1. Improvement Associates Ltd. South West Nova District Health Authority (SWNDHA) Safer Health Care Now! Falls Prevention Project Roseway Hospital Experience to date Nov. 1, 2008 - Feb. 1, 2009

2. Improvement Associates Ltd. South West Nova District Health Authority is one of nine district health authorities serving Nova Scotia. SWNDHA is situated on the southern most tip of Nova Scotia. It covers a geographical area of ~7000 square kilometers. It provides health care services to ~61,000 residents of Shelburne, Yarmouth and Digby Counties.

3. Improvement Associates Ltd. 3 Background PROJECT LOCATION  Roseway Hospital (RH)  Shelburne, Nova Scotia  26 bed unit  14 designated Alternative Level of Care (ALC) beds

4. Improvement Associates Ltd. Improvement Team Members Margo Lowe, Clinical Resource Nurse, Kim Ott, Rehabilitation Services Sheila Hartley Gallion, Environmental Services Angela Stanley, Nursing Team Leader Darlene Huskins, Nurse Manager Dr. Riley, Physician Tamra Farrow, Falls Prevention Coordinator Team Sponsor: Department of Health Promotion and Protection, Department of Health and South West District/Cathy Blades VP, clinical.

5. Improvement Associates Ltd. 5 Aim Purpose of Project: Implement a comprehensive Falls Prevention/ Management program for ALC population at RH that includes: policy and processes, health care provider education, and safe environments. Goal: By May 2009, the goals of the Falls Prevention/Management Program are to: reduce the number of falls and the severity of the falls within RH ALC population by 10%. Scope and Boundaries:  All patients admitted to the 14 bed ALC unit at RH Nov/08- May.  Include all types of falls that occur, according to the Safer Health Care Now! Definition.  Exclude the falls incidents that occur outside the pilot location.

6. Improvement Associates Ltd. Aim (con’t) Improvement Objectives:  Reduce fall rates by 10% compared to baseline data.  Reduce severity of injury by 10% compared to baseline data.  100% of the individuals included in pilot will have a falls risk assessment completed within 24 hours of admission.  Work toward 100% of the individuals at risk for falls to have a documented plan of care to address identified risk factors.  Restraint practice (physical and medical) will follow SWNDHA Least Restraint policy.

7. Improvement Associates Ltd. 7 Results # of falls- RH 07/08 Community Client 1 Employee 7 In Patient/Resident66 Out Patient 1 Visitor/Family 2 Grand Total77

8. Improvement Associates Ltd. 8 Changes tested  Knowledge of employees Falls risk factors  Action for employee education and awareness building  Data collection tool for SHN project stats, created for use with ALC patients - is it user friendly?  Formation/effectiveness of multidisciplinary Falls Prevention team weekly rounds  Action to address environmental hazards

9. Improvement Associates Ltd. PDSA – Employee Knowledge - Plan What change are we testing? Employee knowledge on fall risk factors. What is our prediction and theory? 50% response rate.; 60% the respondents will score 80+% on quiz Details of the plan Who: Project Improvement team and all hospital staff What: Quiz created by RNAO titled Falls Prevention: Building the Foundation for Patient Safety. Where: RH - all units When: December 1-24, 2008 How: The team delivered quiz - memo attached re project; a ballot was attached as incentive to complete and return - three prizes were available. Data collection: 1. # quiz distributed 2. # returned/completed quiz

10. Improvement Associates Ltd. PDSA – Employee Knowledge - Do Returned Quiz By department: # returned; knowledge level, average # correct answers Every department participated and had correct and incorrect answers. Only one returned quiz had a perfect score. Which questions were correctly answered; highest percentage All respondents correctly answered that a risk assessment should be performed on all admissions Which questions were incorrectly answered; highest percentage #1 – death in the elderly, # 2 – acute care setting, #9 Restraint use, # 5 – laxative use (shown in highest-lowest %)

11. Improvement Associates Ltd. PDSA – Employee Knowledge - Study Do the results agree with the predictions? Yes and No Predicted a 50% return of quiz sheets - had a 51% return; predicted 60% of staff would score 80+% - only 42% met the prediction. What new questions or issues arose? Quiz not given to the physicians or front desk staff. Question on call bells not included because a new call system is being installed What are our updated theories? The knowledge level is not as high predicted therefore more employee education and awareness is necessary - there are specific areas identified from the quiz. Under what conditions could the results be different? Stronger employee understanding regarding the elderly and fall risk factors. Summarize new knowledge. There are gaps in employee knowledge regarding fall risk factors, particularly the Least Restraint policy and the role of laxative use as it impacts on fall risk.

12. Improvement Associates Ltd. PDSA – Employee Knowledge - Act What action are we going to take as a result of this cycle (Adopt, Adapt or Abandon)? Continue to raise fall risk level of awareness Create a newsletter Logo design contest Are we ready to implement? YES!!! What other processes or systems might be affected by this change? Care for the ALCU patient has improved RH is now looking at other fall risk initiatives Safety Culture at RH will improve. This is a small District – the other sites will hear our success and will want to implement change as well.

13. Improvement Associates Ltd. 13 Universal Falls Precautions All patients are at risk for falls. Everyone has a role in falls prevention.  S afe environment  Bed rails down unless assessed otherwise  Pathways clear of clutter  Bed and chairs in locked position  Adequate and appropriate lighting  A ssist with mobility  Mobility assist documented  Safe and regular toileting  Assistive devices within patient reach  F all risk reduction  Call bell in patient's reach  Bed lowered to patients knee height  Personal items reachable  Proper footwear available and in use  E ngage patient and family  Discuss risk factors with patient and family  Communicate mutual plan Keeping SAFE from falls

14. Improvement Associates Ltd. Other Resources T&F quiz from RNAO Newsletter created specifically for project Branding Poster and Logo contest Handout “Don’t Fall for Christmas” adapted from Community Links Preventing Falls Together Coalition Developing: Falls Prevention education package for patients, education handout for family and caregivers, shoe guidelines, general awareness pamphlet, best practice recommendations for strategic direction, orientation package for new staff

15. Improvement Associates Ltd. 15 Lessons Learned Fall Prevention strategies although identified in Accreditation Canada’s ROPs and accepted by SWNDHA have not been totally embraced. This is primarily due to lack of education and understanding of the complexities of Fall Prevention. There is a need for an ongoing comprehensive Falls Prevention Strategy throughout the District. This is beginning to be developed and actioned.

16. Improvement Associates Ltd. 16 Next Steps Intervention Programs –Patient/Family Strategies –Exercise –Medication Review –Nutrition, Vitamins and Supplements –Rehabilitation Assessment –Environmental Considerations –Continence Management –Behavioural Strategies –Post Fall Management –Education Requirements