Rapid Fire Team Presentation Template

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Falls Facilitated Learning Series

Who We Are

Name of Organization: Rykka Care Centres

Home Names: Anson Place Care Centre, Cooksville Care Centre, Dundurn Place Care Centre, Eatonville Care Centre, Hawthorne Place Care Centre, Orchard Terrace Care Centre and Wellington Park Care Centre Number of Patients/Residents/Clients: 1146 beds providing LTC, Special Programs (Restore/Convalescent) Respite and Short Stay beds www.saferhealthcarenow.ca

Falls Facilitated Learning Series

AIM

From your Team Charter: To learn and integrate strategies into our organization’s Falls Improvement Plans to ensure we increase the likelihood of sustaining change for the prevention of falls and injury reduction while holding the gains over time. We will be active participants in data submission to SHN Falls Intervention and network with other enrolled teams in the National FFLS.

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Falls Facilitated Learning Series

Team Members

Team Roles/Responsibilities: Executive Sponsor: Derrick Hoare – VP Operations Team Lead: Susan Veenstra – Director, Nursing & Wellness Team Members: Debbie Green, Dorie Dulay, Sheila Mathi, Joanne Owasu, Courtney Bailey, Barb Vanmil, Katherine Shaler from RMI/RCC and Diana Gillstrom, Celia Lieu and Nirev Patel from Achieva Health.

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Falls Facilitated Learning Series

Review Falls Change Ideas tested to date in your organization

Changes Implemented within Organization

Reviewed current fall strategies home by home Developed partnership with Achieva Health for PT services Falls Risk Committees started/restarted Data Analysis completed

Working/Not Working

Worked Worked Worked Worked

Facilitators/Barriers identified

Facilitator: as it showed us our limitations Facilitator: pre/post fall outcome measures were obtained for each resident in the FPP Facilitator: Multidisciplinary team participating in each home Facilitator: Pre/post outcome measures obtained for each resident in FPP www.saferhealthcarenow.ca

Falls Facilitated Learning Series

Changes Implemented within Organization

Location and time of Fall Data collected Fall Algorithms Developed Weekly Tracking Tool Implemented Red Flags Checklist for Safe Transfers

Review Falls Change Ideas tested to date in your organization

Communication Plan

Working/Not Working

Worked Working (in progress) Working Working In progress

Facilitators/Barriers identified

Facilitator: allowed for analysis of when falls happen to be graphed Facilitator: Guide for Care Providers Facilitator: Enhances data collection & analysis Facilitator: Info for staff to conduct safe transfers Facilitator: presently working on this as PDSA www.saferhealthcarenow.ca

Falls Facilitated Learning Series

Measures: Fall Risk Algorithm

Low Risk of Falling Medium Risk of Falling High Risk of Falling

Resident Admitted Fall Risk Assessment Completed within 24 hours Good basic nursing care provided

- Bed on lowest setting except when care being provided - Ensure necessary items are within reach - Assess environmental area - Encourage regular toileting Reassessed: quarterly, annually, PRN Refer to members of Falls Team

Additional Strategies to consider:

- Re-orientate confused residents - Assess resident for use of bedrails - Educate residents re safety

Additional Strategies to consider:

- Position resident close to Nurses’ station - Consider using sensor alarms - Consider one-to-one nursing Care Conference to discuss alternatives & create/adjust CP Refer to Falls Team Refer to Falls Team www.saferhealthcarenow.ca

Falls Facilitated Learning Series

Measures: Post Fall Risk Algorithm

Falls Risk Algorithm After A Fall Occurs

After a fall occurs: 1. Always consider “why did this fall happen?” 2. Review the Falls Strategies that were implemented and the resident current fall risk status.

3. Address the resident’s fear of falling again.

4. Implement appropriate new interventions/strategies as per falls team recommendations 5. Report, discuss, document and communicate.

Fall occurred, complete “

Incident Report

” in PCC Did care plan identify resident at High risk for falls?

YES NO

Complete “Fall Risk Assessment” to identify changes in function/status that may have caused the fall and refer to Falls Team Follow HIGH risk guidelines for residents - Follow HIGH Risk guidelines for residents - Document in care plan and PCC - Include additional interventions as appropriate - Continue to monitor for fall risk especially when status has changed - Document in PCC under falls - Include in Care Plan, other interventions as appropriate - Referral to Falls Team

When a resident falls, their fall risk status automatically changes to HIGH

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Falls Facilitated Learning Series

Measures: Weekly Tracking Tool

This tracking Tool is unique to the Responsive Homes and is used to analyze the following information: • • • •

Resident’s Name & Room Number Date, Time, Location Mechanism of Fall: Follow up of Fall

Possible factors that may have contributed to the fall.

: After the PT and RN completed their assessments, what • were the findings?

Recommendations

: Ideas to help prevent the fall from happening again in the future. Should consider both internal and external factors discussed • • above.

To be implemented on… by… Intervention Effectiveness

: needs to be specific and give ownership – Were the recommendations implemented effectively (E) or Ineffective (I). This final column should be filled out one week after the interventions were completed.

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Falls Facilitated Learning Series

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Falls Facilitated Learning Series

Measures: Samples

Time of Fall Location of Fall www.saferhealthcarenow.ca

Falls Facilitated Learning Series

Sample of Meaningful Information that is shared about fall in a simple but effective format

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Falls Facilitated Learning Series

Lessons Learned on Sustaining Falls Improvement Work during Action Period

What advice would you give to other teams?

• Keep it simple • Keep the audience in mind • Expect to meet resistance • Persevere as the residents will be the recipient of better care • We have acknowledged the individuality of each home What are your key insights?

• Encourage family involvement • Continuous education www.saferhealthcarenow.ca

Falls Facilitated Learning Series

Challenges to Sustaining Falls Improvement

• • • • What were some barriers?

Distance between homes Diverse demographics of our resident populations Rolling out Communication Document – electronic or hardcopy • • • Competing interests How do you propose to move forward?

Complete PDSA cycles pertaining to refining communication document with goal to integrate this discussion into daily resident care conversations.

Continue to use In-House Falls Teams to support information and knowledge transfer Allow homes to maintain diversity of approach rural vs. urban www.saferhealthcarenow.ca

Falls Facilitated Learning Series

6 Month Post FFLS Sustainability Plan (continued)

Goal Description ( AIM) 1.

To learn and integrate strategies into our organizations falls improvement Plan Action (What Steps are to be taken to achieve)

1.Implement falls committee review (weekly/bi-weekly/monthly) , which reviews each falls for cause and interventions to prevent recurrent fall 2. Use of weekly tracking documentation tool to track falls, document interventions and Identify responsible person.

3. Review literature for interventions available for reducing falls. Reviewed RNAO Best practice guidelines for prevention of falls, reviewed residents first for interventions to prevent falls, and reviewed the website “fallsinltc” for interventions to prevent falls. Compiled a list of interventions appropriate for home area staff to reference 4. Identification that resident transfer levels may alter throughout the day, so transfer logos to be readily accessible for staff at bedside/point of care.

Timeframe (when to be done by)

Ongoing initiative Ongoing Initiative Ongoing Initiative Ongoing initiative

1.

Ongoing Education of staff on falls prevention program and strategies

1.Education sessions provided to staff on each shift about falls prevention program and strategies to be used within the home. Falls Education binder created to be placed on each home area for staff to reference.

2.Implement the use of a safety checklist that is to be completed 3. Provide ongoing education from RNAO Best Practice Guideline as well as Resident’s First on interventions to reduce falls and Ongoing Initiative completed weekly up to monthly depending on home size.

June 2012 Ongoing

Person Responsible

Falls Prevention Team Home area staff Falls Prevention Committee Lead in conjunction with Staff Educator Audit completion monthly with statistics to Falls Prevention Committee Generate a list of potential interventions available to be used for individual residents to prevent falls. Falls Prevention Committee members Falls Prevention Team in consultation with Staff Educator and Achieva Falls Prevention Team Achieva

Metrics (what is to be monitored to identify achievement

Each resident will have a documented review and statistics will be present to Quality Team for each home Audit monthly to ensure up to date information is at bedside/point of care Document the # of staff educated Set goal of 100% by year end.

Collect checklists monthly and analyze for compliance/issues to be addressed.

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Falls Facilitated Learning Series

6 Month Post FFLS Sustainability Plan (continued)

1.

1.

1.

Identify periods and location of high incidence of falls during 24 hour period Ensuring that every resident has a falls risk assessment completed 1.Use this data to arm staff with information about times and places that residents are at risk.

Use data to advocate for increased staffing during high falls period. 2.Change focus of falls to multidisciplinary in nature and utilize other staff in home to assist during identified high risk fall times (i.e. Activities staff engaging residents with history of falls in activities during high falls time periods – usually pc dinner. Housekeeping staff to monitor residents in their home area with report provided to Charge Nurses

1.All registered staff educated to complete falls risk assessment on admission, readmission, post fall and with a change in health status.

Immediate and ongoing I mmediate and ongoing

Upon resident admission, readmission and after health status change

Medication Review is completed related to high Risk medications Line listing kept on nursing unit of residents who have had a fall.

Pharmacist is to review list and conduct medication review where appropriate.

Attending Physician to review recommendations and adjust resident medication profile accordingly.

Weekly/Monthly as per visit schedule Falls Prevention Committee staff Falls Prevention Team, Multidisciplinary Care Team, Achieva Monitor number of falls at high risk times with goal to reduce during peak fall times, during the time frame when extra activity staff has been added to the unit to engage the residents in activities.

Data to be reported and analyzed by Falls Committee Risk Management tab in PCC generates graphs of each residents falls and this data will be used to trend overall falls stats. Focus to be placed on repeat fallers related to efficacy of interventions.

Registered Nurses and Falls Prevention Committee.

Monthly Audit for compliance using assessment tools and data entered into PCC.

Charge Nurses, Pharmacist and Attending Physicians Falls Prevention Committee Review monthly drug administration statistics received from Pharmacy related to compliance for decrease or eliminating high risk meds.

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Falls Facilitated Learning Series

6 Month Post FFLS Sustainability Plan (continued)

1.

1.

1.

Ensuring that every resident has a falls care plan 1.On admission the admission nurse develops the falls care plan, with interventions based on identified risk. Done within 21 days of admission as per MOH guidelines. 2.With each fall registered staff is to add the date of the fall to the care plan and review the care plan, adding additional interventions as necessary. 3.Education of the registered staff on the importance of falls care planning and expectations 4.Track referrals received by PT versus number of falls recorded.

Also done post fall, readmission from hospital and with a change in condition. Monthly Ongoing Admission Nurse Monitor the number of admissions and the number of falls care plans completed with goal of 100% compliance.

Charge nurse Falls Prevention Team , Achieva Falls Team to audit care plans to record the number of fall dates which are added to the care plan and the number of new interventions added by the registered staff.

Goal set of 100% Risk Management documentation and incident report completion post fall.

Communication of changes in care plan, recent falls to staff

All registered staff re-educated on using the risk management documentation tool Review documentation in PCC to ensure accurate To be communicated to staff at each shift report. With reminders about recent falls, and new falls interventions. Staff are also reminded at each shift report about falls prevention interventions such as alarms, crash mats and restraints. Ongoing Monthly Monthly at Professional Practice meetings

Falls Prevention Team, Staff Educator, Achieva Goal set at 100%

Falls Prevention Team along with Staff Educator DoNPC and/or Falls Prevention Lead Charge nurses, Achieva DoNPC or delegate to audit data entered into PCC Statistics to be reviewed at Falls Prevention Committee.

Focus audits of 24 hour reports are completed to ensure all resident’s specific safety devices are discussed.

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Falls Facilitated Learning Series

Next Steps

What are some things you will be working on in Action Period: • Our goal is to continue to continue to work as a

TEAM

falls.

and decrease • Continue to use a multidisciplinary approach in identifying residents at risk for falls.

• Continue to refine the communication plan acknowledging and allowing for the diversity of approach by each team in the 7 homes •

Achieve Decrease in falls rate by 20% (Benchmark) Presently at 14.4% Decrease

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Falls Facilitated Learning Series

Contact Information

Name: Susan Veenstra Email: [email protected]

Phone Number: 416-479-4345 X 222

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