Engaging the patient in Falls Prevention

Stephanie Gettens Falls Clinical Nurse The Prince Charles Hospital

Session outline

•  The power of reporting incidents

•  Engaging the patient and staff

•  Avoiding patient harm by interviewing

•  The consumer as the teacher

What is a Fall WHO definition: "inadvertently coming to rest on the ground, floor or lower level, excluding intentional change in position to rest on furniture, wall or other objects"

What a Fall is not • Not an accident • Cause can usually be identified • Sequence of events leading up to a fall can be predicted • Therefore falls can be prevented

Why are we talking about falls - what's the problem

•  Leading cause of unintentional harm worldwide

•  Leading cause of hospitalisation in over 65s in Qld

•  13636 falls were reported via electronic incident reporting system in Queensland hospitals in 2012 (Johnson et al., 2014)

•  Australian Commission on Safety and Quality in Health Care (ACSQHC) has dedicated a National Standard to falls prevention within Australian Hospitals (ACSQHC, 2012)

•  Falls can hasten the admission to an aged care facility

•  Reduced confidence can be a predictor of a fall

•  1 fall is a risk factor for further falls

Not just the financial cost •  Cost of independence •  Cost of confidence •  Cost of dignity

Life long debilitation

Fear of Falling

Increased length of hospital

stay

Functional Decline

Pain Hasten

admission to care facility

Falls Prevention is Essential Care

National Standards – Keeping patients

safe

National Standard 10 Governance and systems for the prevention of falls Health service organisations have governance structures and systems in place to reduce falls and minimise harm from falls.

Policies, Procedures, Standard, Best Practice Guidelines Incident reporting

Screening and assessing risks of falls and harm from falling Patients on presentation, during admission, and when clinically indicated, are screened for risk of a fall and the potential to be harmed from falls

Best practice screening tool § Falls Assessment and Management Plan § FROP COM § Residential Falls Assessment and Management Plan

Preventing falls and harm from falling Prevention strategies are in place for patients at risk of falling.

Multi factorial prevention plan Appropriate referral Equipment

Communicating with patients and carers Patients, families and carers are informed of the identified risks from falls and are engaged in the development of a falls prevention plan.

Patient information Prevention plans developed with the patient Engaging with the patient and their carers

Encouraging Reporting

Thank you for reporting

Incident reporting follow up

Don’t miss an opportunity

The story that data tells us •  Where •  When •  Who •  Why

Falls in Hospitals

2 out of 3 Falls

Occur at bedside

Unwitnessed

Males

More likely to fall

Less likely to Fracture

Female

Less likely to fall

More likely to fracture

Where do falls occur in hospital

When is your patient most likely to fall?

Time of reported falls

Why ? •  45% Falls in

hospital related to TOILETING

•  Toileting your patient is ESSENTIAL care

Stay within arms reach of the Cognitively Impaired patient

• Get patient off floor

•  Make patient comfortable

•  Take a set of observations

• Call Medical Officer

• Clean and dress wound

• Clean area where patient fell

• Call family

• Document

5 minutes now will save you an hour

Top 5 Reported injury types

Fractures related to falling

Part of body most likely to be hurt?

What about the unseen “injury”

Confidence and falls •  Confidence levels are

an accurate predictor of falls

•  The less confident the more likely to fall

•  The less confident the longer the length of stay

Who: Use YOUR data to identify your most at risk patient

Over 65 Toileting

Over confident

Non compliant

Mobile

Cognitively Impaired

Male

Skin tear

Head

Make the data work for you

•  Use your data to target those most at risk

Lets engage the Patient in Falls Prevention!

20

Consumer & Staff Engagement

Fatality Free Friday Why not have Falls Free

Fridays! •  More people

die as the result of a fall than in road traffic accidents

Don’t use the F Word!

Engage the patient by changing your language

¢ Patients don't associate themselves as a falls risk

¢ Handing them a brochure on falls prevention is not enough

¢ Strength and balance, enhance fitness and mobility

Consumer as the teacher

Thank you

References: ¢  AIHW: Bradley C (2013). Hospitalisations due to falls by older people. Australia 2009 – 2010. injury research and statistics series no 70.

cat. INJCAT 146.Canberrra: AIHW

¢  Black A & Begg S (2010). Cost of hospitalisations due to fall-related injuries among people aged 65 years and older in Queensland,

2006-07 to 2008-09. Queensland Health, Brisbane

¢  Haines, T.P., Nitz, J., Grieve, J., Barker, A., Moore, K., Hill, K., Haralambous, B. & Robinson, A. (2013) Cost per fall: a potentially

misleading indicator of burden of disease in health and residential care settings. Journal of Evaluation in Clinical Practice 19(1),

153-161

¢  Hill, K.D., Schwarz, J.A., Kalogeropoulos, A.J., Gibson, S.J. (1996) Fear of falling revisited. Archives of Physical Medicine and

Rehabilitation, 77(10), 1025-1029

¢  Queensland Health (2012). Patient Safety: From Learning To Action 2012. Brisbane: Queensland Government. Available at: http://

www.health.qld.gov.au/psu/reports/docs/lta5.pdf (last accessed 10 February 2014).

¢  Swaminathan, Barker & Black (2011). Fall-related emergency department presentations for older Queenslanders, 2007-08. Queensland

Health, Brisbane.

¢  2013 Queensland Bedside Audit State wide inpatient report March 2014

¢  Oliver D (2004). Prevention of falls in hospital inpatients. Age and Aging vol 33 (4) 328-330

¢  2011 Fatal Road Traffic Crashes in Queensland, Transport and Main Roads, October 2012

¢  Bureau of Infrastructure, Transport and Regional Economics (BITRE), 2013, Road deaths

Australia, 2012 Statistical Summary BITRE, Canberra ACT.

¢  www.health.qld.gov.au/stayonyourfeet/facts/statistics.asp

¢  Ballinger C, Clemson L. Older People’s Views about Community Falls Prevention: an Australian Perspective

¢  Gettens, S and Fulbrook, P (2014) Fear of Falling: association between the Modified Falls Efficacy Scale, in- hospital falls and hospital length of stay.

Journal of Evaluation in Clinical Practice.