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Improving Falls Rates Through ‘Patient Focus’
Emily Raybould Ward Manager
Ward 37
Ward 37
• 22 bed male nephrology ward
• Acute/Chronic kidney damage
• Multiple co-morbidities
• High falls risk – BP, HB levels and metabolic abnormalities
• Intentional rounding introduced August 2010
Intentional Rounding
Observation 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 00:00
1.ORIENTATION Fully alert =FA,Mildly confused/ disorientated =MCSevere confusion = S Asleep = A
2.NURSE CALL WITHIN REACHIf you need me press this button.
3.POSITION/COMFORT Are you comfortable and pain free?
4.CONTINENCE Do you need to go to the toilet?
5.DRINK/MOUTHCARE Is your water jug full and in reach? Do you need assistance?
6.IS THERE ANYTHING ELSE I CAN DO?
INITIALS:
Name:
Hospital number:
Date:
INTENTIONAL ROUNDINGOBSERVATIONAL CHECKLIST (to be asked as appropriate)
Time
Data Review
• 71 falls from June 2010-June 2011
• Average age of patient who fell – 78 years
• 96% level 1 falls with no serious falls at level 3-4
• IQP model to review falls
Data – Number Of Falls
0
2
4
6
8
10
12
Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11
Falls Rounding
Data – Time Of Falls
0
1
2
3
4
5
Peak of falls between 5am and 7am
Aims And Measures
1. Improve patient experience
2. Collect patient feedback from QCR + Patient tracker
3. Eliminate avoidable falls
4. Meet patients needs
5. Reduce nurse call bell usage
Implementing ‘Patient Focus’Plan Nominate champions and plan meetings.
Do Define what you want to do. Review current practice. Pilot new tool
Study Review pilot data e.g. patient and staff feedback.
Act Amend tool / method based on feedback. Roll out with continuous feedback for improvement
‘Patient Focus’
Is there anything I can do?
A3 Report
The staff on ward 37 worked together to identify a way to reduce the number of falls occuring on this ward. We looked at the data to see whenever patients fell - what was the time? and what was the reason? We worked together to
develop a process we call 'Patient Focus'. This involves staff checking on patients at set times and asking - Is there anything I can do? Since introducing this change we have had less than 5 falls per month. We are currently working
on patient focus alloaction on late and night shifts to improve compliance.
How are we making the improvements?
Improvement target 4: to improve overall patient experience on ward 37 This reduced the number of call
bells needing answering between 8am - 4pm by
80%
reduction
Improvement Target 3: to reduce number of call bells (between 8am - 4pm)
overall aim - to improve patient experience by checking patients frequently
Improving falls through 'Patient Focus'
Improvement target 1: to ensure 'Patient Focus' occurs daily (>80% checks done)
Improvement target 2: to reduce number of falls
0
10
20
30
40
50
60
70
80
90
100
08
/08
/20
11
15
/08
/20
11
22
/08
/20
11
29
/08
/20
11
05
/09
/20
11
12
/09
/20
11
19
/09
/20
11
26
/09
/20
11
03
/10
/20
11
10
/10
/20
11
17
/10
/20
11
24
/10
/20
11
31
/10
/20
11
07
/11
/20
11
14
/11
/20
11
21
/11
/20
11
28
/11
/20
11
05
/12
/20
11
12
/12
/20
11
19
/12
/20
11
26
/12
/20
11
02
/01
/20
12
09
/01
/20
12
16
/01
/20
12
% a
chie
ved
number ofdays patientfocusoccurred
at least 80%of timescompleted
0
5
10
15
20
25
before after
Overall Quality
40%
50%
60%
70%
80%
90%
100%
12/1
0
01/1
1
02/1
1
03/1
1
04/1
1
05/1
1
06/1
1
07/1
1
08/1
1
09/1
1
10/1
1
11/1
1
12/1
1
Monitoring Patient Falls
0
5
10
15
20
25
30
35
40
12/1
0
01/1
1
02/1
1
03/1
1
04/1
1
05/1
1
06/1
1
07/1
1
08/1
1
09/1
1
10/1
1
11/1
1
12/1
1
Reducing Number Of Falls
0
2
4
6
8
10
12
Jun-10 Jul-10 Aug-10 Sep-10
Oct-10 Nov-10 Dec-10
Jan-11 Feb-11 Mar-11 Apr-11 May-11
Jun-11 Jul-11 Aug-11 Sep-11
Oct-11 Nov-11 Dec-11
Jan-12
Falls Rounding
Patient Focus
Data – Times Of Falls
Peak at evening shift
handover
What We Have Achieved
• Reduced falls - 14 falls (Aug 11 – Jan 12) compared to - 39 in same period last year
• Indirect consequences
• Positive feedback
• Continuous improvement journey
• Electronic system pilot
• Roll out programme
Thank You
Emily Raybould Ward Manager
Ward 37