Transcript Insert Session Title

Evercare Quality Improvement Awards
Falls Reduction Program
Susan E. Harris, CRA, ADC, LNHA
Assistant Executive Director
Daughters of Israel
West Orange, New Jersey
Faculty Disclosures:
Ms. Harris has disclosed that
she has no relevant financial
relationship(s).
Learning Objectives
By the end of the session, participants will be able
to:
• Objective 1 Understand the importance of multipronged interventions
• Objective 2 Understand the relationship between falls
patterning and the decrease of falls
• Objective 3 Understand how program model can be
replicated
• Objective 4 Understand how the falls reduction model
can be utilized to affect change in other areas
Facility Demographics
Daughters of Israel
West Orange, New Jersey
• Total # of Beds = 303
– 6 separate nursing units
– Inclusive of Alzheimer’s and End Stage Units
• Type of Ownership = Non-Profit
QI Project
Falls Reduction Program
• Description of Problem- Falls were significantly
higher than others in country, region, state
• Additional compounding problems
– Falls Quality Indicator at 91st Percentile
– Fall Rate = 13.34; Industry standard = *4.16
• Based on historical performance trends
Objective – Develop a Performance Improvement
team to reduce resident falls by 10% annually
*Per study published by L. Rubenstein, et al, in materials distributed by CMS at a QI
training seminar, Baltimore, MD, May 2000
Project Timeline
• Project began – May 1999
– Falls committee met twice weekly, then weekly
– Reported to CQI weekly
– Currently audits reported at CQI
• Planning & Implementation
– Core of program developed over 4 years
– Various components added after that time
When did project end?
– The reduction of falls is an ongoing process
– Monitoring, evaluation and CQI reporting continues
today
QI Planning & Implementation
• Leadership
– Falls Sub-committee of members included staff close
to the problem
Team Work
– Team analyzed falls and determined what could be
done to reduce them
– Data collection tools developed
• Communication
– Project introduced through care plan team meetings;
in-service education
– Results communicated to staff through
• Team meetings
• In-service education
• Posted QI studies
Falls Sub-Committee
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Charge nurse
Floor nurse
Nursing assistants
In-service coordinator
MDS coordinator
Activities staff
Alzheimer’s Unit
Director
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Physical therapist
Social worker
Dietician
Medical Director
Administrator
Quality Assurance
Director
Falls Reduction Program
Issues Encountered
–Tried falling leaf program briefly but
too much was involved
–Tried developing a definition of what
is a fall which didn’t make any
difference in what we were looking
to accomplish
Tools Used to Affect Change
• Computerized falls tracking system to identify
– Unit
– Time of fall
– Ambulatory status
– Use of side rails
– Use of restraining device
– Any injury incurred
– Staff involved
– Shift
Expanded to look at other relationships with falls
Tools Used to Affect Change
• Data on the patterning of falls
• Developed a weighted falls risk assessment – at specific score
CP required
• Policies and Procedures for Falls Reduction Program
• Changed incident report to better collect needed data
– Back page included list of investigation points to cover
– Today divided into 3 columns to improve data collections
and understanding
• Falls Care Plan Book – interventions listed by reason for fall
• Created Falls Tracking System
• Staff Education
• Falls Investigators
• QI audits of falls care plans and changes made to them per fall
• Incentive programs for units with the lowest number of falls
monthly
Facility Expenses
• The cost to us to reduce falls is minimal
• $1500 covered
– educational seminars,
– travel to seminars
• Planning and implementation for all staff
involved approximately 654 hours per year
Resident Outcomes
Prior to Program
Today – 2008
• Falls QI 91st to 95th
• Falls QI 37th
percentile
percentile
• Fall Rate = 13.34
• Fall Rate = 4.16
• Average of 1119 falls • Average of 398 falls
annually
annually
Regulatory Outcomes
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No deficiencies for falls
Surveyors not looking as hard in this area
Falls QI is low
Compliance with regulatory codes has
increased
Improved Quality of Service
Outcomes
• In the first 4 years of this program dropped
our fall rate by 59.2%
• Staff follow-up for care plans and intervention
changes went from 0% accuracy to 95%
accuracy
• Exceeded 10% goal
• Restraint use has not increased
• Fall related fractures has decreased
• Met national benchmark
Enhanced Staff Performance
Outcomes
Improvement on:
• Investigation of falls
• Understanding patterning/causal factors
– Trained to pay attention to observable facts surrounding a fall
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Immediate response to care plan for updates
Understanding when to change or add interventions
Understand importance of immediate intervention
Care Plans no longer state “will not fall” , “Will not have
any injury”
• Retain personhood
• Activities are crucial
• Good communication with families in regard to a fall
Improved Organization,
Management Structure and
Systems Outcomes
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Entire process changed centralized at CQI to decentralized on units
Fall Management is a priority for everyone
Chair and bed alarms are overused or misused – changes in intervention
use
Weekend supervisor now begins investigation at the time the fall occurred
All shifts trained on falls prevention
Nursing assistants held accountable for falls interventions
All CP and CNA CP updated at every fall
Interventions in place earlier at admission, readmission, unit or room
change
Response at one fall or to high risk assessment score
No longer document care plan remains same – change what isn’t working
Starts prior to admission
Tracking system used for falls carried over to skin tears and bruises
Investigation process now used to investigate abuse allegations
Financial Outcomes
• Average hospital charge for fall related injury
$11,800.70 (Nurse Practitioner, March 2002)
• Decreased rate of emergency admissions to
hospital
– Most recent Evercare rate = 77 admissions per 1000
member years; one of lowest in country
• QI New Fractures declined from 67th percentile
in 2002 to 38th percentile in 2007
– Results in less need for post fracture care
Closing Thoughts
• Replication of Model – inexpensive to set up;
easy to implement; mostly requires staff buy in
and understanding that it is a priority for all
• Lessons Learned – It is not any one
intervention that made a difference but instead
the use of a multi-pronged attack of the problem
and using multiple interventions at one time.
• Insights –
– Not all falls can be prevented must also look at
what can be done to minimize severity of injury
• Questions?