Unique Approaches to Prevent Falls! Coming to rest unintentionally at a lower level

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1 Unique Approaches to Prevent Falls! Coming to rest unintentionally at a lower level Presented by Sanja Freeborn-Hart -Leisureworld Caregiving Centre Richmond Hill Janet Keall- Kristus Darzs Latvian Home Natalie Warner & Sue Bailey RNAO

2 What doesn t happen.

3 Facts and Stats Fracture Over Long Long Over Age Term Age Term Costs of Care 80 of Care in 65 years in Ontario years Sector = FALLS Prevention is is needed =2,400 =1 =Osteoporosis =1 =1 1 =$15,251 in year in 32 Ontario people per cost make after fall LTC fall is patient is a a difference fracture residents contributing least for for 1x 11x a x hip is per is will per replacement sustain in year $33,729 factor a in in in hip majority of of LTC fracture resident of each of falls year at a cost of healthcare! $22 million; =2,400 Ontario LTC residents will at a cost of $22 million; =45% = 1.4 1% = Length million of of all those all falls of of Canadians stay falls result on result on in avg in will hip in in 11.4 fall in in =Life = days. severe 2010 fractures newly expectancy admitted injuries after to to a LTC hip cost is is fracture $44,156 is is per reduced resident by by 6 years;

4 Falls Collaborative Related Goals Kristus Darzs was a part of the National Collaborative on the Prevention of Falls in Long Term Care. Leisureworld Richmond Hill followed the collaborative goals and interventions. 1. Both organizations aimed to lower the number of falls by 40%. 2. Both homes aimed to decrease the severity of injury sustained from falling. 3. Both homes implemented and achieved RNAO s best practice guidelines.

The apple theme provided us with visual cues and healthy snacks to provide during team

5 Unique Approaches Team Granny Smith! Apples fall from trees, and residents fall from one level to another! The apple theme provided us with visual cues and healthy snacks to provide during team meetings and staff education PDSA (plan, do, study, act) approach! Started in 1 home area (the home area that had the most frequent fallers) and worked our way through the whole home.

Falls Assessments & Logos Action Plan Fall assessments created with clear RAI MDS language and

those first couple of changes the # of falls fell dramatically Soon after, a survey was taken of

What we found was that part time nursing staff and the housekeeping departments needed some more

6 Falls Assessments & Logos Action Plan Fall assessments created with clear RAI MDS language and were completed for all our residents. High risk residents were identified by putting an apple logo on the spine of their charts and on their nameplates outside of their room Education was done for staff and residents Results After those first couple of changes the # of falls fell dramatically Soon after, a survey was taken of the staff to test their knowledge surrounding the apple what did it mean? What we found was that part time nursing staff and the housekeeping departments needed some more in servicing on what the apple meant. Which led to. Morning Huddles every morning at 9:15 all staff met for 5-10 min to discuss falls, potential risks for falls, and solutions.

7 Hi Low Beds Action Plan When we started the project we had high low beds in the building When used correctly with the right residents we saw a decline in falls Kristus Darzs due to a fundraiser and a generous donor we have purchased high low beds for the entire facility residents and staff couldn t be happier! Budget accordingly Challenges Ensure you get to all staff to inform them on how to use the bed correctly and safely for them and the residents Assessing the proper heights for all residents to get in and out of bed if they are self-or one person transfer Cost we were lucky that we could purchase them for everyone, if not budget accordingly Safety- making sure there are lock out functions on bed controls for those residents with cognitive impairment.

Room Changes Action Plan Look at residents that were becoming frequent fallers and determine if you are able to move them closer to the nursing station We were able to do a couple of room changes and

8 Room Changes Action Plan Look at residents that were becoming frequent fallers and determine if you are able to move them closer to the nursing station We were able to do a couple of room changes and placed these residents closer to the nursing stations One resident has not fallen since! Challenges The less you move residents the better. Not always an option Upsetting other residents and their families

Family Involvement Action Plan Family BBQ s and family councils to educate about

furniture that was not needed in the residents rooms Floor mats were removed Proper

9 Family Involvement Action Plan Family BBQ s and family councils to educate about the collaborative and the positive changes Encouraged families to take away furniture that was not needed in the residents rooms Floor mats were removed Proper footwear was purchased Families to purchase hip protectors for their loved ones Challenges Residents can be stubborn. And family members can have little input on what their loved one does Resistance to wearing proper footwear. Resistance to wearing hip protectors

10 Communication Communication was the hardest part of the collaborative and the program itself Making sure that everyone knows what s going on Making sure that we investigate a fall find out the reasons why and share this information amongst others Informing everyone if a resident has a change of status higher risk of falling then before.

Interventions Ensure you implement multifactorial interventions to prevent future falls; Establish a Falls Committee that meets on a quarterly or as needed basis for analysis and brainstorming of

11 Interventions Ensure you implement multifactorial interventions to prevent future falls; Establish a Falls Committee that meets on a quarterly or as needed basis for analysis and brainstorming of future interventions; Ensure you have established a policy and procedure and is shared with all front line employees on a yearly basis (or as required); Meet with your service provider-increase your physiotherapy visits; If not already in existence, ask your therapy service provider to provide the home with an OT on a regular basis who would follow up on referrals with your falls prevention program and least restraint programs; Purchase sample hipsters and ask families to purchase for their loved one;

12 Exercise is always a good idea! Group Exercise

13 Did You Know? Studies have shown least restraint use both physical and chemical restraints may reduce the # of falls per person;

Interventions Continued Eliminate full/half side rails as these are not used for falls prevention, purchase assist rails; Vitamin D/calcium supplementation or for those that cannot or will not afford

14 Interventions Continued Eliminate full/half side rails as these are not used for falls prevention, purchase assist rails; Vitamin D/calcium supplementation or for those that cannot or will not afford this offer a multi-vitamin from government stock; Ensure to include your external supports when investigating post fall, i.e. physiatrist, doctors, outside educators, families, vendors; During a Resident Council and Family Council meeting ask your therapy service provider to provide education Environmental modifications and preventative strategies including de-cluttering a space, improve or leave lighting on and ensure proper footwear; Falls Prevention 5-10 minute huddles during report; The use of anti- sliding sheets while resident is in their wheelchair, to prevent residents from sliding out of their wheelchairs; The use of bed, chair alarms, floor mats, high/low beds

Central LHIN Priority Emergency Department and Alternate Level of Care What the future would look like: Reduce ER visits by targeted group Improved triage and admission process Reduce

15 Central LHIN Priority Emergency Department and Alternate Level of Care What the future would look like: Reduce ER visits by targeted group Improved triage and admission process Reduce unplanned re-admission rate to emergency departments Reduce ER wait times and achieve targets identified for admitted patients Reduce delays in placement to appropriate level of care settings

Central Integrated Health Service Plan -Embedding Quality in Our Planning 1. Patient Centred- we will promote patient and family centred care and culturally appropriate programs We do this by.

16 Central Integrated Health Service Plan -Embedding Quality in Our Planning 1. Patient Centred- we will promote patient and family centred care and culturally appropriate programs We do this by. All approaches are focused on and has the involvement of the resident and family, which in turn, leads to a decrease in ED visits Nurse Practitioner to assist in providing medical care at their home versus waiting in ED for a long period of time

17 Central Integrated Health Service Plan -Embedding Quality in Our Planning 2. Appropriately Resourced- Will support evidence- based, best practice programs Criteria for funding approvals will include a focus on sustainability and cost effectiveness. We do this by Manage your budgets early, so you are able to purchase falls related resources. Involving Nurse Practitioner services to ensure best practice programs are sustained. Strength in numbers- Use a multidisciplinary team approach. Frontline staff are your best resource.

18 Central Integrated Health Service Plan -Embedding Quality in Our Planning 3. Population Based- Our plans and strategies are based on our current and projected demographics and focus on improving population health. We do this by Having these unique approaches ingrained in our day to day culture will prepare our homes for the changing demographics in Long Term Care.

19 Central Integrated Health Service Plan -Embedding Quality in Our Planning 4. Safe- We will participate in and foster quality improvement and risk management programs that are geared towards ensuring safe health care within our region. We do this by Use your stakeholder meetings as a forum to share your fall approaches, challenges and outcomes. i.e. Falls Collaborative, LHINS, CCAC, OHQC, RNAO

20 LTC sector supporting Falls Prevention (Sustainability) Be transparent and openly share knowledge with your peers Take advantage of your local and regional resources Be excited about trying new approaches even though you may encounter challenges along the way. Keep it as a top priority as soon as it loses focus falls will begin again. Overall, we will be able to use these unique approaches as they relate to the facts and stats!

21 RNAO LTC Best Practice Initiative Mission to enhance the quality of care for residents in LTC homes to facilitate a culture of evidencebased practice through the implementation of best practice guidelines by front-line staff in LTC homes 21

22 Accessing Best Practice Guidelines (Promoting evidence-based practice) Click on Nursing Best Practice Guidelines Choose from: Clinical Practice Guidelines and Fact Sheets Condensed Guidelines for Personal Digital Assistants (PDAs) Healthy Work Environment Best Practice Guidelines Best Practices Toolkit (for Long-term Care) *found in left margin

23 Clinical Practice Guidelines Abuse, Addiction, Asthma, Client Centred Care, Chronic Kidney Disease, COPD, Cognitive Impairment, Continence, Constipation, Diabetes, Falls, Family, Hypertension, Ostomy, Oral Health, Pain, Skin and Wound, Smoking Cessation, Stroke, Suicidal Ideation, Therapeutic Relationships (42 guidelines in total)

24 LTC Best Practice Toolkit Top 5 topics requested by LTC Client Centred Care Continence and Constipation Falls Pain Pressure Ulcer LTC Toolkit- over 21,500 visitors from 114 countries since February 2009 launch Includes Guidelines + many other resources for Assessment, Planning, Implementation, Evaluation

25 Accessing Best Practice Resources in LTC Natalie Warner LTC Best Practice Coordinator Sue Bailey LTC Best Practice Coordinator

26 Falls Collaborative Summary Would anyone like to share your unique approaches that you use? Does your organization have a AIM statement to decrease falls in your home? Please share the challenges you are experiencing? Are you tracking falls and fall injuries? If so, how?

27 Thank you

28 References Central LHIN- Integrated Health Service Plan RNAO Nursing Best Practice Guidelines Prevention of Falls and Fall Injuries in the Older Adult CIHI- Definition BP Blogger Volume 3, Issue 1- January 2008 National Collaborative on the Prevention of Falls in Long Term Care

RNAO International Affairs and Best Practice Guidelines Program

RNAO International Affairs and Best Practice Guidelines Program Dr. Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT Chief Executive Officer Dr. Irmajean Bajnok, RN, MScN, PhD Director, RNAO International