From the ward to the board approach to reducing falls with major harm

8 April 2013

A focus on patient safety is an ‘every day, every minute’ event throughout Auckland DHB. This focus in combination with a number of changes introduced is having an impact on the number of inpatients who suffer a fall with major harm.

“We have achieved a significant and sustained shift in falls with major harm over a six month period,” says Nurse Director Jane Lees.

“This improvement is a result of developing an understanding of why or how harm was occurring and putting the right interventions in place. An increased awareness of the risk of harm and having patient safety on everyone’s radar has made a shift in the culture and contributed to reducing harm.”

Auckland DHB has implemented a Management Operating System (MOS) which promotes greater visibility, transparency and shared ownership for organisational priorities. Two of the key elements of MOS are creating visibility of the team’s issues, priorities and actions, and holding regular meetings to discuss these.

Wards with a MOS have a daily start up meeting using ‘Cause, Concern and Countermeasures’. The Nurse Director’s wall carries the headline ‘Are we safe today?’, and Auckland City Hospital’s boardroom walls are decorated with the latest patient safety progress.

The initiatives that collectively help to reduce harm from falls include:

  • Intentional rounding, sometimes known as hourly rounding, is a process where nurses spend time with their patients regularly (usually every hour) focussing on four aspects of care: toileting requirements, positioning, pain management and possessions, and always ending their interaction with the sentence “is there anything else I can do for you, I have time”.
  • Patient status boards.
  • Uncluttered bed space, with some wards reserving one side of the patient’s bed for visitors and the other for nurses and their equipment.
  • Developing a better understanding of why nurses leave the patient bedside and how this can be managed so the nurse can spend more time with the patient.
  • Falls information brochures for patients.

“If you put all those together you get results,” says Jane.