Androscoggin Valley Hospital A Critical Access Hospital

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1 Androscoggin Valley Hospital A Critical Access Hospital Clare M. Vallee MS, RN, JD, NEA-BC Vice President, Nursing Services Jean M. Wolf, RHIT, CHP Director, Quality & Patient Safety

2 Androscoggin Valley Hospital Critical Access Hospital Medical/Surgical Unit - 24 beds >>> Observation/Acute/Swing 900 Discharges/Year Hospitalist Program

3 Falls Project Profile Problem >>> Falls rate 1-1.5% (15-20/year) Acute & Skilled >>> Falls with serious injury: 1-2/year Goals >>> Prevent falls with serious injury >>> Reduce all falls >>> Proactive anticipation and prevention

4 Falls Project Strategies >>> Literature review >>> Falls reduction programs/inservices >>> Multi-disciplinary team >>> New modalities/best practices: Ruby Slipper Program More alarms (chair pads/tabs) Sensory cart Fall risk assessment q shift (self-designed) Focus on reducing injury

5 Falls Project PDSA >>> Constant education/re-education of staff >>> Daily review for modality implementation >>> Still having issues Falls alarms not on/not reset Patients not identified Unable to catch patients Running for alarms where Solution was elusive

6 Falls Project Next step(s): Replace antiquated call bell system: December 2009 PLUS >>> Wireless staff phones/hallway monitor screens for: Bed alarms Chair pad/tabs alarms IV pump alarms Hourly rounding/patient turns Hospital wide culture project - Hardwiring Excellence

9 Falls Project Now, to change behavior Much resistance to new systems Daily PDSA to tweak system Daily education/re-education for staff and patients

10 Falls Project Our results: Falls with serious injury ELIMINATED since the implementation of the new systems 3 YEARS

11 Falls with Serious Injury Percent Upper Control Limit = RAM Lower Control Limit = 0 Mean =

12 Fall Rate - Acute(#/Discharge) Upper Control Limit = Percent Mean = Q Q Q Q Q Q Q Q Q Q Q Q RAM Q Q Q Q Q Q Q Lower Control Limit = 0 Q Q Q Q Q4 2012

13 Falls Project Additional advantages >>> Rounding on steroids >>> Wound care/pressure ulcer timing >>> Changing staff roles: Unit Coordinator >>> Decreased call bells (30% or more) >>> HCAHPS scores improved Nursing communication 48 th > 93 rd percentile Quiet at night 33 rd > 72 nd percentile Pain Management 45 th > 67 th percentile

14 HCAHPS Survey National Percentile Ranking Overall Ranking Communication with Nurses Pain Management Quietness of Hospital Environment HCAHPS Standard

15 Lessons learned: >>> All processes require constant education >>> Change takes time Falls Project >>> Front line staff need to be part of the solution >>> Even the electronic solutions require continuous PDCA/tweaking >>> Ask for the solutions you want >>> Keep looking for solutions and better ways to solve problems >>> Share success

Project Title: Reducing Falls Date: December 2012 Hospital Name: Androscoggin Valley Hospital State: NH Self Assessment Score =5 Aim Statement Sustain the successful elimination of falls with serious

: Patient safety and avoidance of further injury is paramount to our organization. We want all to be safe and not experience injury while in our care.

patient rounding (S) -All nursing team members responsible for patient rounding -Unit Coordinators became Care Traffic Controllers to intercept call bells and direct care tasks to staff.

16 Project Title: Reducing Falls Date: December 2012 Hospital Name: Androscoggin Valley Hospital State: NH Self Assessment Score =5 Aim Statement Sustain the successful elimination of falls with serious injury. Reduce the number of patient falls for all acute patients by 20% by December Baseline rate = 0.64% in Achieved/exceeded-2012 rate=0.4%. Why is the project important?: Patient safety and avoidance of further injury is paramount to our organization. We want all to be safe and not experience injury while in our care. Changes Being Tested, Implemented or Spread Implement Remote Alarm Monitoring (RAM) system (bed and chair-pad alarms, IV pump alarms and hourly-rounding/patient turns) on Med-Surg Unit (S) Hardwire patient rounding (S) -All nursing team members responsible for patient rounding -Unit Coordinators became Care Traffic Controllers to intercept call bells and direct care tasks to staff. Enhance remote monitoring system capabilities (T) Staff Education (S) -include Rehab and Housekeeping staff Patient & family education (S) -educate re: use of wireless phones for patient care; personalize messages on alarm systems Control Charts Lessons Learned Hourly patient rounds using automated/central electronic prompting system can prevent falls with serious injury especially when combined with other processes: Falls risk assessment (q. shift), Ruby slippers, sensory cart, interdisciplinary falls team. Positive consequences of this system also included on-time patient turning and zero HAPU as well as improved HCAHPS scores. Recommendations and Next Steps Continue to train/retrain staff on system to insure sustainability of successes. Analyze data obtained for trends. Expand other uses of system. Continue to monitor impact of changes on patient satisfaction (HCAHPS). Team Members Clare Vallee, RN, MS, JD, NEA-BC, Vice President, Nursing Services Brenda Aubin, BSN, RN, Med-Surg Director Rita Dalphonse, LPN, Robin Poirier, LNA, Nursing staff Heather Wiley, Erin Kelley, Rehab Staff Jean Wolf, Director Quality and Patient Safety Clare.Vallee@avhnh.org

17 Falls Project Future: >>> Rounding data into EMR >>> Bathroom alarms (Posey) >>> Purposeful rounding >>> Sustainability

18 Androscoggin Valley Hospital Questions?

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