13 December 2012
Presenting at First, Do No Harm’s Falls and Pressure Injuries Collaborative Learning Session 2 on 5 November 2012 was a big moment for Waitemata DHB’s Head of Division Nursing for Medicine and Health of Oder People, Shirley Ross. Shirley is a member of the DHB’s well-established Falls Steering Group which has so far been responsible for introducing 19 improvements focusing on falls prevention. The presentation provided the impetus to pull together an overview of activity to date. It was also an ideal opportunity to showcase the outcomes of their activity, which are beginning to validate the approach and effort put in by the Group and wider team.
Waitemata’s Falls Steering Group, comprised of 20 members from medical, nursing, quality and allied health disciplines, was set up in June 2010. Initial activity involved comprehensive root cause analysis and a substantial literature review. This led to the establishment of multidisciplinary working groups to focus on the following areas:
- repeat fallers group
- visual reminders and communication
- toileting and mobility
- post incident falls review.
Since then numerous interventions have been tested, policies updated, and awareness and prevention strategies put in place in each of the areas.
Key improvements among the 19 introduced include: falls prevention posters and pamphlets, falls alert stickers and magnets, red non-slip socks, floor line beds for use with multi-fallers and patients with delirium, Pyxis alerts for medications that cause drowsiness, and hourly rounding.
“I can honestly confirm that the Plan-Do-Study-Act (PDSA) cycle works,” says Shirley. “We ran regular pilots for two weeks at a time to ensure new strategies were adequately tested and refined.”
The approach has been validated. Since April 2012 falls rates have stabilised and there has been a steady decline in repeat fallers since June 2012.
Shirley says that in addition to the improvement process undertaken there are three other factors that have contributed to the overall improvement in falls reduction.
“Having a large multi-disciplinary team with fortnightly meetings and clear objectives ensures buy-in and motivation across all disciplines. It’s about how engaged the nurse manager is and we have five nurse managers represented on our Steering Group.
“We now have standardised quality boards in every ward and these increase visibility and ownership. Each board is of the same colour, with standardised headings – patient safety, patient experience, staff well-being, and our quality focus. They are a focal point for all staff as well as patients and their families.
“We encourage senior management to visit the wards and on each ward quality board there is somewhere to record their visits. Our Chief Executive is a regular visitor. While there he talks to staff and finds out first hand about barriers to improving patient safety and what needs to be done to make improvements. This not only demonstrates that patient safety is a priority for Waitemata DHB, but helps ensure the necessary resources to make it happen are made available.
“All this activity is reflected in the improved outcomes we are now seeing. However our falls reduction programme is very much work in progress. We are continuing to monitor and pilot several potential initiatives such as the use of red shower curtains, hip protectors, personal monitors and a patient information poster. Staff awareness and education is also a large part of what we are doing.”
Click here to view Shirley’s presentation at Learning Session 2.