13 July 2012
A simple sticker that costs only a few cents to print is helping the team at Waitemata DHB in their mission to stop vulnerable inpatients from having falls.
The sticker is placed on the charts of inpatients following a fall to assist the multi-disciplinary team in providing appropriate input as well as to highlight the fact that they are at-risk of injury from further falls.
This allows nursing and allied health teams to be mindful of the patient’s status and to ‘wrap’ individual care packages around them that will help prevent further falls and minimise harm in the event that a second fall does occur.
The sticker strategy is one of many initiatives Waitemata DHB is employing to reduce falls among inpatients.
The idea came about during a discussion among a multi-disciplinary team about how to better protect patients who are vulnerable to injuries from falls.
It involves borrowing and adapting the sticker concept from the DHB’s existing NEWS (North Shore Early Warning System) Score risk trigger system.
“The big advantage of this sticker is that it makes falls transparent – and that, hopefully, will make the process of supporting the patient more coherent,” said Andrew Jones, Professional Leader of Physiotherapy.
“Often, a fall is a flag something else is going on with the patient.
“Tools such as the chart sticker are helping us to ask the right questions, so we can tease the issues out and wrap the right services around the patient.
“One of the things about falls is that sometimes they happen and people don’t necessarily know they have happened.
“From a physiotherapy point of view, if we don’t know what has happened, it is difficult for us to get involved in a timely way.
“Often, when nurses write their notes, a fall can appear as a one-liner in a large document and the fact a patient has had a fall doesn’t necessarily stand out.
“We need to make falls obvious (to staff providing care) and the sticker system is an effective way of doing that.”
The roll-out of the chart sticker system began in March and, although it is too early for data showing a meaningful improvement in fall rates, anecdotal evidence is favourable.
“The early feedback from nursing staff is that the sticker is easy to use and, from an allied health point of view, the issues that need to be flagged-up are being flagged-up,” Andrew said.
This is considered as particularly significant by allied health staff as they tend to have a degree of transience across hospital services and don’t have the same intimate knowledge of patients that ward-based nurses tend to.
Waitemata DHB has taken the view that a long-term approach to falls reduction is required as a series of ‘quick-fixes’ will not change the internal culture and will not result in better or more timely care.
“It’s about making falls a live, ongoing issue so there is not just a short-term burst of energy and then a drift back to former practice,” Andrew said.
“All the evidence says you can’t ‘do’ falls in a burst; you have to keep chipping away and consolidating over time to bring about a meaningful reduction.
“It has to be part of an overall strategy to raise staff awareness and to increase activity on the preventative side of the ledger.
“We know that patients who fall more than once are at greater risk of severe harm, so, by highlighting the first fall, we are more able to do all we can to prevent further occurrences.”