February 27th, 2013 These presenters have nothing to disclose IHI Expedition Protecting Your Patients from Injurious Falls Session 3 Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP Kathy Duncan, RN Expedition Coordinator 2 Kayla DeVincentis, CHES, Project Coordinator, has worked at IHI since 2009, starting as an intern in the Event Planning department. Since then, Kayla has contributed to the STAAR Initiative, the IHI Summer Immersion Program, and the Expeditions. Kayla obtained her Bachelor s in Health Science from Northeastern University and brings her interest in health education and wellness to IHI s Work-Life Wellness Team. 1
WebEx Quick Reference 3 Welcome to today s session! Please use chat to All Participants for questions For technology issues only, please chat to Host WebEx Technical Support: 866-569-3239 Dial-in Info: Communicate / Join Teleconference (in menu) Raise your hand Select Chat recipient Enter Text When Chatting 4 Please send your message to All Participants 2
Expedition Director 5 Kathy D. Duncan, RN, Faculty, Institute for Healthcare Improvement (IHI), co-leads IHI's National Learning Network and manages the 24 IHI Improvement Map support care processes. Ms. Duncan also directs IHI Expeditions, manages IHI's work in rural settings, and provides spread expertise to Project JOINTS. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She also served as the content lead for the Campaign's Prevention of Pressure Ulcers and Deployment of Rapid Response Teams areas. She is a member of the Scientific Advisory Board for the AHA NRCPR, NQF's Coordination of Care Advisory Panel, and NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the director of critical care for a large community hospital. Today s Agenda 6 Introductions Debrief Session 2 Assignment Interventions to Reduce Falls and Falls Harm, Part 1 Homework for Session 4 Optional Office Hours 3
Expedition Objectives 7 At the end of the Expedition each participant will be able to: Differentiate types of falls as a basis for analysis of program effectiveness Integrate injury prevention into existing fall prevention programs Inventory tests of change in fall and injury prevention interventions Summarize successes ready for adoption and spread Plan small tests of change they can test throughout the Expedition Faculty 8 Patricia Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP, Associate Director, VISN 8 Patient Safety Center of Inquiry, is both a Clinical Nurse Specialist and a Nurse Practitioner in Rehabilitation. As Associate Chief of Nursing for Research, she is also a funded researcher with the Research Center of Excellence: Maximizing Rehabilitation Outcomes, jointly funding by HSR&D and RR&D. Her contributions to patient safety, nursing and rehabilitation are evident at a national level with emphasis on clinical practice innovations designed to promote elders independence and safety. She is nationally known for her program of research in patient safety, particularly in fall prevention. The falls program research agenda continues to drive research efforts across health services and rehabilitation researchers. 4
Assignments for Today 9 Did you test? Test injury risk assessment on admission on 3-5 patients Test use of ABCS tool on 3-5 patients Test use of visual cues Standardize and test risk communication hand off tool Practice Teach Back Strategy on 2-3 patients Volunteers Interventions to Reduce Falls and Falls Harm, Part 1 Special Recognition: Robert Wood Johnson Foundation Funding This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans Hospital. 5
Today s Topics Assessment of Environments Use of Equipment (low beds, bed alarms, floor mats, hip protectors) Bathroom Safety Segment Technology/Equipment for Fall Prevention, Detection, Protection At the end of this Session The attendees will be able to: Assess the environment for fall hazards Identify processes and equipment that prevent, detect and protect patients from injuries. Evaluate the use of the newest devices Formulate strategies for implementing technologies and confirming staff competency 6
Environmental Assessment: Do you need equipment or repairs? How often? Develop a schedule Who rounds? Areas of concern? Safety Huddles during shift change Environmental Assessment Tool Room Hand Rail secure Free of clutter Good Lighting W/C in good repair Bed wheels lock Bed Exit Functio ning Yellow Clip for Fall Risk, if applica ble #101 #102 #103 #104 Or any design of your own vs. VISN 8 s Injurious Fall Prevention Assessment Tool 7
Environmental Safety to Reduce Severity of Injury Hip Protectors Floor Mats Non-slip flooring Height-adjustable bed (in low position, except during transfers) Bed-rail alternatives (body pillows, assist rails) Raised toilet seats Elimination of sharp edges Use of safe exit side from bed (pt transfer to unaffected side) Use of alarms (bed, w/c) Pt access to mobility aides (walkers, canes) as appropriate www.visn8.va.gov/patientsafetycenter/fallsteam/default.asp Bathroom Safety Enough Grab Bars? How about folding grab bars? Elevated Toilet Seats Yes or No Toilet Alarms clips on emergency cords Non-skid floors with grit or traction kleen Rubber floor mats antimicrobial Padded walls and sharp surfaces? Motion Sensing Lights 16 8
Make Toilet Safer Why not this? 9
Eliminate Sharp Edges KidCo KidSafe Search: Furniture Corner Cushions Shower Rooms Grab Bars Liquid soap vs. bar soap Plenty of towels available Grit on floors vs. floor mats Shower chairs in working order/wheels lock? Right size? Does water drain off quickly? 20 10
Rubberized Flooring Technology and Equipment ADJUNCT to ASSESSMENT 11
Evaluation of Equipment Patient friendly Product safety Quantity and cost HOW DO WE PAY FOR THIS? Staff friendly All Services/Departments need to evaluate Easy to implement and clean Distribution How to Implement Do you have formal and informal support for change? Leaders must lead How will the new process or equipment impact the facility? Get staff feedback and involvement through: Plan-Do-Study-Act: Small cycles of change Early Adopters can help with assessment phase Advertise Advertise Advertise Provide lots of education and handouts 12
Lack of Adoption of New Processes/Equipment Staff education inadequate Staff turnover Too complicated Availability Central Supply vs. Unit storage? Supply?/Repair battery change Staff attitudes Improves quality of care, decrease costs, reduces patient pain/suffering Implementing Change Determine if this new process or equipment will make the job easier or less stressful? 13
Methods of Education Staff Meetings 15 minute show and tell Process or Equipment Demonstration with return demos or hands on practice Skill Fairs Develop How To Handouts include repairs Super Users identified as Trainers Discussion and Q+A time Add to New Employee Orientation Update Unit Handbooks or Facility Web Site Competencies Include not only ability of the operator but the SOP for cleaning. How will you accomplish this? 14
Other Considerations Keep list/spreadsheet of where products are distributed. Shift rounds to ensure equipment is turned on check for patient sabotage! Maintenance and inventory checks -how will that get done? Fall Prevention Assessment Universal Fall Precautions Care planning Arm bands Signage for high risk for injury Other Report/Assignment sheets/handoffs Intentional Rounds every hour- Environmental Rounds as discussed. Video Monitoring 15
Bundling Moderate to High Risk most Vulnerable Fallers The right interventions that combine Prevention Detection Protection Items Fall Detection Alarms Chairs Pull cord alarms Voice activated alarms One arm seat belt alarms Sensor mats- light weight Bed Pull cord alarms Mattress sensor mats Large Small Light Weight 6 month pads Built in bed alarms - Bathrooms Call system attachment Toilet seat alarm Clips on Emergency Cords? 16
Fall Detection 33 Floor/Door Alarms Floor Mat alarms Cordless Motion Detecting Beams over bed Passive Infrared Alarms on beds Pull cord alarm to doors Wander Detection Devices Placement Wrist/ankle Wheelchair Video Monitoring Connecting Patients, Families and Healthcare Providers 17
Value Proposition The product suite offers unique value to care providers and patients Administration Increase patient safety Avoid frivolous lawsuits Nurses Monitor multiple patients Alert patient movement Doctors View patients remotely Provide access to patients Clinical Products NurseView SecureView PhysicianView FacilityView EquipmentView Virtual Bed Rails Ulcer Management ProcedureView Video Bed Board Pat Activity Boards Patient Service Products Net View Movie View Greetings & Orientation Room Service Shopping Satisfaction Surveys Education PatientView BabyVIew Patients Access broadband Internet from bed Enjoy movies and on demand Families Contact patient from home Foster collective peace of mind 36 18
37 Virtual Bed Rails 38 The colors above are designed to measure movement in & out of zones as well as movement within. The upper portion of the bed is handled different from the bottom. Moving an arm will not trigger and alarm. Moving a leg out of the bed will. 19
39 Fall Management - Record If an event happens (fall, near fall, etc) immediately document the occurrence and forward that to a secure location Fall Management - Investigate Review Fall Incidents Were Virtual BedRails armed? Was the fall risk scored correctly? When did the fall occur? When was the fall recorded? How fast did nurses respond? 20
Fall Management - Investigate Review Fall Video Why did this patient fall? What could we have done to prevent this fall? Was the staff effective in preventing the fall, or preventing further injury? Fall Management - Evaluate Evaluate Falls by Site and Risk Level Which units are experiencing the highest rate of falls? Are we using VBR effectively? Is our fall risk measurement effective? Where do we need to improve? 21
Levels of Detection Ambulatory Wander detection devices/monitors Partially Ambulatory Bed/Chair Alarms/Monitors Non Ambulatory/Bed rest Bed Alarms/Monitors Fall Protection Mattresses-beveled edges Floor mats-size? Length Thickness Beveled edges Non-slip/Hygienic Night time glow strip Flooring Color Padding Helmets Hard Soft Reusable Available for PRN use Hip pads Soft pads and hard shell External Undergarments Sweat pants and shorts 22
Hip Protectors Poll Questions 46 Do you teach patients with osteoporosis or history of hip fracture about hip protectors? Do you offer hip protectors to patients? 23
Fall Protection continued Low Beds What is the patient s height and right level? Wheel chair Size/features Brake extensions Anti -tippers Front and Back Auto Brakes? Chairs/cushions Right height Right cushion Anti slip materials Seat lifts Toilet Seat elevation/lifts Swing Away grab bars Resources Alimed Catalog: www.alimed.com Care View: www.care-view.com Carroll Healthcare Low Beds: www.carrollhospitalgroup.com Comfortex Landing Strips: www.comfortex.com Swing away grab bars: www.elcoma.com Hill Rom Low Beds: www.hill-rom.com Hip Savers: www.hipsaver.com 48 24
Resources Sammons Preston Catalog: www.pattersonmedical.com Plum Enterprises Helmets/Hip Pads: www.fallssafety.com Posey: www.posey.com Satech Floor Mats: www.satechinc.com Span America: contoured mattresses: www.spanamerica.com 49 Questions? 50 Raise your hand Use the Chat 25
Assignments for Session 4 Test one new intervention Attempt to acquire one new piece of equipment for integration into your patient care environment Explore at least 2 patient education resources about new safety equipment that you just learned about Assess compliance with injury risk assessment on 3-5 admissions Volunteers? 52 26
Expedition Communications 53 Listserv for session communications: FallsExpedition@ls.ihi.org To add colleagues, email us at info@ihi.org Pose questions, share resources, discuss barriers or successes Next Session 54 Wednesday, March 13, 1:00 PM 2:00 PM ET Session 4 Interventions to Prevent Falls and Fall Injury Part 2 27
Office Hours 55 All are invited to spend 30 minutes with Pat Quigley for additional Q&A 2:00-2:30 PM ET 28