10 October 2012
Ward 15 at Whangarei Hospital aims to reduce falls by 20 percent by December 2012. The goal was set after Clinical Nurse Manager Denise Watene and Assistant Clinical Nurse Manager Lisa Cutts attended the First, Do No Harm Learning Session One in June of this year. This Learning Session presented an opportunity to network with others undertaking projects on falls and pressure injuries and to learn what work is currently underway and how this is improving patient outcomes.
“It was fantastic,” said Denise. “We were there with people who wanted to make a difference. Lisa and I manage a ward so we normally spend our time focussing on day-to-day things that keep the ward running. The Session triggered ideas and sparked energy about how we could do things better.”
In the year ended July 2012, 181 falls were recorded at Whangarei Hospital. Thirty-four of these were on Ward 15, which houses the Assessment, Treatment and Rehabilitation Unit as well as the Stroke Unit. Ninety-five per cent of mainly older patients in this ward are classified as having a high risk of falling. A Falls Group, established in 2010, had been making some progress and a bundle of interventions to reduce falls, including risk assessment tool and falls management plan, was in place. But, Denise and Lisa knew they could be doing more. They began by surveying everyone on Ward 15 – even the cleaner – about the falls bundle of care in place and how it was being used.
“The results were a real eye-opener to us,” said Denise. “The cleaner had a sound knowledge about falls interventions and it made us realise that the falls bundle had primarily been targeted as a nursing responsibility but what we needed to do was adopt a team approach to reducing patient falls in our area.”
Learning Session One also made the Falls Group more aware about ways that they could improve the use of the falls bundle that they had implemented. They adopted the Plan-Do-Study-Act (PDSA) approach for testing change in the real work setting. This approach involves planning, trying, observing the results and acting on what is learned.
New initiatives that have resulted include:
• Improving use of falls monitors.
• Having staff start earlier in the morning to focus on regular toileting during day and at night.
• Regular walks.
• Review of medications by medical team, with consideration of Vitamin D and Fosamax.
• A focus on footwear, with non-slip socks issued along with supportive footwear.
“We’ve put extra attention to discharge planning and making sure that the patient’s home environment is safe and that their footwear provides good support when mobilising,” says Lisa. “We’ve also lent our falls monitors to residential care facilities and to patients to take home for a short trial to establish whether this assists with patients who may have impulsive tendencies. We do this because we want to make sure patients, once discharged, are moving into environments that meet special needs they may have that increase their risk of falling.”
The staffing model in Ward 15 has also been changed as a result of the increased attention on preventing falls. The group observed that risk of a fall was higher at 6am, when patients were waking and wanting to get up to the toilet. A staff member has been rostered to start at 6am to assist night staff with attending to patients’ needs in a timely manner.
“We have been monitoring the number of days between patient falls for 2012 and have a target of 20 days which we are trying to beat,” says Denise. “We’ve made our measurements highly visible and we talk about our target a lot. Our dedicated noticeboard was a new idea and it’s fully engaged the team. Staff talk about how we are progressing and the number of days that we have had since the last fall. If someone falls we discuss it at our daily morning meetings and examine why it occurred and what we can do to prevent it happening again. It’s this attitude, combined with teamwork and ongoing education that will be instrumental in achieving our goal.”