Transcript 6 P*s: A Fall Prevention Program

6 P’s: A Fall Prevention Program
Colleen Dougan, MSN, RN
The Road to Fall Prevention
• Group convened in 2008 to address fall prevention
and pressure ulcer prevention for inpatients
– Nurses, Nurse Assistants, Clinical Nurse Specialists, Nurse
Managers, Nurse Administrators, Physical Therapist,
Wound Care Specialist, Physician and Quality Specialist
Team Members
•
•
•
•
•
•
•
•
•
•
•
•
•
Wendy Quinn-Scott, RN, Nurse
Administrator
Sue Craft, RN, NM MICU
Colleen Dougan, RN, CNS,
Hematology/ Oncology
Catherine Draus, RN, CNS, Cardiology
Lynne Freimuts, RN, Quality Specialist
Dana Greggs, RN, CNS, Internal
Medicine
Joanne Guanio, RN, NE,
Neurosciences
Catherine Jackman, RN, CNS, MICU
Mary Kravutske, PhD, Nursing
Development
Cathleen McCloskey, RN, NM,
Neurosciences and Neuro ICU
Geri Muller, RN, CNS, DEM
Adele Myszenski, Physical Therapist
Kathy Raniszeski, Respiratory
Therapist
•
•
•
•
•
•
•
•
•
•
•
•
Stephanie Schuldt, RN, CNS, MICU
Christine Seigert, RN, Wound Care
Specialist
Christine Sotto, RN, NE, Cardiology
Cheryl Stone, RN, Nurse
Administrator, Ambulatory
Rebecca White, RN, NM, Internal
Medicine
Sheila Daley, RN, Neurosciences
Rebecca Gregory, RN
Katherine Herrmann, RN, Quality
Specialist
Shereen Patten, RN, NE, ICU
Sonalee Shah, MD
Nicole Sims, NA
Carolyn Taylor, RN, ANM
Getting to the 6 P’s
• Decided that we needed to bundle together
the two issues—fall prevention and pressure
ulcer prevention
• Reviewed literature that detailed other ‘P’
programs
• Added to ‘P’ list from HFH incident reviews
The 6 P’s
•
•
•
•
•
•
Pain
Personal Needs
Pulmonary Hygiene
Position
Possessions
Place
The 6 P’s Program
•
•
•
•
•
Dry erase board for every patient
Fall Risk Sun signage
Switch to yellow arm bands/socks
Patient education brochure
Partners in Patient Care ‘Agreements’
– Fall Prevention
– Pressure Ulcer Prevention
• Medications increasing fall risk identified on MAR
The 6P’s Program cont’d
• Post-fall debriefing
protocol and audit
• Employee Education
– RNs and NAs attended
mandatory classes
including videos with
scripting
– Competency validation at
the bedside
• Monitoring of Incidence,
Compliance and Patient
Satisfaction
HFH Falls/1,000 Patient Days
HFH Total Falls/1,000 Patient Days
6Ps implementation house-wide
Ja
n09
Ap
r- 0
9
Ju
l-0
9
Oc
t- 0
9
Ja
n10
Ap
r- 1
0
Ju
l-1
0
Oc
t- 1
0
Ja
n11
Ap
r- 1
1
Ju
l-1
1
4.50
4.00
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
Falls / 1,000 Pt Days
Monthly Average/1,000 Pt
Days
HFH Falls with Injury/1,000 Patient Days
HFH Falls with Injury/1,000 Patient Days
6Ps implementation house-wide
Ja
n09
Ap
r- 0
9
Ju
l-0
9
Oc
t- 0
9
Ja
n10
Ap
r- 1
0
Ju
l-1
0
Oc
t- 1
0
Ja
n11
Ap
r- 1
1
Ju
l-1
1
1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Falls with Injury per 1,000
days
Monthly Average/1,000 Pt
Days
Hospital Acquired Pressure Ulcers > Stage 1
Percentage of Patients with Hospital Acquired Pressure Ulcers >
Stage 1
6Ps implementation house-wide
Ja
n09
Ap
r- 0
9
Ju
l-0
9
Oc
t- 0
9
Ja
n10
Ap
r- 1
0
Ju
l-1
0
Oc
t- 1
0
Ja
n11
Ap
r- 1
1
Ju
l-1
1
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Percentage of Patients
Monthly Average
Patient Satisfaction:
Noise Level In and Around Room
HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Noise Level In and
Around Room
77.0
76.0
75.0
74.0
73.0
72.0
71.0
70.0
69.0
68.0
67.0
66.0
Noise Level In and Around Room
Quarterly Average
6Ps implementation housewide, higher score = higher
satisfaction
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008
2009
2010
2011
Patient Satisfaction:
Promptness Response to Call
HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Promptness Response to
Call
85.5
85.0
84.5
84.0
Promptness Response to Call
83.5
83.0
82.5
82.0
81.5
Quarterly Average
6Ps implementation housewide, higher score = higher
satisfaction
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008
2009
2010
2011
Patient Satisfaction:
Staff Sensitivity to Inconvenience
HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Staff Sensitivity to
Inconvenience
84.0
83.5
83.0
82.5
Staff Sensitivity to Inconvenience
82.0
Quarterly Average
6Ps implementation
house-wide, higher score
= higher satisfaction
81.5
81.0
80.5
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008
2009
2010
2011
Staff Feedback
• Do you think hourly rounding has:
– Decreased patient falls
• Strongly Agree 19.5%
• Agree 37.9%
• Neutral 25.0%
– Decreased falls with injury
• Strongly Agree 19.7%
• Agree 37.0%
• Neutral 26.1%
– Decreased pressure ulcers
• Strongly Agree 15.4%
• Agree 37.8%
• Neutral 29.3%
• I can incorporate the 6 P’s concepts into my daily practice
– Always 50.7%
– Sometimes 27.8%
– Neutral 15.7%
• Feedback given for dry erase boards
Staff and Customer Feedback
• RN staff were surveyed 1 year after go-live
• Family member reported that she was so
relieved to really know that her mother was
checked on over night
• Patient reported that she felt safer knowing
that someone was checking on her regularly
even if she was asleep
• Some patients are bothered by the frequent
checking
6 P’s Lessons Learned
and Refreshed
• Pilot program in all practice areas
• Adjust for different patient
populations
– ICU
– OB/NICU
• White boards are not a part of
the Medical Record
• Test your materials—dry erase
board
• Engage as many frontline staff as
possible
– Review results frequently
– Listen to feedback carefully
• Maintain momentum
• Share the knowledge
• Some of 6 P’s reworked
• Dry Erase Board modified
• Partners in Patient Care
‘Agreement’ modified
– On every admission
– Includes basic information about
fall and pressure ulcer
prevention and now with
infection prevention measures
• Re-education of the Staff
– Healthstream for RNs and NAs
• Results, 6Ps review, reinforce
content of conversation, less
focus on actual scripting
General Practice Unit Board
Intensive Care Unit Board
Questions?