1. Falls Facilitated Learning Series Final presentation Kateri Memorial Hospital Centre Tehsakotitsén:tha Kahnawake, Quebec Prepared and Presented by: Marla Rapoport, pht March 2012

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3. Team Members: Team Leader: Marla Rapoport, Pht, Manager of Rehabilitation Team sponsor: Tracy Johnson, BscN Team Members: PAB’s -Bettina Anaquod -Karen Daigle -Stavroula Kostoulias, -Suzie Norton, -Nick Norton, -Edmar Ninalda, Adjunct members: Pauline Jardine, RN, Oliver Reves, RN, Sonny Dudek, Activity Department Manager Stats: Lidia Desimone, RN, Quality Improvement Coordinator

4. - First Nations hospital. The only First Nations hospital on its own territory. -Servicing the Mohawk Community of Kahnawake and surrounding areas -Community population of over 9,000 Kahnawaker ón :non

5. 5 -Located 15 km from downtown Montreal -43 Bed facility with -33 Long-term beds -10 Active beds -Both, long and short term clients in same unit -Extensive ambulatory health care services -Extensive Community: Home Care services (Nurses and Home Health Aides)

6. 6 200 employees (including 44 nurses, 2 physiotherapists, 2 Occupational therapists) 10 family doctors (all part-time) Specialists working at KMHC include a pediatrician, neurologist, psychiatrist, dentist, optician, optometrists, 3 pharmacists, foot care specialist etc More than 75 % of staff live within the community Aprox. 1/3 of the nurses are natives Many of the staff are related to the clients they treat and care for 9,343 active charts, 85 % native

7. 7 AIM: From Team Charter The AIM of our team: Is to brainstorm and come up with ideas on how to reduce the number of falls and injuries from falls, in our in patient department. To investigate barriers/problems related to communication To statistically improve fall risk reassessment secondary to a change in status. To improve fall risk re-assessments completed, post fall To brainstorm with team and make a decision on what to do in specific cases To document the interventions determined above To determine ways to sustain positive changes and methods. To engage and motivate staff 5 % reduction of falls and injuries from falls from September 2011 to March 2012.

8. 8 Background information: Long history of data collection and concerns about the annual number of falls and injury of falls, at KMHC Promoting a “Least Restraint” environment Balance between minimizing the number of falls and injuries to falls, while respecting a restraint free environment Involved in the 2009 Falls collaborative Falls prevention program necessary for Accreditation Aware of problems with sustainability 2011: Joined the FFLS Administration has always been supportive, but this time there was a marked increased number of grass root staff members involved: PAB’s, home care, more members of our MDA team

9. 9 It was important for us to remember that we already had a lot of strategies in place and using numerous tools to prevent falls: There was already an awareness, equipment, risk assessments and interventions in place Home Care Department had an post fall assessment tool for Home and Community Care Although we have done well, we were concerned with a recent increase in the number of falls in LTC. There was a sense that we could be doing better We knew that more involvement of front line workers was important.

10. 10 Changes tested - Attempts to reinstate walking program - Huddles - Improved collaboration between the PAB’s, IPD and Rehab department - Footwear audit, with recommendations - Chair and bed alarm audit, review of equipment and clients - Newer members include a Home Care Nurse on our team

11. 11 Past on going Accomplishments Existing protocol binder: “Falls and least restraints” Past: Fall Risk assessments being done on all new admissions (very good compliance in this area) Existing pamphlet for families about KMHC “Least Restraints” philosophy. Stats collected and submitted High risk fallers have “a feather” on their door, bed, walker, as an identifier. Yearly and ongoing staff education concerning falls, every “Quality Improvement Day” and for all new staff Most staff have completed the NVCI (Non violence crisis intervention) training and almost all in-patient department (IPD) PAB (Préposé(e) aux Bénéficiaire: Personal service workers) have training on how to move patient’s safely.

12. 12 Accomplishments Having 6 front line workers on this team To communicate the agreed upon intervention with other team members Regular committee meetings, brainstorming sessions with members (PAB’s): very receptive to hearing what the front line workers had to say (feedback, ideas) Incident and Accident reports being encouraged and completed concerning falls and improper use of alarms Chair and Bed alarm audit has been done Recent shoe and footwear audit Document being developed, explaining features of proper footwear

13. 13 Accomplishments IPD clerk does contact the Rehab professionals to inform the OT and PT, post fall Past: Most LTC clients are on vitamin D and Calcium Doctors are encouraged to review medication post fall All in-patients have a PAB and nursing care plan Past: Existing equipment available including bed, chair alarms, landing pads Discussion with foot and shoe specialist, about setting up a clinic to help us evaluate the feet and the appropriate footwear of our in patient clientele. Recent ErroMed, Human Factors training program on safety, with staff from all areas. Falls were discussed and analyzed

14. 14 Barriers Initially there were no clinical nurses on our committee We do have alarms on beds and chairs but staff do not always respond quick enough or use the alarms correctly. We are now wondering if have too many clients with alarms, at the same time Not all clients are reassessed post fall or when there is a change in status. Issues of communication and interpersonal relations. Although it was great having so many front line workers on our working team, not all staff were receptive to proposed changes

15. 15 Future plans... Considering discussing high risk clients during our weekly Long Term Care Multi Disciplinary team meetings (inviting appropriate staff prior to our scheduled meetings)

16. 16 Miscellaneous thoughts and activities Putting notices in the hospital newsletter (The Well) relating to falls and putting up poster with different strategies Recent visits to other institutions to see their bed and chair alarms and pager systems Discussion with members of their Falls teams from other institutions

17. MEASURES Concern as the number of falls increased from Dec 2010 till August 2011 Then joined the FFLS, unfortunately, we had a number of falls with injury since August 2011. 17

18. 18 Lessons Learned on Sustaining Falls Improvement Work during Action Period Change takes time Change takes team work We are really excited and fortunate that we have such excellent PAB’s on our team, helping to move us forward: you need to get the involvement of staff, at all levels. Having the front line workers involved, was an asset: they appreciated having a voice and seeing changes.

19. 19 Challenges to Sustaining Falls Improvement Maintaining interest Maintaining momentum Ensuring all new staff are informed Not all staff saw changes as a way to make their work easier nor were they receptive to proposals.

20. 20 6 Month Post FFLS Sustainability Plans for Falls Improvement Work Goal Description (What is AIM) Action (What STEPS are to be taken to achieve) Timeframe (When to be done by) Person Responsible Metrics: What is to be monitored to identify achievement Further reduce # of falls and fall injuries at KMHC Continue to investigate a better bed/chair alarm system Further research over the next 2-3 months, decision within 6 months Nurse Manager, Physiotherapist, Director of nursing and input from OT and IPD staff Before our weekly MDA team meetings, choose a specific resident, who is a high risk for falls, to be discussed. Invite PAB’s who work with this client By April 1, 2012 Nurse manager and Rehabilitation Department manager Consider modifying or feather logo: perhaps making it bigger May 1, 2012 Team Leader, in consultation with staff Continue with shoe audit: having specialist, measure feet, making suggestions on proper footwear. Complete footwear document to be given to family. February 2012 Document: by March 1, 2012 Manager of Rehabilitation Continued involvement of PAB’s, monthly meetings to discuss falls and fallers Immediate To be determined: query Nursing Team Leader vs Rehabilitation Department manager

21. 21 6 Month Post FFLS Sustainability Plan (continued) Goal Description (What is AIM) Action (What STEPS are to be taken to achieve) Timeframe (When to be done by) Person Responsible Metrics: What is to be monitored to identify achievement Reduce falls in the community Fall reduction and strategy presentation to be given by Marla, FFLS Team Leader - January - February Marla, Team Leader Review existing Fall education programs, for the Elderly May 1, 2012 Rehabilitation Department Manager in consultation with the Home care Nurse manager Chose and modify program that will meet the needs of our Elderly September 1, 2012 Home Care Nursing Manager and Rehabilitation Department manager Invite high risk fallers from the community to participate in the program. October 1, 2012 Home Care Nursing Manager and Rehabilitation Department manager Ensure all falls are documented and analyzed when possible Immediately Home Care Nursing Manager

22. 22 Contact Information Name: Marla Rapoport Email: marla.rapoport@rrsss16.gouv.qc.ca Phone Number: 450-638-3930 ext 288

23. 23 NIA: WEN