NorthCrest Medical Center Amanda Costello RN, BSN, CMSRN

Transcription

1 NorthCrest Medical Center Amanda Costello RN, BSN, CMSRN

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3 Robertson County is located approximately 30 miles north of Nashville. Robertson county sits between Cheatham, Davidson and Sumner counties and borders Kentucky along the North. Cities located within Robertson County include, Adams, Cedar Hill, Coopertown, Cross Plains, Greenbrier, Orlinda, Ridgetop and Springfield with portions of Millersville, Portland, and White House located in Robertson County as well.

4 Est Licensed Beds 72 Active Not-For-Profit, Community Hospital Fully Independent Mission To enhance community and patient wellness. Service Area Northern Middle Tennessee and Southern Kentucky

5 175 providers Specialties Anesthesiology Pain Management Cardiology Emergency Medicine Endocrinology Family Practice General/Vascular Surgery Gynecology Internal Medicine Pediatrics Neonatology Nephrology Neurology Obstetrics/Gynecology Oncology/Hematology Ophthalmology Orthopedic Spine Orthopedics Otolaryngology Plastic Surgery Podiatry Pulmonology Rheumatology Urology

6 What is CUSP? Comprehensive Unit-based Safety Program An intervention to learn from mistakes and improve safety culture - CUSP Interventions: Improve or reinforce good cross-disciplinary communication and teamwork Enhance coordination of care Address overall patient safety Work towards healthy unit culture

7 Team Development Team Composition Team Leader Champions (nurse and physician) Local opinion leaders People with diverse opinions Someone outgoing Someone who sees the big picture Someone detail-oriented Everyone dedicated

8 A sudden, unintentional descent, with or without injury to the patient, that results in the patient coming to rest on the floor, on or against some other surface (e.g., a counter), on another person, or on an object (e.g., a trash can). When a patient is found on a surface where you would not expect to find a patient, this is considered a fall. If a patient who is attempting to stand or sit falls back onto a bed, chair, or commode, this is only counted as a fall if the patient is injured.

9 RN is to perform a comprehensive falls assessment: Admission interview Any change of condition and upon any transfer of the patient and following a fall or near fall episode. A reevaluation of interventions will be done upon any temporary environmental change due to a procedure, limited patient condition change, changes/additions to the medication regime, etc. It is important to note that the patient may be bumped up based on clinical judgment, but they can not be bumped down based on clinical judgment.

10 MORSE Scale

11 Medications

12 Risk for Injury based on the ABCS method: A: Age over 64 and male B: Bones-history of fractures and/or osteoporosis C: Coagulation any patient who is on anticoagulants S: Surgery-post-op patients

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15 Every morning pharmacy look for patients 65 years or older who are on at least 3 BEERS medications. The point of this task is to alert the providers of patients who are at risk of falling because of sedating medications. Once the patients have been identified, a Provider Notification document will be entered into Allscripts listing the medications that the patient is receiving and that they are at risk for falling.

16 Example: Clinical Pharmacy FALLS Assessment Patient is 65 years or older and is currently receiving: (BEERS med 1, 2,3). This combination of medications tends to have additive effects of over sedation/increase fall risk. Please consider closely monitoring this patient with possibility of discontinuing any medication not warranted only if the patient s condition permits. Thanks for your consideration

17 Collect data retrospectively post fall regarding any Provider Notifications in Allscripts and medication modifications done by the provider as a result. Information sent to Pharmacy Director

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19 In the event the patient/family refuses to adhere to the recommended fall prevention interventions, the nurse will ask the patient/family to sign a Falls Prevention Acknowledgment and Waiver form. If the patient/family refuses to sign the Waiver, two licensed nurses may witness and co-sign the form.

20 The primary nurse has the right to revoke the Waiver at any time if he/she feels the patient is no longer steady to ambulate unsupervised. Waivers are given and taken away based on nursing judgment.

21 Each hour the patient is assessed for 4 P s: Pain How is your pain? Potty Do you need to use the restroom? Position Are you comfortable? Personal Items All personal items within reach?

22 House Supervisor rounds once per shift. Identifies Waiver patients first Physically goes into each applicable room to ensure the bed or chair alarm is ON. If the patient does not have the appropriate alarm on, the Supervisor hands out a ticket to the nurse/care partner. Tickets are meant to be a real time flag for staff that the precautions are not being met.

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24 Each month a list is compiled of staff having 2 or more tickets and is sent to the appropriate Manager. Opportunities for improvement Educational needs for staff

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26 Includes: EVERY employee of NorthCrest Medical Center Responding to EVERY patient or visitor in need Finding someone else to assist the patient if you are unable to fulfill their needs EVERY Patient, EVERY Visitor, EVERY Employee, EVERY Time

27 Patient calls for assistance Light blinks above door Do NOT pass by

28 Education sent out on hire and annually for all in-house staff. Includes information regarding sounding bed alarms and what to do Includes guidelines for non-clinical staff on what they can and cannot do for the patients. Also includes information regarding infection control, scripting ideas, and how to notify the proper staff for the patient s need.

29 Fill out a Post Fall Huddle form with all staff involved. Enter a MIDAS report (Risk Management) Move patient closer to the desk if applicable Fall Waiver automatically revoked Consider calling in extra staff to sit with patient Provider notified Manager notified

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31 If unwitnessed, patient is unable to recall events, or any neurological impairment, IMPLEMENT q2 hour neuro checks x 24 hours and document on the Post Fall Flowsheet in Allscripts Post Fall Flowsheet includes: Have vitals been taken and documented Affect and Behavior LOC Extremity tone Speech Pupil Assessment GCS

32 Falls Prevention CUSP team meets every other week at a set time and location. Reviews every inpatient fall Team Lead keeps spreadsheet of metrics to monitor Risk Management enters falls data into reports for Senior Leadership

33 Team leader reports to the Quality Accountability meetings on the 2 nd and 4 th Wednesday of every month Team Leader reports to QIC (Quality Improvement Committee) ~every quarter QIC is compiled of Senior Administration, the vice-chairs of the Medical Staff Committees and Board of Trustees)

34 All falls reported (2 required intervention) New hourly rounding started to include checking bed alarms. Participation in IHI falls expedition 5 of 12 months below the state benchmark

35 5 falls required intervention Change in definition of reportable falls RCAs implemented for all falls with injury 9 of 12 months below benchmark

36 All reportable falls required ZERO intervention Reportable falls now ONLY include inpatient falls THA HEN CUSP team started BEERS criteria implemented Post Fall Huddle up and forms developed

37 Of reportable falls only 1 required intervention FY 2014 changed reporting to Monthly rate: The number of reportable falls/patient days x 1000 New goal to achieve 25 th percentile of NDNQI rate Achieved 12 months below NDNQI

38 Change reporting from NDNQI to THA which requires falls with minor or greater injury for reporting 8 months of the year below the state rate! Initiated Supervisor rounding every shift Hourly rounds per nursing and care partners

39 6 months below the state rate Encourage use of COWs and nurse s station computers for charting to enable greater visualization of rooms

40 Initiated bed alarm tickets during Supervisor bed alarm checks Gait belt training

41 85 NorthCrest Inpatient Falls Falls per fiscal year Trendline

42 office

43 THANK YOU!