1. Join the Falls Prevention Virtual Learning Collaborative Falls Virtual Learning Session # 4 & Closing Congress Team Rapid Fire Presentation Template Name of Organization: Annapolis Valley Health Name of Speaker:

2. Location of Facility: Annapolis Valley Health Number and type of Patients/Residents/Clients: 21 medical beds with a mixture of acute patients, and longer term care patients. Our patients are generally geriatric, frail and have complex medical conditions and co-morbidities. Who We Are

3. Team Members Team MemberRole Donna ArsenaultNurse Manager Julie Sutherland-JotchamClinical Resource RN - geriatrics Jodi GoudeyOccupational Therapy Kathie SwindellManager ICU, Medicine Stephanie HarveyManager Surgical Program Tom MacNeilSeniors LINCS AVH (community) Sean SmithData Analyst Jane ThompsonAssistant Manager Ambulatory Care Jenn BestER Manager Karen IlsleyPhysiotherapist Cheryl BoyerPharmacist

4. AIM Reduce incidence of falls (fall rate) by 40% from baseline by March 2011 Reduce injury from falls by 40% from baseline by March 2011 Monitor falls rate per 1000 pt days on the pilot unit

5. Change Ideas List Changes you have tested during Falls VLC PDSA Cycles: Updating mobility logos to reflect patients ability to ambulate/transfer Trialed set of safety interventions/care plan (x2) limited and then an expanded interventions list Education blitz (raising awareness) – correct categorization of falls into the AEMS system to ensure more accurate data collection for analysis (ToW) Audits and posting results for sharing and learning, and compliance

6. Measures 1.% of patients with assessments completed on admission went from 86.2% at baseline (October 2010) to 100% in January 2011; using the Morse Fall Scale. 2.% of patients at risk with care plans documented was 5% at baseline, and has steadily increased to 33.3%. Strategies have been targeted to try to increase this objective. 3. % of falls causing injury for the 4 month period of October 2010 to January 2011 Goal – 40% reduction Total # of falls with injury X 100 = Total number of falls 16 X 100 = 43% reduction 37 4. Monitored fall rate per 1000 pt days ( goal will be a reduction of 40% annually) data for January – Dec 2010 7069 patient days with 55 falls = 10% Will continue to monitor

7. Lessons Learned List any “key” advice or insights you would like to share with other teams? Lessons Learned/Key Insights Documentation continues to be an issue Compliance with completing the MFS is excellent, and there is evidence of care planning to meet identified risk level (but not the consistent documentation) Our patients are frail and elderly and have continued to fall but our incidents of injuries has decreased

8. What are some things you will do to sustain the work on reducing falls and injury from falls and by what date? Next Steps Key Sustainability Steps/Plan:Target Dates Monitoring and education – sharing results Ongoing Sharing information and successes across the district Ongoing Implementation of a pt safety care plan across inpt units Fall 2011

9. Name: Donna Arsenault Julie Sutherland-Jotcham Email: darsenault@avdha.nshealth.cadarsenault@avdha.nshealth.ca jsutherland-jotcham@avdha.nshealth.ca Phone Number: 902-825-6160 Ext 312 902-825-6160 Ext 229 Contact Information