National Collaborative for the Prevention of Falls in Long-Term Care

1. Edmonton General Continuing Care CentreCovenant Health (Formerly Caritas Health Group) National Collaborative for the Prevention of Falls in Long-Term Care

2. Background • Covenant Health (Caritas Health Group) is a faith based organization with : • two large acute care sites • 150 bed continuing care site under construction (Pineview) • 220 bed continuing care site ( Youville Home, in St. Albert) • Edmonton General Continuing Care Centre (500 Bed Facility) -478 Continuing Care Bed - 22 Palliative Care Hospice Beds - 20 Sub-acute beds

3. Edmonton General Continuing Care Centre • 500 bed facility (previously an acute care facility) - 478 continuing care beds - 22 palliative care hospice beds - 20 sub acute beds

4. Aim • To learn and develop a process for creating an awareness of our residents falling to reduce the incidence of falls, particularly major injuries from falls using a multidisciplinary approach.

5. Goal • Reduce the number of major injuries from falls by 50% and the number of falls by 10% by May 2009 on pilot unit.

6. Team Members

7. Improvement Objectives • Increase staff, family and resident awareness and implement fall prevention strategies • Fall Risk Assessment for every new admission within 24 - 72 hours. • Reduce number of major injury falls by 50% and falls by 10%. • Post fall defining process.

8. Changes Tested • Testing of knowledge re: fall policy and procedure lead to increased need for education • Provide education and retesting lead to increased knowledge • Identification of residents at risk of falling • Interdisciplinary input to identify interventions needed, many in place already; some were added • Accurate recording and communication redundancy ineffective • Selection process of Fall logo intervention increases awareness

9. Results • Tested 13 staff from 6 disciplines • 18% less than predicted knowledge of 75%

10. Lessons Learned • Streamlined reporting process • Effective lines of communications are vital • ID team approach is essential for fall reduction and awareness • Staff enthusiastic with the participation/interactive format • Staff still unsure about what constitutes a restraint and least restraint policy and procedure • Poor understanding of the risk factors involved in a falls risk assessment • Education strategy needs revision to prevent ambiguous results • Staff unaware of definition of a fall • Consistency of staff and team leadership for follow through or fall risk assessment • Regional education sessions required to update, review data with staff and involve in this process

11. Next Steps • Test Post Fall Algorithm • Await regional Fall Continuing Care Committee re: possibilities of implementation of Fall Logo • Retest Modified v. Scott tool • Review fall reporting system • Regular Best Practice Fall Committee Meetings (ID) • Test injury prevention products

12. Results • Knowledge level up 21% to 78% (3% higher than predicted) • Data accumulation difficult (group vs. individual) • Able to identify specific areas lacking

13. Changes Tested • Did staff knowledge increase having the policy and procedure made available and being asked to read? • Get PDJA cycles

14. Complicating Factors PastPresent • No unit RCM-Rotating coverage • Unit LPN went off on WCB ▪Regular PT off due to • Pharmacy shortage left limited disability coverage ▪Inconsistencies & shortage • Improvement team member and of staff data recorder/submitter off and ▪Coordinating with regional unavailable group requires a wait • Improvement team key contact time away for an extended time

15. Expectations • Decrease falls and injuries from falls • Continue education to increase knowledge • Develop and test strategies • Identify high risk fallers • Ensure interventions are in place • Re-evaluate on going strategies • Reduce restraints • Regular unit post fall team meetings • Fall Consult Team implementation and expansion