LESS RESTRAINT LESS FALL PROJECT IN KH

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

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

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

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

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

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

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

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

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

Demographic & Cognitive - Data of the Recruited Patients No. of Patients (from Mar 2016 to Feb 2017) A Ward B Ward Total samples for analysis 52 59 Successfully off PR before the patient discharged 16 (30 % success) 19 (32 % success) Range of Age 57-93 65-100 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) 24-126 (mean: 59.8) 40:19 (68% Male) 12-15 (mean: 14) 2-24 / 2-6 (mean: 15 / 4) 19-102 (mean: 62) 12

Prevalence PR Rate (%) 35% 30% 25% 20% 15% 10% 5% Monthly Prevalence PR Rate (checked by CND staff) 80 70 60 50 40 30 20 10 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

Monthly Prevalence PR Rate for Fall Prevention 80% (checked by CND staff) 80 70% 70 Restraint Rate (%) 60% 50% 40% 30% 20% 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

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 Different Fall rates of Both Wards from Mar 2016 to Jan 2017 2 1.83 1.66 Previous Year Fall Rate Fall Rate Previous Year Fall Rate Trend Fall Rate Trend 1.47 1.55 1.35 Fall Rate, % 1 0.81 0.82 0.84 0.82 0.78 1.17 0.99 0.66 1.01 0.84 1.00 0.97 0.74 0.49 0.23 0.27 0.26 0 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-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

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

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