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Using a Neuroscience Diagnosis as the Patient’s Primary Risk Factor for Falling. Neuroscience Fall Prevention and Safety Performance Improvement Team. Darlene Bailey, PCT Leslie Barna, Manager 2 NE William Benedict, MD Barbara Buturusis, Administrative Director Jose Biller, MD

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slide1

Using a Neuroscience Diagnosis

as the Patient’s Primary Risk Factor for Falling

slide2

Neuroscience Fall Prevention and

Safety Performance Improvement Team

Darlene Bailey, PCT

Leslie Barna, Manager 2 NE

William Benedict, MD

Barbara Buturusis, Administrative Director

Jose Biller, MD

Mary Healey, Manager 2 S/2 Neuro ICU

Meri Hix, PharmD

Corrie Husak, RN

Bresha Mc Clain, RN

Judy Mc Hugh, NQI, Team Leader

Lisa Millsap, APN

Martina Notovny, PharmD

Vikram Prabju, MD

Karen Potoki, APN, Risk Management

Devra Romick, PT

Joanne Scharnak, Nurse Educator, Team Facilitator

Theresa Schwenkel, RN Liaison

Kate Steinhable, Physical Therapy Educator

Azucena Uy, RN

opportunity statement
Opportunity Statement

Reduce inpatient falls on the 2 NE Neuroscience Unit and increase staff knowledge related to patient safety

slide5

Potential Cause of Falls

Environment

People

Documentation

Post Fall Analysis

(1/06)

Age

Education

Flowsheet Fall Section

Incomplete

(7-13-05, 8-10-05)

Admitting Issues

HX of Falls

Not in EPIC

(7-13-05, 8-10-05)

Clutter

Bedroom

Plan of Care

Not Documented

(8-10-05)

Patient

Staff

History Of Falls(7-13-05, 8-10-05)

Over Estimate Strength & Ability

Long Length of Stay

IV Poles

Chairs

Frequent transfers

Inappropriate Adm

Fast Turn-over

Unfamiliar Room

Staff Communication

Lack of Reg Rounds

Not Using Equipment

Fall Risk (8-10-05)

Gait Belt (7-13-05, 8-10-05)

Medications (7-13-05, 8-10-05)

Patient Transfers

Elimination

Medication (7-13-05, 8-10-05)

Cannot reach call light

Call light too complicated

Family assists patient to bathroom

Not Answering Call Lights

Patients At

Risk

For Falls

Patient Decreased Sensorium

Materials

Confusion/Altered

Mental Status

(7-13-05//8-10-05)

Medication

(7-13-05/8-10-05)

Balance

Gait

Postural

Hypotension

Call Light Issues Bed Alarm Door Reminder Risk Levels

Not on

Lost in covers

Not available 7/05

Sedation

Narcotics

Sleepers

Gait Belt

(8-10-05)

Stroke

Don’t Realize They Need Assistance

Sundowner

Weakness

Confidential: For Quality Improvement Purpose Only

slide6

Solutions Implemented

  • Multidisciplinary Staff Education
    • New fall assessment flowsheets
    • Fall extrinsic and intrinsic factors
    • Appropriate Bed Alarm Use
    • Gait belt use and transfer competency
    • Fall risk associated with neurologic impaired patient
    • Monthly fall prevention updates
slide7

Solutions Implemented

  • Neuroscience Safety Awareness Week
    • Falls in the Elderly
    • Is Polypharmacy Causing Acute Confusion
    • Touch Therapy
    • Guided Imagery
    • Gait Belt Use and Transfer Competency
    • Massages for staff
slide8

Designed a Level 3 Fall Prevention Interventions

    • All neuroscience patients are at risk for falls
    • Increased elimination rounds to include mealtime and bedtimes
    • Observe patient activity ever hour or more
    • Implemented Bathroom Buddy- staff stays with patient during elimination
    • Bathroom Buddy- nursing staff stays with patient during elimination
    • Place patient on a BedCheck Classic bed alarm and chair alarm
    • Consult pharmacy regarding medications that can cause altered mental status
    • Repeatedly reinforced limits and safety needs to patient and family
    • Assign bed that enable patient to exit towards stronger side whenever possible and transfer patient toward stronger side.
    • Provide comfort rounds- repositioning, back rub with PM care, assisted ambulation before bedtime.
    • Developed Post Fall Assessment Environment Study
slide9

Neuroscience Safety Awareness

Week of September 26, 2005

Monday, September 26, 2005

Message of Touch Massage & Guided Imagery by Fran Glowinski, MPS, OSS

2 Neuroscience Unit

11:00 to 13:00

18:00 to 20:00

Tuesday, September 27, 2005

Lunch and Learn -Falls in the Elderly by Dr. Jose Biller

Bldg. 105 Maguire, Room 2812.

11:00 12:00

Bed Check Bed Alarm Use Inservice by Bill Saemann,

Macon Company

2 Neuroscience Unit

6:00 to 8:00

10:00 to 11:00

18:00 to 20:00

Wednesday, September 28, 2005

Seated Back Massage by Loyola Health and Fitness Club

2 Neuroscience Unit

6:00 to 7:00

16:00 to 17:00

Posey Restraint Use and Other Restraint Alternatives by Fred Demshar, Posey Company

2 Neuroscience Unit

11:00 to 12:00

14:00 to 15:00

Thursday, September 29, 2005

Lunch and Learn –Healing Touch by Ann O’ Malley , RN., C.H.T.P.,

EMS Bldg. Room 3284

11:00 to 12:00

Bed Check Bed Alarm Use Inservice by Dick Tedesco, Macon Company

2 Neuroscience Unit

6:00 to 8:00

10:00 to 11:00

18:00 to 20:00

Gait Belt Training by Kate Steinhable, PT, MPT.

08:00 to 09:00

Friday, September 30, 2005

Message of Touch & Guided Imagery by Fran Glowinski,MPS, OSS

2 Neuroscience Unit

6:00 to 8:00

Lunch and Learn –Is Polypharmacy Causing Acute Confusion In Your Patient?

by Martina Novotny, Pharm. D

EMS Bldg. Room 3284

11:00 to 12:00

Nursing Performance Improvement Fall Prevention Initiative 2005

slide11

NEXT STEPS

  • Develop monthly education poster series for Medications Contributing to Mental Status Changes
  • Design patient and family safety education to neuroscience population
  • Partner with the Loyola Niehoff School of Nursing to introduce the Neuroscience Level III Fall Prevention Program into student curriculum
  • Integrate fall risk factors and history of fall into the Electronic Medical Record
  • Produce and videotape Lunch and Learn Safety Programs
  • Improve patient care handoff utilizing SBAR Situation, Background, Assessment, and Recommendations