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

2. 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

3. 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 times more likely to sustain hip fractures from falls than people years.
Fear of falling, leading to decreased mobility and increased fall risk.

4. 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

5. 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

6. “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

7. 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)

8. 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

9. 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

10. 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

11. 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?

12. Communication

13. Engaging Our Patients

14. 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

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

16. 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

17. Falls Related to Toileting

18. 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

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

20. It’s a Journey…