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
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