Fall Prevention Activities in WA Health: A State and Tertiary Hospital

Perspective

Khye Davey Senior Physiotherapist (Falls) Royal Perth Hospital South Metropolitan Health Service

Outline

SQuIRe and Community of Practice Falls Risk Management Tool Blended learning Data for improvement Auditing, technology and engagement Falls team experiences Where to next?

SQuIRe Safety and Quality Investment for Reform

(SQuIRe) program Strengthen the Department of Health’s

clinical governance and patient safety management systems Delivery of safe, high quality, evidence-

based health care to patients and the WA community

SQuIRe The Safety and Quality in Healthcare and

Health Finance Division provide policy and financial support for the SQuIRe Program respectively 8 clinical governance standards The Health Services are responsible for

the delivery of the SQuIRe Program and clinical care Project officers and clinicians

Community of Practice Groups of people who share a concern, a set of

problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis

Consists of SQuIRe falls project officers medical, nursing and allied health Public and private Metropolitan and country

Community of Practice

Social interaction Knowledge sharing Knowledge creation Identity building

Falls Risk Management Tool

Developed from the Falls Risk Assessment Tool Pragmatic approach with ownership PDSA cycle Used by most sites across the state Lessons learnt thus far

Falls Risk Management Tool

Blended Learning Combining lectures, workshops, hands on

clinical, and electronic learning Meeting the demands of a changing

workforce Variety of opportunities for staff Recognising our gaps

Advantages of an eLearning Adjunct Accessibility and flexibility Ease in updating content Learning styles Ease of distribution Standardisation of content Accountability

http://www.health.wa.gov.au/education/index.cfm

Data for Improvement Driven by the Office of Safety and Quality Shift in thinking for the uninitiated Are we adding value to the patients journey? Each system is perfectly designed to give the

results it is getting Weighing yourself 10 times a day wont help lose

the weight Is the current process capable of meeting the

goal Enumerative statistics versus analytical statistics

Data for Improvement Most inefficiencies are the result of measureable

variations in a process Asses the stability of a process Expose and reduce significant sources of

variation- common cause vs special cause Avoids over reaction Moves toward more productive conversations An interdepartmental, cross functional team

approach is often the most effective means of identifying process problems

Ward level changes

Data for Improvement

Individual control charts - Swiss army knife of charts 3 second rule Limitations

need enough data points seasonal variation Too low an average Often lack of familiarity

Data for Improvement

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7

Oct-07

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8

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8

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9

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9

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Jan-1

0

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1

Apr-11

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1

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2

Apr-12

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2

falls

/100

0 O

BD

Data for Improvement

Auditing, Technology and Engagement Aim to improve efficiency and usefulness

of audits iPad and survey monkey Small trial success Hospital wide deployment for all audits

Modified state wide audit tool Compliance and patient profiles Information on

Falls assessment Management plan Bedside implementation

Evaluation

Auditing, Technology and Engagement

Benefits so far Access for a variety of staff Education opportunities Quicker Rapid feedback Increased accuracy Increased information Ownership

Auditing, Technology and Engagement

Falls Team Experiences

Clinical consults and clinical interface Education Monitoring standards Project management Facilitating change

Where to Next? Improving older patients’ safety in WA

hospitals Specifically reducing falls in rehabilitation

units Research Question Can providing falls prevention education to cognitively intact older patients in addition to usual care reduce rates of falls on rehabilitation units?

Where to Next?

SHRAC funded project with SQuIRe and CoP support Clinical leads - Hill, Waldron, Haines,

Etherton-Beer, McPhail, Ingram, Flicker Area Leads - Carr, Simpson, Kitchen,

Fletcher, Seymour CoP members

Intervention Multi site clustered trial Multi-media education – DVD /workbook Trained health professional follow-up Structured progression through education

content Usually 2 to 4 sessions Commence January 2013 End data collection January 2014

Outcome Measures

Falls rates ( falls and injurious falls) on site wards Sub group analysis of cognitively intact

patients Economic analysis – cost of education

vs cost per faller – modelling of data

Thankyou

Questions….