23/03/2014. Bed Entrapment Prevention Program. nce upon a. time, in a kingdom far, far away

Transcription

1 Bed Entrapment Prevention Program nce upon a time, in a kingdom far, far away 1

2 A Queen decreed that every bed in the kingdom should be inspected. To be sure all of her subjects slept soundly. And were safe! Yikes! cried all the leaders throughout the kingdom. That s a big job! 2

3 Oh dear! What shall we do? moaned the head of Peel province. We have five villages and more than 700 beds! We must get to work! exclaimed Sir Facilities, with his usual, can-do spirit. But where to start, and what to do, these are important questions, 3

4 I can help with that! the leader of QPD* said. I will make a guide. *Quality and Program Development No..., nope..., definitely not. 4

5 Here it is! I knew I could do it! 2010/11 Moving from awareness into action Health Canada guidance document distributed to service providers detailing tests for four zones Initial plan and program envisions a facilitiesfocused program to reduce risk through compliance to new standards Bed test kits purchased, training provided to facilities staff and supervisors of care Process map created to ensure consistent testing across all five LTC homes 5

6 Evolution of a project 2010: From here to here 2011: From here to here to here 2012: From here to here to here! And beyond nd so, it came to pass that the guide was distributed across the land. And each of the village leaders and their esteemed teams gathered to implement the plan that QPD had created. 6

7 Each bed, in every home, in Peel was carefully and thoroughly inspected. And tested. 7

8 There were no bigsurprises. More than half of the beds needed to be retrofitted to meet the Queen's decree. Mattresses, that did not meet the required standards or were at the end of their useful life, were replaced. 8

9 2011 High-level review of best practices Retrofitted beds in three of five homes to reduce risk of bed entrapment Change to 1/2 rails from full and 3/4 rails, then planned move to no rails - Some tied rails down and noted in resident charts Rail naming issue between home and manufacturer increased confusion: ¼ rail in home is ½ rail for manufacturer. The wise Queen, had alsodecreed that all loyal subjects should be tested to see if they needed rails upon their beds. And those who did, must be checked upon the hour to ensure they were safe and well. 9

10 Peel Manor, the oldest village, had 177 beds. It was the early adopter and began removing bed rails through a team effort that was limited to staff. The rumour mill had been abuzz about strange doings in the village, But residents and families only learned of the change to their rail-status just before it was their turn. 10

11 Your chart says you don t need rails. What about MY rights!!! Wait until my Sonny gets here. 11

12 I m going to have word with the Queen about what you re doin to mum. Photo by Icarus Vitae Inari professional art photographer/ Creative Commons Just love that kid! 12

13 midst the buzz of the roll-out, the Queen sent her royal inspectors upon the Kingdom to ensure her laws were being upheld across the lands. t Peel Manor Village, inspectors observed the work being done. In the Queen's name they called a scribe to write down their decrees. 13

14 Written notification: 2012/13 Outcome of Resident Quality Inspection Directed to test additional zones 5-7, even though not required by Health Canada Guidance document Added nursing component: need to include assessment of resident in relation to need for bed rails Rails = restraint if resident has rails and cannot get out of bed alone Hourly monitoring required when rails in use 2012/13 Outcome of Resident Quality Inspection Continued Action Planning for RQI visit: Enhanced the bed entrapment program with nursing perspective Developed risk assessment tool in Point Click Care to support assessment of all residents Update bed testing process, with reassessment of all residents Replace therapeutic surfaces 14

15 nd, when it was done, at last, Peel Manor had made all of its beds safe and 35 villagers did not use rails. A 20% reduction! Peel Manor Results 2012/13 Total beds in home 177 Initial residents using rails 177 Project start date 09/2012 Project completion date 06/2013 Final rail-free residents % ½ rail 66 Full rail 35 Single Rail 41 Valet Assist Rail 0 Total

16 In the villages of Tall Pines and Malton Village, the leaders had been watching their neighbour work. Since the villages were practically twins of each other, they decided to work together. 16

17 2013 Learning from each other After analyzing the results at Peel Manor, the Tall Pines/ Malton Village project team thought a different approach could achieve better results. The centres decided to approach the challenges of this project from a change-management perspective. The team recognized that staff would be a critical audience and a key driver of a successful change, since many of them also believed bedrails were a benefit not a risk for residents. Learning from each other (Continued) All of the key stakeholders: staff, residents, family members needed to understand the risks of bedrails, and the benefits of the change. Because the accuracy of the bedrail assessment tool had been challenged at Peel Manor, it was reviewed and improved to better reflect the capabilities of residents. The project team identified key activities to support staff, residents and family understanding of the project and its goals. 17

18 Process in a nutshell Face-to-face, one-one communication primary tool An individualized approach for residents, families e.g. Choices about how this process happened for them and the supports available to support this transition Flexibility with individual progress Celebrating successes, sharing best practices locally Keeping families in the loop The Directors of Care met with all of their Supervisors of Care to share theplans and key messages: Why Benefits Process Safeguards 18

19 Hear ye, hear ye! Town criers were sent throughout the village to let the people know what was afoot. So everyone knew what the Queen had decreed and what was to come. And so the villagers of Tall Pines and Malton Village: Knew of the Queen s decrees Understood she was concerned for their well being Talked with the village leaders about how the change would take place; and Had safety equipment to help with the change 19

20 Registered nursing staff Reviewed resident needs using the assessment tool in PCC to identify those who needed rails Reviewed alternatives to rails prior to changes being made Spoke to residents (and SDM s) identified as rail-free candidates, to review the rationale for removing rails Residents and SDM s agreeing with the approach were scheduled to have their rails removed in a phased-in approach Clinical excellence The assessment tool was reviewed and improved based on an English assessment, identified as a best practice. Residents are reassessed monthly on a regular basis and after any significant health change. 20

21 Clinical excellence Continued Our Point Click Care software help us to monitor residents who require 2 bedrails. They need to be checked hourly while bed rails are in use and documented in the EHR. Facilities staff Maintenance staff removed rails for those residents that did not require rails Maintenance staff removed long rails and replaced with ½ rails for residents that did require rails Cleaning staff assisted with sanitizing beds and mattresses during transitions Continue to do bedrail entrapment audits 21

22 Other investments To support the transition to a rail-free environment some supports were needed including: Bolster mattresses Hip protectors Non-skid socks Floor mats Valet rails Bed alarms ndso they were not afraid to try to let go of their rails. And in each village nearly half went off the rails completely! 22

23 Tall Pines and Malton Village go off the rails: Going off the Rails Tall Pines Malton Village Total beds in home Initial residents using rails Project start date 01/ /2013 Project completion date 11/ /2013 Alternate Final rail-free residents % % ½ rail Full rail 3 10 Single Rail 1 2 Valet Assist Rail 10 Total And so they slept Happily ever after. 23

24 And for the leaders of the villages. Developing a rail-free culture : Rails are removed from beds as part of the terminal cleaning Admission guide describes the rail-free culture New residents are assessed on admission The journey continues Questions? 24