Toileting Comfort Pain
Insert text
Collaborative Team
Culture
Multi Disciplinary Engagement
Resources, videos, literature
PR at orientation to ward
IPR at Induction to hospital
Education
Update eMR
IPR documentation form
Documentation Falls Mats used on everyone
5pm on everyone
Desensitise staff
Alarms cause agitation
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The Problem
The period from October 2016 to
November 2017, the AGEM recorded
76 Falls for a 12 bed unit.
The Aim
Reduce falls and reduce serious
harm from falls by 5% within 12
months. For our unit this
calculates to 3.8 less falls per
annum.
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Primary Drivers
Gaps in fundamentals of
care
Education
Culture of change
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Secondary Drivers
From the list of available
options we chose
• Documentation,
• Intentional rounding and
• Education for nurses
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SMART Aim:
Reduce falls and
serious harm from
falls by 5% within 12
months (ie 3.8 less
falls)
The Problem:
In the period October 2016
to November 2017 in the
AGEM there were 76 Falls,
there were XXX serious
injuries from .
Outcome Measure:
How much: Decrease rate of
falls with harm by 5% by
October 2018.
Inclusions: Age ≥ 70 years
Inpatients in a health service
Partial and assisted falls
Exclusions: Staff, visitors.
Primary
DriversSecondary Drivers
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What now?
It’s just something
else we are
expected to do!
We do this anyway!
We can’t prevent all falls
from happening!
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Like the lady in this picture who is wondering what is
happening, the Visilert reminds me to go and check in on
the patient.
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I feel the forms & the visilert are too much to do together.
What could enhance intentional rounding, times on the visilerts
could be adapted to suit individual patient needs, rather than
make one size fits all.
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The balls remind me of the colour of the visilert…..
Yellow for the forms, and then there’s the nursing
notes, handover and the board as well…. Like having
to do extra steps for the same thing. Lots of the same
balls to juggle.
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It’s like we’re always looking above the
surface. But sometimes you need to delve a
bit deeper and do all the tasks for the patient
at once. The visilert helps to do this.
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It’s about leadership and walking together
as a team and listening to the team’s ideas to
shape a new practice to fit.
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For me it’s about all the components that go into the know
similar to all the elements with Intentional Rounding. With all
the elements combined in Intentional Rounding. It is big and
strong, just like the strength of the safety which is in the knot
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Feed Back included…..
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OUTCOME MEASURES
• REDUCTION IN FALLS
• REDUCTION IN CALL BELL USE
• IMPROVED PATIENT EXPERIENCE
• IMPROVED STAFF SATISFACTION
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PROCESS MEASURES:
• PERCENT OF ROUNDING FORMS COMPLETED ON
SCHEDULE – AIMING FOR 95%
BALANCING MEASURES:
• REDUCTION IN MEDICATION ERRORS
• STAFF LEAVING WORK ON TIME
• REDUCTION IN PRESSURE INJURIES
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Time Data Sourced
Rat
e H
ou
rly
Inte
nti
on
al
Ro
un
din
g C
om
ple
ted
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76 falls, with 1 fracture before our
initiative started from 31 October 2016 –
November 2017 (6.3 / month)
53 falls w nil fractures from 12 months
from beginning of November 2017 (4.4/
month)
21 falls from Nov 1 2018 to end April
2019 (3.5 average )
A much improved statistic
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I’d like to acknowledge:
Ben Walkling Occupational Therapist and current LBVC Project Manager for the MNCLHD for his
unswerving support throughout this entire initiative.
Ann Bodill DON of Wauchope District Hospital and LBVC Lead for her vital part in this initiative.
Michelle Pope NUM of AGEM/1C for her support and direction.
Lorraine Lovitt Lead NSW Falls Prevention Program | Clinical Excellence Commission for
coaching and support.
And last by no means least
AGEM nursing and Allied Health staff. Without them this initiative would not have gotten where
it has. THANK YOU
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0
5
10
15
20
25
30
35
40
45
50
Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
Num
ber
of
Fal
ls
Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19
No of Falls 4 2 7 2 6 5 7 6 6 2 6 4 5 2 2 3 2 5
Fall Rate/ 1000 bed days 11.05 5.29 18.92 5.99 16.22 13.89 18.87 16.71 16.17 5.41 16.71 10.78 13.93 5.41 5.41 8.93 5.39 13.89
PMBH AGEM Patient Falls IIMS Notifications
No of Falls Fall Rate/ 1000 bed days
Data from beginning of initiative Nov 2017to April 2019 shows a steady
downward trend and well below the state average per 1000 bed days.