respond deliver & enable improving dementia care - falls prevention julie vale 26 th january...

Respond Deliver & Enable

IMPROVING DEMENTIA CARE

- FALLS PREVENTION

Julie Vale 26th January 2010


The Numbers

• 200,000 falls per year in acute, community and mental health units (NPSA, 2007)

• Nationwide 500 people suffer a # hip following a fall in hospital

• R,D&E = 1,821 falls in 2009• Average of 152/month


The R,D&E story

• Two fatalities Jan – Mar 08• One pt fell 15-20 times – no action taken • One pt fell twice in the same night over

bedrails• Both patients had cognitive impairment• Culture of normalisation to falls across the

trust and division


Assessment.

• On admission – within 24 hours• After any ward moves.• After any change in condition – e.g. patient

becomes unwell or has a fall.• Routinely on a weekly basis moving to every

72 hours • Top tip: Beware underscoring


Risk planning.• Cohort at-risk patients. • Bed position – visible and low.• Footwear.• No bed rails.• Refer to OT and Physio – for falls assessment and

planning.• Keep area clean and tidy – remove obstacles.• No commodes left by bed. • Communication to team – highlighting risk.• Document all actions and processes followed.


• Leadership intervention – test of change re development of falls checklist/bundle

• Targeted formal falls education

• Intentional round every hour for patients

with falls risk score >20

• Checklist with key quality questions

• Verbal feedback from staff, patients

and carers

• Positive results with decrease in falls

across directorate and Trust

Intentional Rounding Checklist

Intentional rounding provides the visible presence of nursing staff on the ward and patients and carers have commented on it improving their experience while in hospital:

“ I feel safe”“ I didn’t realise I had dropped my call bell”“ Nurses are saying they have time to care”


Hospital No. ………………….Name: …………………………DoB: …………………………..Affix patient label here

For patients with a falls risk score of 20 or if any degree of cognitive impairment please enter either ‘A’ = achieved or ‘V’ = variance in columns. Record reason for variance and action taken overleaf. This patient requires observation every ....... hour …..... minutes.

DATE: TIMES

1. CONTINENCE Do you need to go to the toilet?

2. PAIN Do you have any pain?

3. ORIENTATION – fully alert=FA; mildly confused/disorientated=MC; severe confusion/disorientation=SC; asleep=A

4. POSITION / COMFORT Are you comfortable?

5. DRINK / MOUTHCARE Would you like a drink?

6. CALL BELL WITHIN REACH If you need me, please press this button

7. BED RAILS DOWN

8. BED TO THE LOWEST POINT TO THE FLOOR and underbed light on at night

9. IS THERE ANYTHING ELSE I CAN DO FOR YOU BECAUSE I HAVE THE TIME?

INITIALS

Intentional Rounding Checklist


Principles and Lessons Learned• Round >20 or if any degree of cognitive impairment/confusion

• All questions need to be asked in order

• Patients need to be rounded every hour over 24 hour period

• If patient asleep over night, when they wake, restart the clock

• Don’t stop if they haven’t fallen!

• Draft training package and targeted education vital for success

• Its more than managing the falls risk … patients feel cared for

• Build in audit cycle for sustainability

• Clinical champions

• Be relentless in approach

Respond, Deliver & Enable


10/1/09 admitted to RD&E from Hay House

13/1/09 admitted to medical ward Falls assessment score 23

17/1/09 transferred to another ward not reassessed

25/1/09 routine falls reassessed as 34 IR not commenced


7/2/09routine falls reassessed as 33 IR not commenced




2/3/09routine falls reassessed as 33 IR not commencedCRP 92 1/3/09

2/3/09Fall

b

c

d

b

Time____

Event

SupportingInformation

Incident


Results

Number of falls

0

10

20

30

40

50

60

31/03/0821/04/0812/05/0802/06/0823/06/0814/07/0804/08/0825/08/0815/09/0806/10/0827/10/0817/11/0808/12/0829/12/0819/01/0909/02/0902/03/0923/03/0913/04/0904/05/0925/05/0915/06/0906/07/09

D ate

Individual Value

C

S pecia l Cause Flag

Total number of inpatient falls in 10 medical wards April 2008 to July 2009


Kenn Ward – Slips, trips and fallsKenn in-patient slips, trips & falls SPC Chart (Apr-08 to Dec-09)

-6

-4

-2

0

2

4

6

8

10

Week Beginning

Volume UCL Median LCL


Very High RiskSome patients risk cannot be adequately

reduced despite all of the above actions.

1. Risk assess and document any actions.2. Alert your Matron and Senior Matron if

patients remain at very high risk.3. Consider 1:1 special4. Consider using hip protectors5. Reassess and document change on a daily

basis.

respond deliver & enable improving dementia care - falls prevention julie vale 26 th january...

Documents