Taking a Leap: Implementing the Hester Davis Fall Risk Assessment Tool Susan B Schumacher, MS,APRN,CNS Methodist Hospital- Park Nicollet

Objective Discuss key strategies to effectively implement a new falls risk assessment tool. Enterprise work to streamline falls prevention and injury across 6 hospitals of varying sizes

38-78% of hospital falls can be anticipated Approximately a third of falls occur in the bathroom 40% of falls occur within 30 minutes of hourly rounding. People 85 years and older are 10-15 times more likely to sustain hip fractures from falls than people 60-65 years. Fear of falling, leading to decreased mobility and increased fall risk.

Why Make a Change? Patient Safety Experience with falls risk assessment tool Hospital-wide falls rate of 2.21 during 2017; not achieving our goal of 1.41 falls/1000 patient days and patients were falling and some were injured; striving to have 0 injuries-Top decile being a high reliability organization Johns Hopkins Falls Risk Assessment tool…”All of my patients are high risk.” Lack of individualization with bundles of interventions based on level of risk; over-reliance with alarms

Creating a climate for change Engaging the group or organization Change Management 1. Create a sense of urgency 2. Build guiding teams 3. Get the vision right 4. Communicate for buy-in 5. Enable action 6. Create short-term wins 7. Don’t let up 8. Make it stick Creating a climate for change Engaging the group or organization Sustaining the change Framework to implementing a change improves likelihood of success; Reduce injuries related to falls Sense of urgency to improve patient safety related to falls and injuries- Zero injuries

“It’s Everyone’s Responsibility to Prevent Falls and Their Injuries” Inter-professional: PT, Quality, Leaders, CNE, Educators, Informatics, CNS’ from each of the HP hospitals; critical care, m/s, behavioral health Representative of hospital and seeking feedback and communicating… Individual hospitals committees provided feedback and guidance It Takes a Team

Setting the Stage for Implementation Evidence on Falls Assessment Tools Evaluation of Falls Assessment Tools EPIC Development Evidence- Lack of evidence related to predictable nature of falls risk assessment tools; Evaluation of Johns Hopkins, MHA Framework and Hester Davis (Formal process using Quality Improvement tools- Increase objectivity; site visits; conference calls; discussion with leaders, nursing staff and other disciplines; Cost, Resources needed for education and EPIC development CNS – bridges the practice at the bedside and leaders; CNS plays an important role of understanding the evidence, informing leaders and being in touch with clinical practice at the bedside… EPIC Development Standards(Policies, work standards)

EPIC Development Build of HD Falls Risk Assessment Tool linking risk factors and interventions Interventions within flow sheet rows and Care Plan Visual indicators (Yellow wristbands) BPAs to support standards Non-evidence based interventions used frequently, “What are our assumptions that may be incorrect?”—Alarms, signage, socks… IHI Webinar: Fresh Facts: Hospital Falls and Fall Prevention: STOP and START—mobilizing and patient engagement Prior to the roll-out: NQSI discussing with colleagues risk factors and interventions implemented

Thinking in New Directions “A common mistake is prescribing interventions based on a patient’s level of risk (Low, moderate, or high), rather than tailoring interventions based on patient-specific risk factors.” (Dykes, 2018) Challenge the assumptions…Oliver, David (over-reliance on risk scores and interventions with lack of evidence) Complacency with patients who are moderate or low risk

Successful Plan: Variety of strategies Inter-professional approach Subgroups for “getting the work done” Enterprise data- goals and measurement (different definitions, different data systems, measures, etc.) –Lengthy process Data analysis- audits (interventions implemented) communication, education, committees; Sharing of standards, flyers and communication Data—digging deeper to understand our patients who fall and the circumstances---RCAs after falls whether injury or not-unit based Inter-professional approach Engagement of leaders

Education/Communication System-wide communication E-learning Huddles Newsletters Video E-learning (RN, Nas), huddles, newsletters, committees; Strengthen NA role in falls prevention Interdisciplinary—Role of ancillary staff; professional staff other than nursing Case Studies—”What’s the same” vs What’s different?

Communication

Engaging Our Patients

Go-Live At the elbow—all hands on deck with teams-educators, CNS’, informatics Daily calls—system for issues that came up and whether it’s optimization vs critical to change Innovators, Early adopters, Early Majority, Late Majority, Laggards

Will there be Magical Changes? Consistency of interventions…critical to success; patient populations

Show me the Data... A3—high impact units, toileting, interventions and clinical conditions Trending down- falls; below goal; reduction in toileting-related falls; 100 days without fall Case studies—shared learning Looking upstream for patient education Accessibility of equipment, technology Visibility of data and success (days since last fall---; pizza party) Sponsor meeting presentations: progress and areas needing support Listening to staff

Falls Related to Toileting

Key Strategy: PDCA with EPIC Critical thinking and patient populations Dizziness and History of falls, Coagulopathy and anti-coagulants; levels of assistance definitions, behavioral risk factor descriptions; BPAs

Key Strategies Beyond EPIC Change Management Tactics Communication Engagement of leaders, team members and patients

It’s a Journey…