Leading the way on falls prevention

10 May 2012
The introduction of a new falls risk assessment tool is part of a package of changes that has seen a sharp decline in patient falls with major harm at Counties Manukau DHB.

Since the Morse tool was introduced under the DHB’s Aiming for Zero Patient Harm campaign in mid-2011, staff have been able to detect and respond to potential falls issues more quickly and effectively.

“Initially, we did see total falls rate numbers increase as the new tool came in but now the number of falls resulting in moderate-to-serious harm is down by approximately 50 per cent,” says Simon Kerr, Clinical Leader of CMDHB’s Falls Prevention Group.

The Morse tool, named after US falls prevention expert Janice Morse, allows a more detailed and patient-specific approach to falls prevention than the tool the DHB was previously using.

Common issues with the old tool included lack of uniform usage and examples of it not being applied appropriately.

“Thresholds were artificially high under the old system but now we see a more accurate assessment of risk and this allows us to use targeted interventions.

“We can never totally remove the risk of patients falling because we want to protect their right to independence but the Morse tool is proving very effective and we would recommend it to other DHBs.

“We’ve seen an increase in falls reporting, a subsequent decrease in the overall falls rate and the rate of patients being harmed in falls has halved.

“We still get the occasional ‘bad’ month but we are now moving into a phase where we are focusing on ensuring patients don’t experience major harm if they do fall.”

This includes the use of non-slip socks, hip protector pads and investigating retro-fitting old hospital buildings with newer equipment such as non-slip, impact-absorbing flooring where this is feasible, cost-effective and doesn’t pose a risk of injury to staff.

Middlemore Hospital’s new Clinical Services Block will have technology built-in to help reduce the risk of harm from major falls.

The Morse risk assessment tool is now part of the orientation process for all new CMDHB nursing staff and this, combined with a proactive training package rollout, has seen a ‘snowball effect’ in terms of acceptance among staff.

The benefits for patients are clear – falls are down to three per 1000 bed days (this has been as high as 3.8) and falls resulting in major harm are down to around 0.08 per 1000 bed days (having been as high as 0.5).

This reflects the success of CMDHB’s well-established internal Aiming for Zero Patient Harm campaign, which has seen a number of significant patient safety advances delivered over the last two years.

The Counties Manukau team is keen for other DHBs to share their learnings and experiences over the patient safety improvement journey to help minimise risks to their own patients.

“It’s worth doing. It’s hard work and it often seems like you’re never going to win,” says Simon Kerr.

“But you have to remember that every improvement is a step in the right direction and it means a lot to patients and their families.

“Don’t be afraid to fail – you have to be prepared to find that not everything you do will work. That’s part of the process.

“Sometimes, the improvements are not immediately apparent, either, but we have found that if you keep working at it, they do happen.

“Staff may be resistant and cynical at times but they will get on board as the social movement gathers momentum.

“It’s all about local ownership and growing the enthusiasm for implementation while giving staff the support and the tools they need to do the job right.”

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