6 P’s: A Fall Prevention Program

Colleen Dougan, MSN, RN

The Road to Fall Prevention

• Group convened in 2008 to address fall prevention and pressure ulcer prevention for inpatients– Nurses, Nurse Assistants, Clinical Nurse Specialists, Nurse

Managers, Nurse Administrators, Physical Therapist, Wound Care Specialist, Physician and Quality Specialist

Team Members• Wendy Quinn-Scott, RN, Nurse

Administrator• Sue Craft, RN, NM MICU• Colleen Dougan, RN, CNS,

Hematology/ Oncology• Catherine Draus, RN, CNS, Cardiology• Lynne Freimuts, RN, Quality Specialist• Dana Greggs, RN, CNS, Internal

Medicine• Joanne Guanio, RN, NE,

Neurosciences• Catherine Jackman, RN, CNS, MICU• Mary Kravutske, PhD, Nursing

Development• Cathleen McCloskey, RN, NM,

Neurosciences and Neuro ICU• Geri Muller, RN, CNS, DEM• Adele Myszenski, Physical Therapist• Kathy Raniszeski, Respiratory

Therapist

• Sheila Daley, RN, Neurosciences• Rebecca Gregory, RN• Katherine Herrmann, RN, Quality

Specialist• Shereen Patten, RN, NE, ICU• Sonalee Shah, MD• Nicole Sims, NA• Carolyn Taylor, RN, ANM

• Stephanie Schuldt, RN, CNS, MICU• Christine Seigert, RN, Wound Care

Specialist• Christine Sotto, RN, NE, Cardiology• Cheryl Stone, RN, Nurse

Administrator, Ambulatory• Rebecca White, RN, NM, Internal

Medicine

Getting to the 6 P’s

• Decided that we needed to bundle together the two issues—fall prevention and pressure ulcer prevention

• Reviewed literature that detailed other ‘P’ programs

• Added to ‘P’ list from HFH incident reviews

The 6 P’s

• Pain• Personal Needs• Pulmonary Hygiene• Position • Possessions• Place

The 6 P’s Program• Dry erase board for every patient• Fall Risk Sun signage• Switch to yellow arm bands/socks• Patient education brochure• Partners in Patient Care ‘Agreements’

– Fall Prevention– Pressure Ulcer Prevention

• Medications increasing fall risk identified on MAR

The 6P’s Program cont’d• Post-fall debriefing

protocol and audit• Employee Education

– RNs and NAs attended mandatory classes including videos with scripting

– Competency validation at the bedside

• Monitoring of Incidence, Compliance and Patient Satisfaction

HFH Falls/1,000 Patient Days

HFH Total Falls/1,000 Patient Days

0.000.501.001.502.002.503.003.504.004.50

Falls / 1,000 Pt Days

Monthly Average/1,000 PtDays

6Ps implementation house-wide

HFH Falls with Injury/1,000 Patient Days

HFH Falls with Injury/1,000 Patient Days

0.000.100.200.300.400.500.600.700.800.901.00

Falls with Injury per 1,000days

Monthly Average/1,000 PtDays

6Ps implementation house-wide

Hospital Acquired Pressure Ulcers > Stage 1

Percentage of Patients with Hospital Acquired Pressure Ulcers > Stage 1

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%

Percentage of Patients

Monthly Average

6Ps implementation house-wide

Patient Satisfaction: Noise Level In and Around Room

HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Noise Level In and Around Room

66.067.068.069.070.071.072.073.074.075.076.077.0

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2008 2009 2010 2011

Noise Level In and Around RoomQuarterly Average

6Ps implementation house-wide, higher score = higher satisfaction

Patient Satisfaction: Promptness Response to Call

HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Promptness Response to Call

81.582.082.583.083.584.084.585.085.5

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2008 2009 2010 2011

Promptness Response to CallQuarterly Average

6Ps implementation house-wide, higher score = higher satisfaction

Patient Satisfaction: Staff Sensitivity to Inconvenience

HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Staff Sensitivity to Inconvenience

80.5

81.081.5

82.0

82.5

83.083.5

84.0

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2008 2009 2010 2011

Staff Sensitivity to InconvenienceQuarterly Average

6Ps implementation house-wide, higher score = higher satisfaction

Staff Feedback• Do you think hourly rounding has:

– Decreased patient falls• Strongly Agree 19.5%• Agree 37.9%• Neutral 25.0%

– Decreased falls with injury• Strongly Agree 19.7%• Agree 37.0%• Neutral 26.1%

– Decreased pressure ulcers• Strongly Agree 15.4%• Agree 37.8%• Neutral 29.3%

• I can incorporate the 6 P’s concepts into my daily practice– Always 50.7%– Sometimes 27.8%– Neutral 15.7%

• Feedback given for dry erase boards

Staff and Customer Feedback

• RN staff were surveyed 1 year after go-live

• Family member reported that she was so relieved to really know that her mother was checked on over night

• Patient reported that she felt safer knowing that someone was checking on her regularly even if she was asleep

• Some patients are bothered by the frequent checking

6 P’s Lessons Learned and Refreshed

• Pilot program in all practice areas• Adjust for different patient

populations– ICU– OB/NICU

• White boards are not a part of the Medical Record

• Test your materials—dry erase board

• Engage as many frontline staff as possible– Review results frequently– Listen to feedback carefully

• Maintain momentum• Share the knowledge

• Some of 6 P’s reworked• Dry Erase Board modified• Partners in Patient Care

‘Agreement’ modified– On every admission– Includes basic information about

fall and pressure ulcer prevention and now with infection prevention measures

• Re-education of the Staff– Healthstream for RNs and NAs

• Results, 6Ps review, reinforce content of conversation, less focus on actual scripting

General Practice Unit Board

Intensive Care Unit Board

Questions?