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IMPROVING DEMENTIA CARE

- FALLS PREVENTION

Julie Vale 26 th January 2010

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The Numbers

200,000 falls per year in acute, communityand mental health units (NPSA, 2007)

Nationwide 500 people suffer a # hipfollowing a fall in hospital

R,D&E = 1,821 falls in 2009

Average of 152/month

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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 thetrust and division

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Assessment.

On admission within 24 hours After any ward moves.

After any change in condition e.g. patientbecomes unwell or has a fall.

Routinely on a weekly basis moving to every

72 hours Top tip: Beware underscoring

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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.

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Leadership intervention test of change redevelopment 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 fallsacross directorate and Trust

Intentional Rounding Checklist

Intentional rounding provides thevisible presence of nursing staff on the ward and patients andcarers have commented on itimproving their experience whilein hospital:

I feel safe I didnt realise Ihad

dropped my callbell Nurses are saying

they havetime to care

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

For patients with a falls risk score of 20 or if any degreeof cognitive impairment please enter either A =achieved or V = variance in columns. Record reason forvariance and action taken overleaf. This patient requires

observation every ....... hour ..... minutes.DATE: TIMES

1. CONTINENCEDo you need to go to the toilet?

2. PAINDo you have any pain?

3. ORIENTATION fully alert=FA;mildly confused/disorientated=MC;

severe confusion/disorientation=SC; asleep=A

4. POSITION / COMFORTAre you comfortable?

5. DRINK / MOUTHCAREWould you like a drink?

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

7. BED RAILS DOWN

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

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

INITIALS

Intentional Rounding Checklist

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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

Dont stop if they havent fallen! Draft training package and targetededucation 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

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10/1/09admitted toRD&E fromHay House

13/1/09admitted tomedicalward Fallsassessmentscore 23

17/1/09transferredto anotherward notreassessed

25/1/09routine fallsreassessedas 34 IR notcommenced

2/2/09routine fallsreassessedas 33 IR notcommenced

7/2/09routine fallsreassessedas 33 IR notcommenced

14/2/09routine fallsreassessedas 33 IR notcommenced

16/2/09routine fallsreassessedas 33 IR notcommenced

24/2/09routine fallsreassessedas 33 IR notcommenced

2/3/09routine fallsreassessedas 33 IR notcommenced

CRP 92 1/3/09

2/3/09Fall

b

c

d

b

Time____

Event

SupportingInformation

Incident

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Results

Number of falls

0

10

20

30

40

50

60

Date

Special Cause Flag

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

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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

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Very High Risk

Some patients risk cannot be adequatelyreduced 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 special

4. Consider using hip protectors5. Reassess and document change on a daily

basis.