1 Home Health Timely Care Value Stream Mapping Event Proactive Strategies for Fall Prevention November 7 & 8, 2012 Laura McNicholl, MS, RN-BC, CNS-BC; Mary Gibbons, MSN, RN, NE-BC
Patient Falls-IFOH
A Call To Action June 2, 2014- Fall Tactical Meeting CNO, PCD, NM, CNS, Quality, staff Members June 13, 2014 Follow up CNO, CNS, Quality July 16, 2014 Follow up CNO, CNS, Quality, LEAN September 23, 2014-2 nd Fall Kaizen CNO, PCD, NM, CNS, Quality, LEAN, staff members, Bathroom Buddy, Nurse Supervisor
IFOH Assisted/Unassisted Falls
Activity Prior to Falls
Hypothesis By reducing the number of patients falling trying to go to the bathroom, we can reduce falls by 50%. No falls with injury
Initial A3
Most Recent A3
Unit Specific Initiatives Surgical Unit Utilize bedside commode first 24 hrs post op Purchased additional equipment First 24hrs. all patients will have bed alarm activated Chair alarms for all post-op patients Medical Unit Bed exit alarm verified by staff at shift ISHAPED handoff Key Process Indicator- 1 st time Quality Tracked daily Telemetry Unit No pass zone Bed exit alarm verified by staff at shift ISHAPED handoff
Unit Specific Initiatives ICU Bed exit alarm verified by staff at shift ISHAPED handoff Family Centered Care (FCC) Parent education r/g baby falls/drops Education provided at hospital tour Pediatric Unit Parent education Algorithm Purchased floor mats
Hospital Wide Initiatives Safety Response Team (SRT) Initiated as a pilot- Medical Unit June 9, 2014 Moved to house wide- June 19, 2014 When to activate the SRT If a patient or family member is refusing the proper equipment to sit in If a patient or family member is refusing the bed exit alarm If a patient or family member is refusing staff staying in the bathroom (moderate/high fall risk) Patient requires a sitter? Who responds to the SRT Unit charge nurse (Days, Nights) Chief Nurse Officer (Days) Patient Placement Coordinator/Administrative Supervisor (Days/Nights) Nurse Director (Days) Nurse Managers (Days) Clinical Nurse Specialist (Days)
Hospital Wide Initiatives-SRT Purpose Discuss why the patient/family do not want specific fall intervention Provide education to patient and family member Educate on fall risk factors Discuss potential harm/injury Outcome Partnership with patient/family Increased knowledge regarding fall prevention Buy in from patient/family
Safety Response Team (SRT) Flyer
Safety Response Team
Safety Response Team
Safety Response Team (SRT) Increase Awareness of Program The Daily Unit Posted Flyers Safety Huddle Safety Coach Program Staff Meetings IFOH Fall Committee Meetings IFOH Nursing Orientation
Hospital Wide Initiatives Bathroom Buddy (BRB) Program A3 identified proactive toileting as an opportunity Senior Leadership support Staff & Patient satisfaction Initiated June 14, 2014 Medical and Telemetry Units 9am-9pm Friday, Saturday, Sunday Patient Sitter Associates (PSA) Expanded to Surgical Unit- End of August, 2014
Hospital Wide Initiatives Bathroom Buddy Program
Standard Work
Bathroom Buddy Collection Tool
Bathroom Buddy Totals
Bathroom Buddy Outcomes
Next Steps-Bathroom Buddy (BRB) Surgical Unit Pilot To start -mid November Tuesday, Wednesday, Thursday High surgical volume 9am-9pm Visual cue of last toileting on vital sign sheet on patient door PSA Education 8 hrs. with Physical Therapist Gait belt Proper transfer techniques Hip, spine, knee precautions Walking Ability Test Fall Prevention Education
Patient Feedback to BRB He is an Angel Has a big heart, very sweet, caring Treated my Dad like his own Dad Helped me to walk safely Dedicated to their job and happy doing it! Can do attitude Compassionate to the patients The most compassionate person I have dealt with, if you don t promote her I will hire her myself
Conclusion No falls to date have occurred on units when BRB have been present Early data suggest decreasing inpatient falls Questions?