Implementing a Falls Prevention Programme in the Acute Hospital Setting Ms Pauline Fordyce, Head of Quality & Safety Ms Helen Ryan, Clinical Governance/Quality Manager Ms Joan Naughton, CNS Gerontology Liaison Beaumont Hospital Dublin

Beaumont Hospital Level 4 Hospital National Specialities Renal/Kidney Transplant Services Neurosurgical Services Tertiary Referral Hospital

RCSI Hospital Group Monaghan Cavan Dundalk Drogheda Beaumont Connolly Rotunda

Beaumont Hospital Serve a population of 1,022,184 Showing a largest population increase of any of the HSE 4 regions since 2006 1997 only 5% of Dublin’s over 65 lived in our catchment Increased significantly to 24% by 2011 85+ age group increased by 20%between 2006 to 2011 Beaumont Catchment increased by 60%

Supporting Structures for Falls Prevention Quality and Safety enabling structures Governance and Risk Committee of the Board Clinical Governance Committee Integrated Quality and Safety Committee; IQS Department (Patient and Staff Safety Model) Directorate Model of Care; 7 Directorates Local Directorate Clinical Governance Committee Falls Group SCA stats in 2012 for a 5 year period indicated that we were in the median range for the number of adverse clinical events reported per bed day with our Peer Group (hospitals that has a similar number of beds)

Where to start ???

Find a few friends !!

Who did we need around the table ? Falls Group Who did we need around the table ? Nursing Representation Medical Representation Health & Social Care Representation Integrated Quality & Safety Representation Any others ??

Falls Group Terms of Reference Background Purpose Roles and Responsibilities Objectives and work plan Reporting relationships/Governance arrangements

Knowing how we are doing !

Clinical Audit – Hospital Wide Methodology Audit tool Timeframe Audit Report

Study the results – What is the data telling us ?

42% of Falls Risk Assessments were completed for patients aged 65 years or older on admission

Opportunity for Improvement Review current policy - Review evidence Draft policy Consultation Agree final draft

Inpatient Falls Prevention Policy Framework Falls Risk Assessment Risk Of Falling Care Plan Patient/Family/Carer Information Leaflet SOP for the use of bedrails Post Fall Management Pathway

STRATIFY Falls Risk Assessment STRATIFY is a risk assessment tool developed to predict patients at high risk of falling with clinically useful sensitivity and specificity.

Risk of Falling Care Plan Care Plan designed by the group Individualised for each patient Documented date of assessment and reassessment Prompted alerting medical team of risk Referral to HSCP Identify the necessary interventions to be undertaken to ensure risk reduction.

Trying to make things better!!!

QI Methodology PDSA Cycle Act Plan Study Do Carry out the plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) What changes are to be made? Next cycle? Study Do Complete the analysis of the data Compare data to predictions Summarize what was learned Carry out the plan Document problems and unexpected observations Begin analysis of the data Model For Improvement

Patient/Family/Carer Information leaflet

Bed rails NOT recommended Use of Bedrails MENTAL STATE A) IMMOBILE Patient is immobile (bed fast or hoist dependant) B) LIMITED MOBILITY Requires some assistance i.e. 1-2 people and mobility aid C) INDEPENDENT Patient can mobilise without help from staff 1)AGITATED/CONFUSED OR UNPREDICTABLE BE HAVIOUR Use Bedrails with care Bed rails NOT recommended 2) DISORIENTATION E.G FLUCTUATING CONSCIOUS LEVELS Bedrails may be used 3) ORIENTATED, ALERT AND ABLE TO SUMMON ASSISTANCE IF REQUIRED 4) PATIENT IS UNCONCIOUS Ref : National Patient Safety Association (NPSA)

Post Fall Management

Inpatient Falls Prevention Policy New policy agreed at Falls Group Ratified by the Senior Management Team Upload onto Q Pulse

Implementation Plan

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Education Who ? What ? When ? How ? Where ?

Inpatient Falls Prevention Policy Implementation Plan - Communication 3000 staff !! Over 25 ward areas!!! 2 sites !!!! 800+ patients!!!

Inpatient Falls Prevention Policy Implementation Plan - Communication Ward walk around Visibility of Falls Group Meet with key staff Circulate information Receive feedback on opportunities/challenges Learning

Inpatient Falls Prevention Policy Implementation Plan - Communication Awareness Campaign Screensavers Posters Stand outside Staff Restaurant/Quiz - Prizes Newsletter Intranet News and Announcements

Monitoring & Evaluation Quality Care-Metrics measure of the quality of nursing and midwifery clinical care processes aligned to evidenced based standards.

Monitoring & Evaluation 87% 2015 2013 42% Falls Risk Assessments

Next Steps …….. Review Current Policy !! Learning Quality Improvement Methodology Collaboration