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IMPROVING DEMENTIA CARE - FALLS PREVENTION Julie Vale 26th January 2010

The Numbers. 200,000 falls per year in acute, community and mental health units (NPSA, 2007)Nationwide 500 people suffer a

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IMPROVING DEMENTIA CARE - FALLS PREVENTION Julie Vale 26th January 2010

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    1. IMPROVING DEMENTIA CARE - FALLS PREVENTION Julie Vale 26th January 2010

    2. The Numbers 200,000 falls per year in acute, community and mental health units (NPSA, 2007) Nationwide 500 people suffer a # hip following a fall in hospital R,D&E = 1,821 falls in 2009 Average of 152/month

    3. The R,D&E story Two fatalities Jan – Mar 08 One pt fell 15-20 times – no action taken One pt fell twice in the same night over bedrails Both patients had cognitive impairment Culture of normalisation to falls across the trust and division

    4. Assessment. On admission – within 24 hours After any ward moves. After any change in condition – e.g. patient becomes unwell or has a fall. Routinely on a weekly basis moving to every 72 hours Top tip: Beware underscoring

    5. Risk planning. Cohort at-risk patients. Bed position – visible and low. Footwear. No bed rails. Refer to OT and Physio – for falls assessment and planning. Keep area clean and tidy – remove obstacles. No commodes left by bed. Communication to team – highlighting risk. Document all actions and processes followed.

    6. Leadership intervention – test of change re development of falls checklist/bundle Targeted formal falls education Intentional round every hour for patients with falls risk score >20 Checklist with key quality questions Verbal feedback from staff, patients and carers Positive results with decrease in falls across directorate and Trust

    7. “Hourly rounding” is an evidence-based practice where nurses and other care staff work together to check in on patients each hour and carry out specific tasks during those visits. “For years, nurses have been taught to check on their patients on a regular basis, but the difference between checking and hourly rounding is we are very intentional about the questions we ask and the specific things we check During hourly rounding, staff members ask patients about their pain level, make sure they are comfortable in their position in bed and see if they need to get up and use the bathroom. Not only does this result in increased patient satisfaction, but more importantly it results in reduced falls in the hospital setting. “One of the things that interested us the most about hourly rounding is the effect on patient safety It has so many side benefits, but the main focus for us is patient safety.” An integral part of hourly rounding is something called “environmental rounding. This includes checking to make sure that everything is within reach – the tissue box, the telephone, drinking water, any reading material the patient may be looking at, etc. If a patient has everything in reach, they are less likely to get out of bed to get something and therefore less likely to fall. “Call lights are very important and we want patients to use them when necessary, studies have shown that when patients know and trust that a nurse will be checking in on them in an hour, they will save their concerns and needs for that time.” “The big thing with this is building trust, communication and consistency – it is important for the patients to know that all their nurses will be doing hourly rounding and that the routine doesn’t change just because there is a shift change,” she said. “As a patient, it is so reassuring to know when the nurse is coming back. Initially this feels like an added task for the nurses, but what happens is there are fewer call bells to answer and it actually saves the nurses time. To prepare for the hourly rounding implementation, nurses and other staff participated in training that was focused on teaching specific behaviours such as asking very exact questions rather than “do you need anything?” Hospital leadership is also making a commitment to this initiative, Swan said. “When hourly rounding is done, staff will mark it on a log to show that it has been done. Managers will be rounding on patients at least once during their stay to assess how well the hourly rounding is meeting the patient’s needs and what the patient’s experience has been.” “Hourly rounding” is an evidence-based practice where nurses and other care staff work together to check in on patients each hour and carry out specific tasks during those visits. “For years, nurses have been taught to check on their patients on a regular basis, but the difference between checking and hourly rounding is we are very intentional about the questions we ask and the specific things we check During hourly rounding, staff members ask patients about their pain level, make sure they are comfortable in their position in bed and see if they need to get up and use the bathroom. Not only does this result in increased patient satisfaction, but more importantly it results in reduced falls in the hospital setting. “One of the things that interested us the most about hourly rounding is the effect on patient safety It has so many side benefits, but the main focus for us is patient safety.” An integral part of hourly rounding is something called “environmental rounding. This includes checking to make sure that everything is within reach – the tissue box, the telephone, drinking water, any reading material the patient may be looking at, etc. If a patient has everything in reach, they are less likely to get out of bed to get something and therefore less likely to fall. “Call lights are very important and we want patients to use them when necessary, studies have shown that when patients know and trust that a nurse will be checking in on them in an hour, they will save their concerns and needs for that time.” “The big thing with this is building trust, communication and consistency – it is important for the patients to know that all their nurses will be doing hourly rounding and that the routine doesn’t change just because there is a shift change,” she said. “As a patient, it is so reassuring to know when the nurse is coming back. Initially this feels like an added task for the nurses, but what happens is there are fewer call bells to answer and it actually saves the nurses time. To prepare for the hourly rounding implementation, nurses and other staff participated in training that was focused on teaching specific behaviours such as asking very exact questions rather than “do you need anything?” Hospital leadership is also making a commitment to this initiative, Swan said. “When hourly rounding is done, staff will mark it on a log to show that it has been done. Managers will be rounding on patients at least once during their stay to assess how well the hourly rounding is meeting the patient’s needs and what the patient’s experience has been.”

    8. Principles and Lessons Learned Round >20 or if any degree of cognitive impairment/confusion All questions need to be asked in order Patients need to be rounded every hour over 24 hour period If patient asleep over night, when they wake, restart the clock Don’t stop if they haven’t fallen! Draft training package and targeted education vital for success Its more than managing the falls risk … patients feel cared for Build in audit cycle for sustainability Clinical champions Be relentless in approach

    10. Results

    11. Kenn Ward – Slips, trips and falls

    12. Very High Risk Some patients risk cannot be adequately reduced despite all of the above actions. Risk assess and document any actions. Alert your Matron and Senior Matron if patients remain at very high risk. Consider 1:1 special Consider using hip protectors Reassess and document change on a daily basis.

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