Rapid Fire Team Presentation Edmonton Home Care

Falls Facilitated Learning Series Alberta Health Services Continuing Care Services Home Care, Geriatric Consult Team Edmonton, Alberta, Canada Who We Are Home Living Program consists of Home Care, Day Programs, and several specialty programs Home Living serves 32,725 unique clients annually in Edmonton Zone Geriatric Consult Team was created in August, 2011, in part to provide assessment and treatment of clients who have a risk or history of falls 64 clients have been served as of February 29, 2012

Falls Facilitated Learning Series Objective of Learning Series Think critically about how the Geriatric Consult Team will achieve improvement in falls screening, falls prevention, and injury reduction Learn strategies of sustainability and integrate into falls improvement plans within overall Home Living Falls Risk Management Strategy Develop skills to sustain practice change for prevention of falls and injury reduction Actively participate in data submission to SHN Falls Intervention and network with other teams in the national Falls Facilitated Learning Series (FFLS)

Falls Facilitated Learning Series Working Team Team Lead: Deb Payne, Manager, Quality Initiatives and Program Support Team Sponsor: Dennie Hycha, Director, Home Living Team Members: Shelley MacGregor, Area Manager, Geriatric Consult Team Erin Meikle, Professional Practice Leader, PT, Home Living Jennifer Russill, PT Amarjit Mann, PT Sandy MacLean, OT Sharon Weleschuk, OT Kelly Frazer, TA Richard Flierl, TA Sharon Storey, RN Winona Mondor, RN Susan Haggerty, Pharmacist Lesley MacGregor, NP Joshua Running, NP Laura Murray, Recreation Therapist

Falls Facilitated Learning Series Changes tested to date Changes ImplementedResultFacilitators/Barriers Community Care Access (CCA) completes 3 screening questions on intake to Home Living Have you fallen in the past 90 days? If so, how many times? Does fear of falling limit your activities? 94% of clients referred had falls screening on intake. Facilitators: Script is provided to all CCA staff – approach is standardized CCA staff were early adopters of Home Care Falls Strategy Barriers: None Falls screening by Home Living Case Manager Partially working.Facilitators: Falls Strategy is now a provincial initiative Strong leadership locally and provincially Completion of Phase I resulted in creation of Geriatric Consult Team, moving more to client focus Barriers: Organization-wide transition from paper to electronic documentation system (Meditech) High workload of Case Managers

Falls Facilitated Learning Series Changes tested to date Changes ImplementedResultFacilitators/Barriers Geriatric Consult Team Assessment Tool including SPLATT SPLATT questionnaire provides details about circumstances around fall (Symptoms, Previous falls, Location, Activity, Time, and Trauma) Partially working.Facilitators: Ease of administration of SPLATT Background knowledge of Phase I to guide team Knowledge and support from Falls Risk Management Implementation and Evaluation Committee Standard of Care for client falls is currently being piloted Barriers: Evolving processes for Geriatric Consult Team to assess falls or falls risk once screening is positive; awaiting Standard of Care

Falls Facilitated Learning Series Baseline Measures A chart review of Geriatric Consult Team clients was conducted in September, 2011 Geriatric Consult Team adopted FFLS goals for study period Actual Goal from Team Charter Percentage of Falls Causing Injury30% 24% (reduce by 20%) Percentage of Clients with Complete Falls Risk Screening on Admission 90%100% Percentage with Documented Falls Prevention/Injury Reduction Plan 70%100%

Falls Facilitated Learning Series Client Group Home Living clients referred by Case Managers to Geriatric Consult Team Study PeriodSeptember 1, 2011 to January 31, 2012 Clients assessed and admitted to Geriatric Consult Team 43 Study Population

Falls Facilitated Learning Series Study Results

Falls Facilitated Learning Series Study Results

Falls Facilitated Learning Series Study Results

Falls Facilitated Learning Series Clients referred to Geriatric Consult Team are often already experiencing falls or have a significant risk of falls Geriatric Consult Team has no influence over the number of clients who have experienced a fall causing injury on admission to the team Assessments may be delayed due to: Client availability Team availability Increase referrals to Geriatric Consult Team Monthly reporting does not provide trend data, only episodic data Factors Affecting Monthly Data

Falls Facilitated Learning Series Continue to visit new clients as soon as possible and include falls screening on initial visit Aim to complete documentation about falls history and risks in a timely manner Review reporting periods to mitigate effect of delayed assessment Identify cases where external factors delayed falls screening Periodic review with Geriatric Consult Team and peers to discuss processes to work towards relevant data collection and best practice Create standardized template and database for reporting of Geriatric Consult Team clients’ falls Ensuring Quality Data

Falls Facilitated Learning Series Geriatric Consult Team Feedback: Falls 18 out of 64 clients have experienced a fall while under the care of Geriatric Consult Team from inception to February Geriatric Consult Team is aware of the need to collect data about number and circumstances of falls in addition to Home Living falls reporting system Family members and Home Care Case Managers report high satisfaction with Geriatric Consult Team’s interventions Geriatric Consult Team members appreciate the benefit of an interdisciplinary approach to falls

Falls Facilitated Learning Series Geriatric Consult Team evaluated its current comprehensive initial assessment tool to determine its usefulness in falls screening and evaluation PDSA cycle determined that the assessment tool in combination with the screening questions and SPLATT was an adequate screening tool, but additional targeted assessments should be explored for further evaluation of falls and falls risk Geriatric Consult Team is exploring documents available in Meditech to assist in interdisciplinary assessment of falls Geriatric Consult Team is working in collaboration with Falls Risk Management Implementation and Evaluation Team to standardize interventions for clients at low and high risk for falls Plan, Do, Study, Act (PDSA) Cycle

Falls Facilitated Learning Series Competing priorities in Alberta Health Services Geriatric Consult Team is a new entity, therefore, its processes and assessment forms are evolving Uncertainty amongst Geriatric Consult Team members as to how to proceed following falls screening Sustaining Falls Improvement: Barriers

Falls Facilitated Learning Series Sustaining Falls Improvement: Facilitators Strong support of Alberta Health Services, Senior Management, and Falls Risk Management Implementation and Evaluation Committee Involvement with Canadian Falls Prevention Curriculum has provided Canadian content and is evidence informed Geriatric Consult Team is a small, interdisciplinary group of experienced professionals who can directly impact the multifactorial reasons clients fall Geriatric Consult Team has the opportunity to create new processes without the change management challenges that occur in a larger organization

Falls Facilitated Learning Series Ensure timely assessment of clients, completeness of falls screening and appropriate, interdisciplinary evaluation of falls Fully implement Standard of Care for falls Determine an evaluation tool for Geriatric Consult Team clients who acknowledge a history of falls Develop database and tracking form for Geriatric Consult Team to record clients’ falls Collaboration with Falls Risk Management Implementation and Evaluation Committee Sustaining Falls Improvement: Moving Forward

Falls Facilitated Learning Series Sustaining Falls Improvement: Key Insights FFLS was beneficial in initiating discussion on a Standard of Care for falls Participating in FFLS has reinforced that falls are a universal problem and Geriatric Consult Team has benefitted from other teams’ knowledge Process needs to be straightforward and implemented by all team members Initial Geriatric Consult Team’s success is facilitated by team members visiting clients frequently and responding in a timely manner FFLS process has provided insight into Geriatric Consult Team’s role in Home Care at large

Falls Facilitated Learning Series Sustaining Falls Improvement: Advice to Teams Keep working team small Focus on one problem at a time Align with larger organizational goals and find supportive leaders in management Learn from other teams’ success and challenges

Falls Facilitated Learning Series 6 Month Post FFLS Sustainability Plans for Falls Improvement Goal DescriptionAction Person Responsible Metrics Targeted Completion 100% of clients will have falls screening completed on intake to Home Care 3 falls screening questions Community Care Access Monitor completion of screening through chart audits Annual process evaluation 100% of Home Care clients will have falls risk screening by Case Manager on initial assessment Completion of FROP- COM in Meditech Home Living Case Managers Meditech chart audits Annual process evaluation Implement organization- wide Standards of Care for falls Compile data based on pilot project to develop Standards of Care Falls Risk Management Implementation and Evaluation Committee TBDApril 2012 Develop Standard of Care for referral to Geriatric Consult Team based on risk stratification Determine criteria for high-risk clients that will indicate referral to Geriatric Consult Team; establish process for screening and assessment Geriatric Consult Team, Falls Risk Management Implementation and Evaluation Committee, Program Support Manager TBDFall 2012

Falls Facilitated Learning Series 6 Month Post FFLS Sustainability Plans for Falls Improvement Goal Description ActionPerson ResponsibleMetricsTargeted Completion Geriatric Consult Team to determine effective falls assessment tool Review assessments available in Meditech Geriatric Consult Team and Meditech support personnel Qualitative review by Geriatric Consult Team April % of clients will be screened for falls risk by Geriatric Consult Team on initial assessment Repeat 3 falls screening questions and administer SPLATT Geriatric Consult Team Meditech and chart audits Quarterly data collection; annual process evaluation 100% of Geriatric Consult Team clients will have falls prevention/ injury reduction plans Establish plans when creating problem list based on assessment Geriatric Consult Team Meditech and chart audits Quarterly data collection; annual process evaluation Reliably record falls of Geriatric Consult Team clients Establish tracking form for Geriatric Consult Team clients re: falls Geriatric Consult TeamDatabase to monitor frequency of falls post- assessment April 2012; quarterly data collection

Falls Facilitated Learning Series Deb Payne, MScHP Manager, Quality Initiatives and Program Support Phone: (780) Jennifer Russill, BScPT Physical Therapist, Geriatric Consult Team Phone: (780) Contact Information