LESS RESTRAINT LESS FALL PROJECT IN KH

Transcription

1 LESS RESTRAINT LESS FALL PROJECT IN KH Hospital Authority Convention 2017 Oral Presentation, F 2.1 KHCND APN Joanna 1 LAI

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3 If you disagree... let s implement Less Restraint Less Fall 3

4 Started Literature review Discussed with others professional in a multidisciplinary approach Preparation work in 2014 Listed out those high fall rate and PR rate s clinical wards Reviewed the falls underlying causes & common factors from 2012 to 2014 Interviewed patients & involved staff after falls for 3 months Reviewed the current fall preventive measures / devices 4

5 Suggested Interventions from Literatures Establish a restraint reduction committee Ensure a multidisciplinary collaboration Educate staff and families Identify the restraint high usage areas as the target areas and implement the program Establish a supportive/ consultation team to work with the nursing staff Develop and implement an interdisciplinary restraint assessment form Scheme a restraint-free care training program Kwok T et al. (2012) & Anonymous. ProQuest (2000) Offer bed alarms as one of the PR alternative measures 5

6 Time Stakeholders Scope Before we start Communication Risk Resource Quality Copyright 2017 Knowledge Century Ltd. 6

7 1. Formed a Multidisciplinary Work Group Leaded by GM(N) Lobbied COS of REH, DM of PT and OT to form a work group to target less restraint less fall Met for sharing and discussion every 3 months at the beginning 7

8 2. Acknowledged the Risk on Less Restraint Predicted that may has an upward number of falls afterwards Reassured frontline staff may increase falls when try to release PR & coped with their stress Should keep patient safety Release of PR. O T P T Could decrease fall rate?! Or... 8

9 3. Safeguarded Quality Care & Patient Safety regarding Fall Prevention Strengthened a multidisciplinary approach All recruited patients should be referred PT & OT to reinforce the patients in hospital training and education on fall prevention Case doctor would pay more attentions on drug effects that causing dizziness / drowsiness / muscle weakness / instability / hypotension / bradycardia Ward nurses would focus on intermittently PR release, bed arrangement, fall preventive device applications, and education on fall prevention Developed a record & flow chart to guard frontline staffs through the project 9

10 4. Kept Well Communication with Stakeholders and Frontline Staffs Shared data & discussed with multidisciplinary members at half-yearly meetings Provided on-site support to frontline staffs by CND staff thrice per week Initiated interdisciplinary round monthly 10

11 5. Report on Project s Progress To frontline staffs, supervisor & members Timely Promptly Appropriately To evaluate the PR & fall rate halfyearly 11

12 Demographic & Cognitive - Data of the Recruited Patients No. of Patients (from Mar 2016 to Feb 2017) A Ward B Ward Total samples for analysis Successfully off PR before the patient discharged 16 (30 % success) 19 (32 % success) Range of Age Ratio of Male & Female 39:13 (75% Male) Range of Glasgow Coma Scale 7-15 (mean: 13.5) Range of Mini Mental State Examination / Abbreviated Mental Test Range of Functional Independence Measure 1-29 / 0-4 (mean: 14 /2) (mean: 59.8) 40:19 (68% Male) (mean: 14) 2-24 / 2-6 (mean: 15 / 4) (mean: 62) 12

13 Prevalence PR Rate (%) 35% 30% 25% 20% 15% 10% 5% Monthly Prevalence PR Rate (checked by CND staff) No. of Total Patients 0% A ward Average: 23.3% Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 A: Prevalence PR Rate B: Prevalence PR Rate A: No. of Total Patients B: No. of Total Patients A: Trendline of Restraint Rate B: Trendline of Restraint Rate 0 B ward Average: 23.7% 13

14 Monthly Prevalence PR Rate for Fall Prevention 80% (checked by CND staff) 80 70% 70 Restraint Rate (%) 60% 50% 40% 30% 20% No. of Total Patients 10% 10 0% Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 A:Prevalence PR Rate for fall prevention B:Prevalence PR Rate for fall prevention A: No. of Total Patients B: No. of Total Patients A: Trendline of Restraint Rate B: Trendline of Restraint Rate 14 0

15 Comparison of Annual /l////////////// Prevalence PR Rates for Fall Ward May 2014 (before the project) Prevention at KH (self-reporting) May 2015 (before the project) Mar 2016 Feb 2017 Monthly Average (checked by CND staff) Lesser Prevalence PR Rate for Fall Prevention A 92.9% 93% 44.2% B 47.4% 77.6% 28.2% 15

16 16 Different Fall rates of Both Wards from Mar 2016 to Jan Previous Year Fall Rate Fall Rate Previous Year Fall Rate Trend Fall Rate Trend Fall Rate, % Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

17 Post Fall Severity Index (SI) from Mar 2016 to Feb 2017 Patients Recruited in the Project SI 2 (2) 22% SI 3 (1) 11% SI 4 (0) 0% SI 1 (6) 67% SI 2 (15) 35% Non Recruited Patients SI 3 (1) 2% SI 4 (1) 2% SI 1 (26) 61% SI 1 SI 2 SI 3 SI 4 17

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19 Acknowledge MR S Y KWAN, KCC DGM(N) / KH GM(N) DR Jennifer MYINT, KHREH COS DR Kenneth CHUNG, KHREH AC MS Olga MA, KH DOM(RM&E) MS K H TING, KHREH DOM(R&E) MR Walen LEUNG, KHREH RN MR Timothy WONG, KH SNO2 (NS&A / Q&S) MR K P PANG, KH WM (PSY) MS Alice LEUNG, KHREH WM & 2A Ward colleagues MS K H CHEUNG, KHREH WM & 3A Ward colleagues DR Serena NG, KHOT DM DR Rosanna CHAU, KHPT DM DR Bobby NG, KHOT SOT MS Irene CHAN, KHOT OTI MR Robert TANG, KHOT PTI MR S YEUNG, KHCND EA1 19

20 References Anonymous. (2000). Fall Prevention without Restraints: A Project:: Long Term Management Care. Nursing Homes.49 (2), Dyck, D., Thiele, T. & Kebicz, R. (2013). Hourly Rounding for Falls Prevention: A Change Initiative. Journal of Creative Nursing, 19 (3), Gulpers, M. J.M., Bleijlevens, M. H.C., Capezuti, E., et al. (2012). Preventing Belt Restraint Use in Newly Admitted Residents in Nursing Homes: A quasi-experimental Study. International Journal of Nursing Studies, Hennessy, C. H., McNeely, E. A., Whittington, F. J., et al. (1997). Perceptions of Physical Restraint Use and Barriers to Restraint Reduction in A Long-term Care Facility. Journal of Aging Studies, 11 (1), Kwok, T., Bai, X., Chui, M. Y.P., et al. (2012). Effect of Physical Reduction on Older Patients' Hospital Length of Stay. Journal of American Medical Directors Association, 13, Lai, C. K.Y., Chow, S. K.Y., Suen, L. K. & Wong, I. Y.C (2013). Reduction of Physical Restraints on Patients during Hospitalization / Rehabilitation: a Clinical Trial. Asian Journal of Gerontology & Geriatrics, 8 (1), Lai, C. K.,Y. Chow, S. K.Y., Suen, L. P. & Wong, I. Y.C. (2011, July 5). The Effect of a Restraint Reduction Program on Physical Restraint Rate in Rehabilitation Settings in Hong Kong. Rehabilitation Research and Practice, pp.1-9. Mccabe, D. E., Alvarez, C. D. & Mcnulty, R. (2010). Perceptions of Physical Restraints Use in the Elderly Among Registered Nurses and Nurses Assistants in a Single Acute Care Hospital. Journal of Geriatric Nursing, 32 (1), Shorr, R. I., Chandler, A. M., Mion, L. C., et al. (2012). Effects of an Intervention to Increase Ved Alarm Use to Prevent Falls in Hospitalized Patients. Annals of Internal Medicine, 157 (10), Tolson, D. & Morley, M. (2012). Physical Restraints: Abusive and Harmful. Journal of American Medical Directors Association, 13, Tzeng, H. M., Yin, C. Y. Anderson, A. & Prakask, A.(2012). Nursing Staff's Awareness of Keeping Beds in the Lowest Position to Prevent Falls and Fall Injuries in an Adult Acute Surgical Inpatient Care Setting. Journal of Medicalsurgical Nursing, 21 (5), Zwijsen, S. A, Depla, M. F.I.A., Niemeijer, A. R., et al. (2012). Surveillance Technology: An alternative to Physical Restraints? A qualitative Study among Professionals Working in Nursing Homes for People with Dementia. International Journal of Nursing Studies,

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