www.saferhealthcarenow.ca name of presenters: daryl dyck & tracy thiele
TRANSCRIPT
www.saferhealthcarenow.ca
Name of Presenters: Daryl Dyck & Tracy Thiele
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Deer Lodge Centre (DLC)Winnipeg, MB
Number of Patients/Residents/Clients:
431 bed hybrid facility 235 PCH beds (155 Veteran beds, 80 General Public)
130 Chronic/Extended Care beds 66 Rehabilitation and Assessment beds
Who We Are
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Aim:
To secure a solidly established base of understanding
regarding the benefits of hourly rounding.
Goal:To integrate hourly rounding as a tool for staff members to utilize and initiate
on any patient/resident that they believe will benefit especially those deemed at high risk for falls.
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Team Members
Team Members: Lynda Hermanson (Health Information Analyst), Carly Erenberg (PT), Daryl Dyck (CNS), Dennis St. Laurent (Manger of Patient Care L2), Diane Rawluk (OT), Michele Klassen (Manager of Patient Care T7), Rod Kebicz (CNS)
Team Lead: Tracy Thiele, Project Coordinator
Team Sponsors and Supporters: Sylvia Ptashnik (Director of Resident Care), Jo-Anne Lapointe McKenzie (CNO), Carol Anderson (Clinical Educator)
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Falls Change Ideas Incorporated to Date
DLC Falls Management Policies and Protocols (since 2008)
• Routine Practice for Falls (everyone considered at risk)
• Assessment of Risk Tool (completed within 48 hours of admission)
• Fall Management Policies
• Falls Clinical Practice Guidelines
• Falls Program and Equipment Algorithms
• Mandatory education for all nursing staff
• Quarterly feedback of fall rates provided to Nursing Units
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
2042
2193 2145
1923
16961576
0
500
1000
1500
2000
2500
To
tal F
alls
2005 2006 2007 2008 2009 2010
Year
Total Falls per Year PCH, Chronic Care, and A&R
Data Source: Occurrence Reporting SystemData Excludes: Near Misses
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
FALLS PROTOCOL ALGORITHM
Provide High Risk Decal
Patient / Resident admitted to DLC (Rehab / Chronic Care / PCH)
Falls Risk Assessment Tool (FRAT) is administered (On admission)
Routine Practice for Falls Prevention
F amily to provide fall history A ssessment of needs and abilities L ook at environment / hazards L ying/standing BP S how surroundings and orientate
Refer to Falls Assessment and Management Clinical Practice Guidelines. Interventions / Care Plan should address Risk Factors identified on FRAT Tool
(CNS available to assist in care planning and to follow-up if Critical Incident)
High Risk (Note as Focus problem)
Low / Medium Risk
Consult: Physician – prior & new medical problems, medications, orthostatic hypotension Physiotherapy – mobility / gait aids / transfers Occupational Therapy – equipment / wheelchair Pharmacy - medication review Nutrition services – nutrition / hydration Consider:
Falls Equipment (refer to Falls Equipment Selection Algorithm – Form # ) Hourly Rounding
Review Interventions/Care Plan at Post Admission Conference and Quarterly at Inter-Disciplinary Team meetings
If resident falls after admission = HIGH RISK (Re-do FRAT)
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Hourly Rounding CheckComfortObservations:Does the resident look comfortable? Call light within reach? Clear pathway to bathroom?
ToiletingObservations:Does their brief/incontinent product need changing?
PositioningObservations:Are their feet out of bed; does it look like they are trying to get up?
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
• Barriers: • Staff buy-in• Recording Sheet• Results
• Facilitators:• A dedicated project lead • Benefits of preventing a fall • Managers/champions/unit staff committed to project
Challenges to Sustaining Falls Improvement
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Feedback
“It hasn’t increased our workload because we do this anyway.”
“Some changes need to be done related to the sheet we sign on – we need somewhere for it to say we are charting more on the progress notes.”
“It is important for the nurses to communicate to the aides that the person is on hourly rounding – otherwise we might not know – especially floats.”
“It is definitely beneficial as a tool to help with falls.”
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Lessons Learned
Advise:
• Start slow and work out the kinks before trying to expand.
• Don’t get discouraged when you don’t see immediate results.
• Conduct ‘Progress Checks’ on the program and address concerns early.
• Getting staff ‘buy-in’ requires them to feel involved in the process.
• Provide positive feedback and reinforcement in different ways.
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Sustainability Plans
•Celebrate successes, reinforce positives back to staff
•Advertise what we are doing
•Create ownership by including staff in problem solving techniques (staff input survey, informal and formal progress checks)
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Moving Forward
• Incorporate hourly rounding onto one or two more units
• Ultimately Centre wide education and implementation for high risk patients/residents
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Name: Tracy Thiele, Project Coordinator
Email: [email protected]
Phone Number:1-204-831-3492
Contact Information