Trinity Regional Medical Center

1. Trinity Regional Medical Center The Turnaround with Fall Prevention

2. The Problem we faced- • TRMC had fall rates ranging from 5.29 in 2002 – to 3.77 in 2006. • We had 15 falls with moderate to major injuries and 460 falls with minor to no injury. Definitions; Major- requiring invasive intervention or fracture Moderate – requiring noninvasive intervention – closed reduction or splint or laceration with sutures Minor – abrasion, bruise or laceration without sutures

3. TRMC Aim We knew we had to decrease our fall rate and especially decrease our falls with moderate to severe injury. We also wanted to help save lives – prevent future falls. We wanted and needed to find champions and give ownership to each unit for their fall rate.

4. Measures • We primarily looked at the overall fall rate – we looked each month at the number of falls per unit • We studied incidence reports for each fall • We tried to reduce harm from injury with decreasing the number of moderate to severe injury from falls.

5. How did we make a turnaround? • One of the first major changes was the initiation of individual unit falls teams – each unit has their own falls team made up of charge nurses, staff nurses and patient care techs. • Initially our house wide falls committee had unit managers – not front line staff. We then went to front line staff as committee members but they were not able to affect change for the whole unit. We now have a committee of both front line staff and managers working together. • Members of the house wide committee than became the leaders of their unit committee or are the champions of fall prevention on their individual unit falls teams.

6. More changes: • We worked with bed control to ensure patients were placed in the right room, in the right bed and on the proper mattress upon arrival to the unit. • We started using Fall Kits on each unit – each kit containing Ruby Red slippers, door and chart signage, pink wrist bracelet and personal alarms.

7. More Changes: • Making sure low beds were already in the rooms closest to the nurses station and having a system in place with environmental services in obtaining a rental low bed if needed. • We posted “Days without a Fall” on each unit and then celebrated each 100 day achieved on the units. Each unit has been able to have a celebration and we have had 2 different months without any falls house wide.

8. 100 Days without a Fall Celebrations

9. Another 100 Day Celebration

10. And even more changes: • “Avoida Fall” was our comic strip way of educating patients and families to fall prevention. • We also initiated post fall huddles – after a fall and the patient was attended to – the immediate people involved huddle to discuss how the fall occurred and what we could have done to prevent it. This information is then shared at monthly staff meetings.

11. Avoida Falls

12. Keep our patient’s room free from clutter. Clean up spills right away. Clear the floor before getting our patient out of bed.

13. A big change for us was the use of “Safety Trumps Privacy” signage and the rule that no fall risk patient is to be left alone in the bathroom or on the bedside commode. We explain that we must try to keep the patient safe and we will stay with them to ensure safe transfers from the bathroom.

14. Privacy is important, but in a situation where safety is concerned… Safety “Trumps” Privacy DO NOT leave patients at high risk for falls to toilet alone! At our hospital, patient safety is a core value. At this time, our team has agreed that you need assistance to the bathroom (or bedside commode), and I am glad to assist you. Our job is to keep you safe. “First, Do No Harm”

15. Individual Unit Specifics • Our telemetry unit gives each fall risk patient 3 alarms – 2 personal alarms and 1 chair alarm and a magnetic reminder is on the inside of each patient room door to remind staff to check the alarms before they leave the patient room. • This same unit has a charge nurse who is a champion for fall prevention – she intentionally goes into a patient room and will activate the alarm, monitor the response time and then reward the first person to respond with a cookie coupon. She also asked our Chief Nurse Executive to help her by participating in this activity when she comes to the unit. • Our Pediatrics unit was concerned about crib falls and devised signage to post beside each crib and they use this for parent and caregiver education as well.

16. Crib Signage

17. Did we meet our Aim? Did our changes bring about a reduction in our fall and injury rate?

18. Way more than we expected!! • Our rate in 2007 dropped to an awesome 1.93 and then in 2008 to 1.87. • We have tried to maintain and in 2009 we had a rate of 2.30. • We have not had a fall with moderate to severe injury since April of 2008.

19. Fall Rates 2002-2009

20. Number of Falls 2002-2010

21. What did we learn? • Ownership and accountability is key to prevention. The units embraced the opportunity to individualize their interventions based on their patient population. We have more staff on board with fall prevention than ever. • The units strive to get 100 days without a fall, the display boards are posted as you enter each unit and the staff takes pride in knowing that the number rises as they strive to protect their patients. There is also a sadness felt on the unit when the board has to go back to zero after a fall.

22. Where do we go from here? • We are participating in the IHS Collaborative for reducing injuries from falls and HAPU. • We are focusing on INTENTIONAL hourly rounding – rounding has been part of our culture but not as specific and INTENTIONAL as we would like and as the collaborative is requiring. • We are hoping to see a decrease in call light usage as we are more consistent with the intentional hourly rounding. • We continue to educate new nursing students to our fall prevention policy and interventions. • Integration of a falls goal for inpatient unit specific manager’s goal for 2010 – i.e. falls will not exceed 7 for 3N for 2010. • We are combining our house wide Falls and HAPU teams into one group - working towards common goals.