Transcript Deer Lodge Centre - Communities of Practice

Name of Presenters: Daryl Dyck & Tracy Thiele
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Falls Facilitated Learning Series
Who We Are
Deer Lodge Centre (DLC)
Winnipeg, MB
Number of Patients/Residents/Clients:
431 bed hybrid facility
235 PCH beds (155 Veteran beds, 80 General Public)
130 Chronic/Extended Care beds
66 Rehabilitation and Assessment beds
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Falls Facilitated Learning Series
Aim:
To secure a solidly established base of understanding
regarding the benefits of hourly rounding.
Goal:
To integrate hourly rounding as a tool for staff members to utilize and initiate
on any patient/resident that they believe will benefit  especially those
deemed at high risk for falls.
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Falls Facilitated Learning Series
Team Members
Team Members: Lynda Hermanson (Health Information Analyst), Carly Erenberg
(PT), Daryl Dyck (CNS), Dennis St. Laurent (Manger of Patient Care L2), Diane
Rawluk (OT), Michele Klassen (Manager of Patient Care T7), Rod Kebicz (CNS)
Team Lead: Tracy Thiele, Project Coordinator
Team Sponsors and Supporters: Sylvia Ptashnik (Director of Resident Care),
Jo-Anne Lapointe McKenzie (CNO), Carol Anderson (Clinical Educator)
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Falls Facilitated Learning Series
Falls Change Ideas Incorporated to Date
DLC Falls Management Policies and Protocols (since 2008)
• Routine Practice for Falls (everyone considered at risk)
• Assessment of Risk Tool (completed within 48 hours of admission)
• Fall Management Policies
• Falls Clinical Practice Guidelines
• Falls Program and Equipment Algorithms
• Mandatory education for all nursing staff
• Quarterly feedback of fall rates provided to Nursing Units
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Falls Facilitated Learning Series
Total Falls per Year
PCH, Chronic Care, and A&R
2500
Total Falls
2000
1500
2193
2145
1923
2042
1696
1576
1000
500
0
2005
2006
2007
2008
2009
2010
Year
Data Source: Occurrence Reporting System
Data Excludes: Near Misses
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Falls Facilitated Learning Series
FALLS PROTOCOL ALGORITHM
Patient / Resident admitted to DLC (Rehab / Chronic Care / PCH)

Routine Practice for Falls Prevention





F amily to provide fall history
A ssessment of needs and abilities
L ook at environment / hazards
L ying/standing BP
S how surroundings and orientate
Falls Risk Assessment Tool (FRAT) is administered
(On admission)
Low / Medium Risk
High Risk
(Note as Focus problem)
Provide High Risk Decal
If resident falls after admission =
HIGH RISK
(Re-do FRAT)
Consult:
Physician – prior & new medical problems, medications, orthostatic hypotension
Physiotherapy – mobility / gait aids / transfers
Occupational Therapy – equipment / wheelchair
Pharmacy - medication review
Nutrition services – nutrition / hydration
Consider:
 Falls Equipment (refer to Falls Equipment Selection Algorithm – Form #
 Hourly Rounding
)
Refer to Falls Assessment and Management Clinical Practice Guidelines.
Interventions / Care Plan should address Risk Factors identified on FRAT Tool
(CNS available to assist in care planning and to follow-up if Critical Incident)
Review Interventions/Care Plan at Post Admission Conference
and Quarterly at Inter-Disciplinary Team meetings
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Falls Facilitated Learning Series
Hourly Rounding Check
Comfort
Observations:
Does the resident look comfortable? Call light within reach? Clear pathway to bathroom?
Toileting
Observations:
Does their brief/incontinent product need changing?
Positioning
Observations:
Are their feet out of bed; does it look like they are trying to get up?
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Falls Facilitated Learning Series
Challenges to Sustaining Falls Improvement
• Barriers:
• Staff buy-in
• Recording Sheet
• Results
• Facilitators:
• A dedicated project lead
• Benefits of preventing a fall
• Managers/champions/unit staff committed to project
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Falls Facilitated Learning Series
Feedback
“It hasn’t increased our workload because we do this anyway.”
“Some changes need to be done related to the sheet we sign on – we need
somewhere for it to say we are charting more on the progress notes.”
“It is important for the nurses to communicate to the aides that the person is on
hourly rounding – otherwise we might not know – especially floats.”
“It is definitely beneficial as a tool to help with falls.”
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Falls Facilitated Learning Series
Lessons Learned
Advise:
• Start slow and work out the kinks before trying to expand.
• Don’t get discouraged when you don’t see immediate results.
• Conduct ‘Progress Checks’ on the program and address concerns early.
• Getting staff ‘buy-in’ requires them to feel involved in the process.
• Provide positive feedback and reinforcement in different ways.
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Falls Facilitated Learning Series
Sustainability Plans
•Celebrate successes, reinforce positives back to staff
•Advertise what we are doing
•Create ownership by including staff in problem
solving techniques (staff input survey, informal and
formal progress checks)
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Falls Facilitated Learning Series
Moving Forward
• Incorporate hourly rounding onto one or two more units
• Ultimately  Centre wide education and
implementation for high risk patients/residents
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Falls Facilitated Learning Series
Contact Information
Name: Tracy Thiele, Project Coordinator
Email: [email protected]
Phone Number:1-204-831-3492
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