Objectives. Why? Enhancing Patient Understanding of Fall Risks Using a Teach-back Tool

Transcription

1 Enhancing Patient Understanding of Fall Risks Using a Teach-back Tool Jennifer P Colwill MSN, APRN Michelle Chaffin BSN, RN Terri Murray MSN, RN Objectives Identify the gap in practice related to patient understanding of falls risks. Describe intervention process and planning Rollout and evaluation Why? Unit Fall Rate /1000 pt. days CV Step-down Center Mean Center Median Center 90 th % tile 1

2 Pre Data from Survey of Factors Affecting falls on a CV step-down unit N =20 25 Patient Understanding/Memory Post Fall Video Viewing N= Patient Understanding/Memory Post Fall Video Viewing N= Documentation of Viewing Fall Patient Remembers Watching Able to speak to Individual Risks video in Epic Video of Falling Targeted Intervention & Teach-back Timeliness of education Assess understanding Reinforce Communicate Partnering The My Safety Plan: Teach back tool User friendly Addressed the why Core fall safety tenets: what & how Rule of 3s Visual & present 2

3 Interventions Steps Objective: To Improve patient education and recall of patient specific plan for fall reduction. Video and timing of watching/education Teach back/partner Communication, Hand-off & Reiteration Who, How and When? Assess all patients on admission Use teach back to assess understanding post video and create the safety plan together Reinforce safety plan with at hand-off with team members Reinforce safety plan with patient every shift Project Details Go Live April 7 th May 19 th Evaluation Outcome measure Fall rate Process Metrics Steps of tool Nurses comfort with the tool Patient s understanding of fall risk and expected behaviors 3

4 Post Pilot Data Assessing Readiness to learn on Admission Were Patients Ready to learn on Admission? n =50 8% Readiness on admission to unit Y 92% Readiness on admission to unit N Assessing Process Metrics of the Pilot Assessing Steps of Fall Prevention Teach Back Procedure n= Assessing steps Viewed Video Teach Back Completed Receptive to Plan Verbalised Plan Hand off done Y 4

5 Assessing RNs Comfort/Perceptions Nurse Comfort/Perception of Fall Prevention Teachback Tool n= Nurse Comfort/Perception of Fall Prevention Teachback Tool 0 Patient Repeat Verbalization of Risk Factors on FU Patient Verbalization of Individual Factor for Fall Risk on FU n= 49 10% Patient Verbalised Why Fall Risk N 90% Patient Descriptors in the Pilot Types of Patients n= 50 Patient Assistance/Mobility Level per RN Assessment n=50 7% 0% 2% 5% Post-op 5% 7% Pre-op Mobility/ Repeat Trasfer Assistance Level 1 Off Service Readmit VAD 45% 50% Mobility/ Assistance Level 2 Mobility/ Assistance Level Lift 79% 5

6 Patient Provided Reasons for Fall Risk Reasons Documented on Teachback for Fall Risk n= 50 Diuretics 3% AF 3% Other 6% New Patient 16% New Patient Drain/Line Weakness First time up/ long time in bed dizzyness Balance CV Meds 9% Surgery Pain Medication Pain Medication 11% Drain/Line 18% CV Meds Diuretics AF VS:Hypotension Surgery 11% Balance 4% Weakness 15% Communication: Other Outcome Metrics Pre/Post Pilot Pre Pilot Post Pilot YTD Nov Fall Rate /1000 pt. days Center Mean Center Median Center 90 th % tile Fall Rate Trend Outcomes Pre and Post implementation Q 1 Q2 Q3 Q 4 Q 1 Q 2 Q 3 Q 4 90 th 50 th Fall rates/ 1K PD Mean (50th) Mean (90th) YTD YTD 6

7 Understand your problem Targeted intervention Patient centered Team oriented Change principles Terri Murray MSN, RN (NM for the unit) Jennifer Templeton MSN, RN( Nursing quality) Nursing staff on J53 (RNs, PCNAs, CTs) Deanna McCormick & Nichole Gulley (CNS students) Questions?????? 7