Reducing Falls at RCHT

Trish Prady – Lead Nurse for Quality Safety and Innovation

Patricia.Prady@rcht.cornwall.nhs.uk

“THE FIRST REQUIREMENT OF A

HOSPITAL IS THAT IT SHOULD DO

THE

SICK NO HARM”

Nightingale (1863)

Aims

• Understand falls prevention in the Context of the “Safety Thermometer” CQUIN

• To understand why patients fall

• Promote the Falls policy and implement the Fallsafe Care Bundle as a method of enhancing patient safety and care

How do we change what we do to ensure that vulnerable people in our care are safe from Falls?

What do you think?

“A normal part of a

hospital stay”

“Falls are a nurse’s responsibility, not a doctor’s”

“Not what you want to happen, but an inevitable

part of getting patients mobile”

“Just one of those things that happens in hospital”

Background – Falls at RCHT The Facts

Falls make up 65% of all reported incidents at RCHTThe majority of falls are on high risk/high dependence inpatient adult wards – Over 90% are on 12 wards (120 per month) Falls with harm - There have been 20 falls with moderate to severe harm since 1st April 2012 of these 7 people have died as a result of the fallThe Falls action Group attended by a cross section of safety and front line staff, meet monthly to examine current data and progress the falls prevention action plan.

“after my fall I was scared to get out of bed or even reach for my drink” “I was in hospital for another 3 weeks after I fractured my hip”

Mapping the changes..

Improved data assurance (safety cross roll out)

Fallsafe links activity on top 14 wards (wards

with highest no of falls

Tool box talk rollout

Team learning and documentation

review

Period of high activity in the organisation

Implementation of trust wide care rounds

Why Do Patients Fall in Hospital?Medical

Problems Confusion Environmental

CVSNeuro

ENTVisual

BiomechanicalMetabolic

Pharmacological

Dementia&

Delerium

Ward Clutter!LightingToileting

Food/ fluidHeightsFlooringCall Bells

1 23 45 6

7 8 9 10 11 1213 14 15 16 17 1819 20 21 22 23 24

25 2627 2829 30 31

1 23 45 6

7 8 9 10 11 1213 14 15 16 17 1819 20 21 22 23 24

25 2627 2829 30 31

INCIDENT FREE DAY

PATIENT FALL

PATIENT FALLS

 Ward:

Month:

MULTIPLE FALLS

What Can you Do?Assess appropriately – Make sure each patient has a prevention plan in place? Consider the Environment (Clutter, property, obstacles) Keep the environment clear!Has MF falls assessment been done? (Meds reviewed, urinalysis, glasses, hearing aid

available…?)Appropriate footwear? (Yellow socks as a temporary solution)Appropriate (Familiar) Walking aid ? Line of sight – Particularly Dementia PatientsSafe Observation policy – escalate if you are concerned for a patients safetyFalls prevention aids where appropriateUse of relatives and carer’s to assist you to protect patients.Increase direct care time – PW keep working at the bedside (reduces patient anxiety) Team Focus on who is at risk – Safety BriefingsCARE ROUNDING

Advantages of Rounding

• Higher patient satisfaction levels• Higher staff satisfaction• Reduction in call bell use• Reduction in falls and pressure ulcers• More effective use of nursing time• Cost savings in reducing harms• (Meade et al 2006; Gardener et al 2009)

Rationale

Provides Reassurance Prompts Basic care in busy environmentsEarly response to patients changing condition Involves the whole teamPromotes Independence While maintaining safety

Any Questions??

Help and advice on falls prevention

Trish PradyExt 3050

email patricia.prady@rcht.cornwall.nhs.uk