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Falling Down is for Babies! Reducing Falls in Hospitalized Pts.

Falling Down is for Babies! Reducing Falls in Hospitalized Pts. MCCG snapshot. 637 beds Level 1 Trauma Center Serves 29 counties (> 750 k residents) 5000 employees; 1500 nurses Regional economic impact > $1 Billion Magnet designated 2005, 2009. MCCG Case for Action.

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Falling Down is for Babies! Reducing Falls in Hospitalized Pts.

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  1. Falling Down is for Babies!Reducing Falls in Hospitalized Pts.

  2. MCCG snapshot • 637 beds • Level 1 Trauma Center • Serves 29 counties (> 750 k residents) • 5000 employees; 1500 nurses • Regional economic impact > $1 Billion • Magnet designated 2005, 2009

  3. MCCG Case for Action • 2009 under-perform NDNQI benchmark 68% of the quarters in MS and CC units • Actions taken 2008-2009 not making a sustained difference…. • On line risk assessment • Fall CQIR • High risk interventions • 3Ps • Bed alarms high risk units

  4. Cost of falls at MCCG: • Injury intervention, discomfort, pain • Scans, films, other diagnostics • ↑ length of stay • psychological effects • lawsuits • Decrease trust/ pt satisfaction • ↓reimbursement- CMS “never” event- IQR

  5. MCCG vs. NDNQI falls 1Q09-4Q09

  6. 2010: Ramping Up • Who falls? When? How? Why? • Re-energize Fall Committee • Strict interpretation of “fall” • Fall reduction as strategic goal • Current EBP • Fall research project • Fall NSICs and prevention bundle

  7. Continuing the work 2010 • Monitoring and feedback • Inter-disciplinary mandatory education • Recognition and accountability • Additional technology • ↓ fall incidence 12% and injury incidence 18% • out-perform NDNQI 52% • 65% prevention strategies • We can do better……………

  8. Bring on 2011 • Continue to review and incorporate best practices • Technology: bed alarms on all, pilots, minimal lift • Integrate processes • 100% daily review of falls with feedback • Patient/ family partnership: contract, brochure:

  9. Patient/ Family Partnership

  10. More 2011 improvements • Strategic goal again • Engagement • Falls = errors: 100% review • Avoiding injury while assisting falls • Modify Morse scale: under-scoring high risk pts. *UNDER-perform 49% 2009 ↑ 81% in 2010

  11. Clinical Documentation of the Morse Screening pre-revision: Protocol Reference Link

  12. Modified Morse Scale 2011

  13. Basic fall prevention ALL patients: • Bathroom light • Education about falls • Shift assessment • De-clutter, belongings • Bed low and locked • “Call Before You Fall”

  14. EBP High fall risk prevention strategies • >50 modified Morse scale or nursing judgment • Yellow for “caution”- signage, armband, non skid slippers • Pt/ family partnership- education each shift, brochure, contract, “teach back” • Bed and chair alarm, familiar voice • All disciplines accountable

  15. More high risk prevention • Strategic side-rails • Bedside change of shift report • Use of minimal lift equipment and BSC • Purposeful/ accompanied toileting • Clinical Observer • Safety Net Bed in special circumstances • Patient Mobility algorithm

  16. Where we’re at today Leading/ process indicators: • Risk assessment accuracy • Prevention strategies • Staffing Effectiveness Lagging/ outcome indicators: • Fall incidence, comparison to benchmark • # fall injuries, comparison

  17. Process/ Outcome Summary • ↓ fall incidence 20% • ↓ falls with injury rate by 43.4% • ↑ by >100% identification of high fall risk patients

  18. More high risk preventionFall % use of preventative strategies where applicable. Baseline to current 3Q10-4Q11

  19. Process Measures risk assessment

  20. Staffing Effectiveness Indicator: falls vs. turnover

  21. Fall incidence 2009-2011

  22. % out-perform NDNQI benchmark

  23. # falls with injury 2009-2011

  24. Injury falls compare to benchmark

  25. Pushing to ZERO preventable falls in 2012 • Chair alarms and familiar voice on PAR • Looking at more supplies: yellow blankets, self releasing belt, diversion apron • Focus on mobility • Monthly tracking of actual vs. goal • Unit specific drill down and action plan • Mid course RCA, process flows, identify projects per GHA HEN HAC

  26. Lessons Learned and Key Enablers #1 • Engage frontline to management to Board • EBP and research should drive practice • Make fall reduction an organizational priority • Don’t forget the other disciplines • Capitalize on the power of peers • Don’t assume knowledge = application

  27. Lessons Learned and Key Enablers #2 • Falls are errors to be eliminated • Monitoring outcomes is good, adding process measures is better • E.H.R. allows knowledge based assessment/intervention • Survey to ascertain perception and belief, i.e. restraints DON’T prevent falls

  28. Lessons Learned and Key Enablers #3 • Incorporate education and communication into everything • Partner with patients and families but factor impulsiveness • It’s just basic nursing care, so integrate HAPU/ minimal lift and falls with mobility and safety • Try and try again- it may work this time!

  29. Contact Information Meryl Montgomery, Nursing QI Coordinator Montgomery.meryl@mccg.org 478 633 1917 “Keep the drum beat going… promote the joy of sharing!” (GHA HEN)

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