Orchestrating a Symphony: Preventing Falls

Transcription

1 Orchestrating a Symphony: Preventing Falls December 12, 2012 Session D 26, E 26 Lily Thomas, Ph.D., RN, Myrta Rabinowitz, Ph.D., RN Denise Mazzapica, BSN, RN BC The presenters have nothing to disclose Session Objectives To describe practice changes used to reduce falls and harm from falls To summarize lessons learned from pilot implementation and spread 1

2 Impact of Falls Impact of Fallls P3 1,000,000 Annually in US Most common Hospital adverse event Leading cause of injury death Age 65 or > Direct medical cost $54.9 Billion by % result In serious injury Sources: Nam, tem re commos nonsero et aut doluptas et fugitature cus nest, to im consequ oditate mpelisconsent peribus senis quis eumquat ecestet aped que eos moloremquemoluptatuseossi a porrovitatis experferumquae vid quo et accaborum illaborro comnientioquos dolorum eariae int volo tem quunt.itatem qui con rem acerion sequae. Et remqui consect otatatis North Shore LIJ Health System 2

3 Background Gaps identified: Definitions, Assessment, Data Collection, Reporting EMR Fall Assessment Tool: created by clinicians, problem differentiating risk (White noise) Best Practice in a tertiary hospital (accountability model) Aim: To decrease falls and harm from falls 3

4 Improvement Methodology Set Aims Meet and exceed national benchmark, Improvement greater than 2.5% Establish Measures Select Changes Improve Data Quality standardizing definitions, collection, analysis, and reporting Standardize and Simplify Fall Risk Assessment Stratify Interventions to Fall Risk Assessment Use organizational processes to optimize clinical processes Test Changes PDSA cycles X 3 Implement Changes - Spread The Four Changes 1. Improving Data Quality 2. Standardizing and Simplifying Fall Risk Assessment 3. Stratifying Interventions to Fall Risk Assessment 4. Using organizational processes to optimize clinical processes 4

5 Change 1 : Improving Data Quality Standardize Definitions, Data Collection, Analysis, and Reporting Change 2 Standardizing and Simplifying Fall Risk Assessment Fall Risk Assessment Questions Yes No 1. Does this patient: a)need assistance with standing, walking, or toileting? b) Attempt to get out of bed/chair unassisted when assistance is needed? 2. Has the patient fallen in last 6 months or during this admission? 3. Are there harm risk factors based on your nursing judgment? Consider: age, potential to break a bone, post operative status, risk for bleeding Donald D Wolff Jr Center for Quality Improvement and Innovation at UPMC 5

6 Change 3 Stratifying Interventions to Fall Risk Assessment Three levels of assessment that will trigger interventions Level I Safety Standard of Care for all hospitalized patients Level II Standard of Care and Selected Interventions- Risk for Falls: Answers yes to question1a, or 1b, or 2 on Falls Risk assessment Level III Standard of Care and Interventions- Increased Risk for Falls and Harm from Falls: Answers yes to question 1a, or 1b, or 2 and yes to question # 3 on Fall Risk assessment 6

7 Change 4 Using Organizational Processes to Optimize Clinical Processes TeamSTEPPS Strategy Clinical Routine/Workflow Brief Identify the Patients on Level 3 Huddle Debrief Cross Monitoring Handoff (IPASStheBATON) Call a huddle to inform the team of change in patient status Conduct a debrief after a patient Fall Maintain situational awareness of patients at risk for falls Include fall risk level in handoff CLINICAL MODEL FOR PRACTICE IMPROVEMENT System Set Aims for improvement, select measures, Standardize definitions, data collection, analysis, and reporting, test and implement changes (toolkit) Design sustainability Engage Individual Practitioner Ensure Competency Transfer accountability Sites: Hospitals, LTCs Facilitate Implementation Oversight Monitoring TeamSTEPPS Briefs, Debriefs, Huddles, Handoffs, Cross Monitoring Patient/Family Educate Partner Improve Outcomes Local: Patient Care Units Prepare for testing & implementing improvement Ensure competency Transfer accountability Embed in practice: work flow/clinical unit Engage Interdisciplinary Team/Collaborative Care Councils Utilize team processes Innovate Customize Provide situational leadership 7

8 Implementation: The Pilot Fall Reduction Task Force 14 Hospitals 2 Rehab/LTC Interdisciplinary 4 Work Groups Data Assessment Interventions Education 8

9 FALL REDUCTION IMPLEMENTATION TIMELINE PREPARE: 7/26 8/15 Designate Infrastructure: Project coordinator, unit champion, Data Manager, Educator Select pilot unit, Complete Tool kit Requirements Plan and complete Training EVALUATE : 10/18 10/29 Monitor process and outcomes, Determine: what worked, what didn t, Finalize interventions 3 Weeks 9 Weeks 2 Weeks ONGOING IMPLEMENT: 8/16 10/17 Cycle 1 8/16-9/5 Cycle 2 9/6-9/26 Cycle 3 9/27-10/17 Implement 3 cycles of change, each change lasting 3 weeks SPREAD & SUSTAIN Design spread and sustainment PREPARE Fall Reduction Toolkit Table of Contents 1. Improvement Method Model for Practice Improvement 2. Change 1: Improving Data Quality 3. Change 2: Fall and Harm from Fall Risk Assessment 4. Change 3: Interventions Stratified to Risk Assessment Change 4: Using organizational processes to optimize clinical processes - TeamSTEPPS 6. Staff and Patient Education Curriculum 7. Implementation Design 8. Forms 9

10 Pilot Sites Forest Hills Hospital Franklin Hospital LIJ Medical Center NSUH Plainview Hospital Southside Hospital Site Fall Reduction Implementation Team Project Leader Educator Unit Champion Data Manager 10

11 1.Beliefs 2.Accountability 3.Ownership 11

12 System-wide Spread: Fall and Harm Reduction Program Inspire Inspire Inform Inform Transform Transform Structure + Process Structure + Process Outcomes 12

13 Spread Methodology Educate: -Train the trainer -Standardized presentation -E-learning modules -Patient scenarios Engage multidisciplinary teams On-site Coaching TeamSTEPPS strategies Conference calls Ongoing Task Force meetings Results 13

14 The Four Changes: Process Outcomes 1. Improving Data Quality 2. Standardizing and Simplifying Fall Risk Assessment 3. Stratifying Interventions to Fall Risk Assessment 4. Using organizational processes to optimize clinical processes Outcome Measures 14

15 P Northshore LIJ Health System Institute for Nursing Patient Falls Index (2011 Q Q2) Q Q Q Q Q Q2 NSLIJ SYSTEM Patient Fall Definition: A patient fall is an unplanned descent to the floor with or without injury to the patient. Patient Falls Index Formula: Number of Patient Falls/Number of Patient Care Days on Eligible Nursing Units x 1000 Excludes: In-patient Psychiatry, Pediatrics and Newborns 15

16 Northshore LIJ Health System Institute for Nursing Patient Falls with Injury Index (2011 Q Q2) NSLIJ System Q Q Q Q Q Q2 Fall Injury Level Definition: The extent of injury experienced by a patient following a fall, including greater than moderate. Index includes moderate and above. Lessons Learned 16

17 Education Visual Cues THEMES Levels of Fall EMR Lessons Learned 1. Ensure Clarity of forms and directions 2. Face to face education works BEST 3. Reporting actual # of Falls increases awareness 17

18 Next Steps P35 Partner with patients Study: Who is falling? Categorize Falls Develop population specific interventions Questions 18