Transcript Alberta Health ServicesContinuing Care ServicesHome Care

Rapid Fire Team Presentation
Edmonton Home Care
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Who We Are
Alberta Health Services
Continuing Care Services
Home Care, Geriatric Consult Team
Edmonton, Alberta, Canada
• 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
www.saferhealthcarenow.ca
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)
www.saferhealthcarenow.ca
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
Sandy MacLean, OT
Kelly Frazer, TA
Sharon Storey, RN
Susan Haggerty, Pharmacist
Joshua Running, NP
Amarjit Mann, PT
Sharon Weleschuk, OT
Richard Flierl, TA
Winona Mondor, RN
Lesley MacGregor, NP
Laura Murray, Recreation Therapist
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Changes tested to date
Changes Implemented
Result
Facilitators/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
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Changes tested to date
Changes Implemented
Result
Facilitators/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
www.saferhealthcarenow.ca
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 Injury
30%
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%
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Study Population
Client Group
Home Living clients referred by Case Managers to
Geriatric Consult Team
Study Period
September 1, 2011 to January 31, 2012
Clients assessed and
admitted to Geriatric
Consult Team
43
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Study Results
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Study Results
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Study Results
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Factors Affecting Monthly Data
• 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
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Ensuring Quality Data
• 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
www.saferhealthcarenow.ca
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 29. 2012
• 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
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Plan, Do, Study, Act (PDSA) Cycle
• 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
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Sustaining Falls Improvement: Barriers
•
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
www.saferhealthcarenow.ca
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
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Sustaining Falls Improvement: Moving Forward
•
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
www.saferhealthcarenow.ca
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
www.saferhealthcarenow.ca
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
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
6 Month Post FFLS Sustainability Plans for Falls Improvement
Goal Description
Action
Person Responsible
Metrics
Targeted Completion
100% of clients will
have falls screening
completed on intake to
Home Care
100% of Home Care
clients will have falls risk
screening by Case
Manager on initial
assessment
Implement organizationwide Standards of Care
for falls
Develop Standard of
Care for referral to
Geriatric Consult Team
based on risk
stratification
3 falls screening
questions
Community Care Access
Monitor completion of
screening through
chart audits
Annual process
evaluation
Completion of FROPCOM in Meditech
Home Living Case
Managers
Meditech chart audits
Annual process
evaluation
Compile data based on
pilot project to develop
Standards of Care
Determine criteria for
high-risk clients that will
indicate referral to
Geriatric Consult Team;
establish process for
screening and
assessment
Falls Risk Management
Implementation and
Evaluation Committee
Geriatric Consult Team,
Falls Risk Management
Implementation and
Evaluation Committee,
Program Support
Manager
TBD
April 2012
TBD
Fall 2012
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
6 Month Post FFLS Sustainability Plans for Falls Improvement
Goal Description
Action
Person Responsible
Metrics
Targeted Completion
Geriatric Consult Team
to determine effective
falls assessment tool
100% of clients will be
screened for falls risk by
Geriatric Consult Team
on initial assessment
100% of Geriatric
Consult Team clients will
have falls prevention/
injury reduction plans
Reliably record falls of
Geriatric Consult Team
clients
Review assessments
available in Meditech
Geriatric Consult Team
and Meditech support
personnel
Geriatric Consult Team
Qualitative review by
Geriatric Consult Team
April 2012
Meditech and chart
audits
Quarterly data
collection; annual
process evaluation
Establish plans when
creating problem list
based on assessment
Geriatric Consult Team
Meditech and chart
audits
Quarterly data
collection; annual
process evaluation
Establish tracking form
for Geriatric Consult
Team clients re: falls
Geriatric Consult Team
Database to monitor
frequency of falls postassessment
April 2012; quarterly
data collection
Repeat 3 falls screening
questions and
administer SPLATT
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Contact Information
Deb Payne, MScHP
Manager, Quality Initiatives and Program Support
Phone: (780)-735-3354
Email: [email protected]
Jennifer Russill, BScPT
Physical Therapist, Geriatric Consult Team
Phone: (780)-408-5973
Email:[email protected]
www.saferhealthcarenow.ca