VISN 8 PATIENT SAFETY CENTER OF INQUIRY: JOURNEY FOR CHANGE:INNOVATIONS TO REDUCING FALL INCIDENCE AND INJURYSESSION 5

Thursday, Nov 29, 2012

PROGRAM GOAL

To provide VHA healthcare and quality teams with tools and strategies to reduce preventable falls incidence, injury from falls and outline key components of sustaining and spreading successfully.

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OBJECTIVES

Inventory tests of change in fall and injury prevention interventions

Differentiate types of falls as a basis for analysis of program effectiveness

Integrate injury prevention into existing fall prevention programs

Summarize successes ready for adoption and spread

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LOOKING AHEAD

Eight Sessions of Learning and Sharing

Oct 25th: State of Science of Falls and Injury Prevention Nov 8th: Integrating Falls and Injury Assessment Nov 29th: Interventions to Reduce Falls and Harm, Part 1

(Equipment and Technology) Dec 20th : Sustain and Spread Improvements in Reducing Falls and

Injury from Falls Jan 3rd: Injury Risk Assessment and Communication of Risk Jan 17th: Interventions to Reduce Falls and Harm, Part 2

(Intentional Rounding, Pre-shift Huddle, Post Fall Huddles) Jan 31st: Use of VANOD, NDNQI and SPOT Databases for Fall

Program Evaluation Feb 7th: Summary of Your Accomplishments

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ASSIGNMENTS FROM SESSION 3

What did you learn from reviewing patient education materials for protection from injury

What did you discover about patient education sessions you observed?

What strategies do you have inplace for one of the select populations: ABCS?

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SESSION 3:“INTERVENTION S TO REDUCE FALLS AND FALLS HARM”, PART I

Mary E. Watson, MSN, RN, CNS-BC.Central Arkansas Veterans Healthcare System Mary.Watson2@va.gov

MARY WATSON, MS, ARNPMary Watson, MS, ARNP, has been a nurse for 44 years. She received her Master’s in Nursing over 23 years ago and has worked at the VA in Little Rock ever since. Mary is a Gerontological CNS and has worked in the capacity as a Falls Clinical Specialist for 12 years managing her facility’s Fall prevention program and providing Fall consult services to nurses.  She has collaborated with Pat Quigley on several projects, including an article published in the Online Journal of Nursing in 2007 entitled “Measuring Fall Program Outcomes.” Mary feels fortunate to be able to lecture locally and nationally on Fall Prevention to help individuals as well as facilities reduce fall-related injuries.

EXPERIENCES WITH FALL PREVENTION EQUIPMENT

MARY E. WATSON, MSN, RN, GCNS-BC. CENTRAL ARKANSAS VETERANS' HEALTHCARE SYSTEM: MARY.WATSON2@VA.GOV

AT THE END OF THIS SESSION:

The attendees will be able to: Discuses assessment of environment 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

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 Handr

ailsecure

Free of clutter

Good Lighting

W/C in good repair

Bed wheels lock

Bed Exit Functioning

Yellow Clip for Fall Risk, if applicable

#101

#102

#103

#104

Or any design of your own vs. VISN 8’s Injurious Fall Prevention Assessment Tool

FROM WWW.VISN8.VA.GOV/PATIENTSAFETYCENTER/FALLSTEAM/DEFAULT.ASP

C. 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

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

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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?

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TECHNOLOGY AND EQUIPMENT

ADJUNCT to ASSESSMENT

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

Advertize Advertize Advertize Provide lots of education and handouts

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 CONTINUED…

Determine if this new process or equipment will make the job easier or less stressful?

METHODS OF EDUCATION

Staff Meetings-15 minute show and tell Process or Equipment Demonstration with

return demos/ 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?

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

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?

DETECTION continued

• 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

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

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

QUESTIONS/SHARINGWhat’s your experience?

RESOURCES

Alimed Catalog: www.AliMed.com Care-view.com Carroll Healthcare Low Beds:

www.carrollhospitalgroup.com Comfortex Landing Strips: www.comfortex.com

Elcoma.com…swing away grab bars Hill Rom Low Beds: www.hill-rom.com/ Hip Savers: www.hipsaver.com

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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.com32

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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

NEXT SESSION

Thursday, December 20, 2012 Session 4

12N-1PM ET

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