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IHI ExpeditionProtecting Your Patients from Injurious Falls
Session 3
February 27th, 2013
These presenters have
nothing to disclose
Pat Quigley, PhD,
ARNP, CRRN, FAAN,
FAANP
Kathy Duncan, RN
Expedition Coordinator2
Kayla DeVincentis, CHES, Project Coordinator,
has worked at IHI since 2009, starting as an intern
in the Event Planning department. Since then,
Kayla has contributed to the STAAR Initiative, the
IHI Summer Immersion Program, and the
Expeditions. Kayla obtained her Bachelor’s in
Health Science from Northeastern University and
brings her interest in health education and
wellness to IHI’s Work-Life Wellness Team.
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Expedition Director5
Kathy D. Duncan, RN, Faculty, Institute for Healthcare Improvement (IHI), co-leads IHI's National Learning Network and manages the 24 IHI Improvement Map support care processes. Ms. Duncan also directs IHI Expeditions, manages IHI's work in rural settings, and provides spread expertise to Project JOINTS. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She also served as the content lead for the Campaign's Prevention of Pressure Ulcers and Deployment of Rapid Response Teams areas. She is a member of the Scientific Advisory Board for the AHA NRCPR, NQF's Coordination of Care Advisory Panel, and NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the director of critical care for a large community hospital.
Today’s Agenda6
Introductions
Debrief Session 2 Assignment
Interventions to Reduce Falls
and Falls Harm, Part 1
Homework for Session 4
Optional Office Hours
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Expedition Objectives
At the end of the Expedition each participant will be able to:
Differentiate types of falls as a basis for analysis of program effectiveness
Integrate injury prevention into existing fall prevention programs
Inventory tests of change in fall and injury prevention interventions
Summarize successes ready for adoption and spread
Plan small tests of change they can test throughout the Expedition
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Faculty8
Patricia Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP, Associate Director, VISN 8 Patient Safety Center of Inquiry, is both a Clinical Nurse Specialist and a Nurse Practitioner in Rehabilitation. As Associate Chief of Nursing for Research, she is also a funded researcher with the Research Center of Excellence: Maximizing Rehabilitation Outcomes, jointly funding by HSR&D and RR&D. Her contributions to patient safety, nursing and rehabilitation are evident at a national level – with emphasis on clinical practice innovations designed to promote elders’ independence and safety. She is nationally known for her program of research in patient safety, particularly in fall prevention. The falls program research agenda continues to drive research efforts across health services and rehabilitation researchers.
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Assignments for Today
Did you test?– Test injury risk assessment on admission on 3-5
patients
– Test use of ABCS tool on 3-5 patients
– Test use of visual cues
– Standardize and test risk communication – hand off tool
– Practice Teach Back Strategy on 2-3 patients
Volunteers
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Interventions to Reduce Falls and Falls Harm, Part 1
Special Recognition: Robert Wood Johnson Foundation Funding
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
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Today’s Topics
Assessment of Environments
Use of Equipment (low beds, bed
alarms, floor mats, hip protectors)
Bathroom Safety
Segment Technology/Equipment for
Fall Prevention, Detection, Protection
At the end of this Session
The attendees will be able to:
– Assess the environment for fall hazards
– Identify processes and equipment that prevent, detect and
protect patients from injuries.
– Evaluate the use of the newest devices
– Formulate strategies for implementing technologies and
confirming staff competency
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Environmental Assessment:
Do you need equipment or repairs?
How often?
– Develop a schedule
Who rounds?
Areas of concern?
Safety Huddles during shift change
Environmental Assessment Tool
Room HandRail
secure
Free of clutter
Good Lighting
W/C in good repair
Bed wheels lock
Bed Exit Functioning
Yellow Clip for
Fall Risk, if
applicable
#101
#102
#103
#104
Or any design of your own vs. VISN 8’s Injurious Fall Prevention
Assessment Tool
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Environmental Safety to Reduce Severity of Injury
Hip ProtectorsFloor MatsNon-slip flooringHeight-adjustable bed (in low position, except during transfers)Bed-rail alternatives (body pillows, assist rails)Raised toilet seatsElimination of sharp edgesUse of safe exit side from bed (pt transfer to unaffected side)Use of alarms (bed, w/c)Pt access to mobility aides (walkers, canes) as appropriate
www.visn8.va.gov/patientsafetycenter/fallsTeam/default.asp
Bathroom Safety
Enough Grab Bars? How about folding grab bars?
Elevated Toilet Seats – Yes or No
Toilet Alarms – clips on emergency cords
Non-skid floors with grit or traction kleen
Rubber floor mats – antimicrobial
Padded walls and sharp surfaces?
Motion Sensing Lights
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Make Toilet Safer
Why not this?
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KidCo
KidSafe
Search:
Furniture
Corner
Cushions
Eliminate Sharp Edges
Shower Rooms
Grab Bars
Liquid soap vs. bar soap
Plenty of towels available
Grit on floors vs. floor mats
Shower chairs in working order/wheels lock? Right size?
Does water drain off quickly?
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Rubberized Flooring
Technology and Equipment
ADJUNCT to ASSESSMENT
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Evaluation of Equipment
Patient friendly
Product safety
Quantity and cost
– HOW DO WE PAY FOR THIS?
Staff friendly
– All Services/Departments need to evaluate
Easy to implement and clean
Distribution
How to Implement
Do you have formal and informal support for change? Leaders must lead…
How will the new process or equipment impact the facility?– Get staff feedback and involvement through:
– Plan-Do-Study-Act: Small cycles of change
– Early Adopters can help with assessment phase
Advertise Advertise Advertise– Provide lots of education and handouts
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Lack of Adoption of New Processes/Equipment
Staff education inadequate
Staff turnover
Too complicated
Availability
– Central Supply vs. Unit storage?
Supply?/Repair…battery change
Staff attitudes
– Improves quality of care, decrease costs, reduces
patient pain/suffering
Implementing Change
Determine if this new process or equipment will make
the job easier or less stressful?
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Methods of Education
Staff Meetings – 15 minute show and tell
Process or Equipment Demonstration with return demos or hands on practice – “Skill Fairs”
Develop “How To” Handouts – include repairs
Super Users identified as Trainers
Discussion and Q+A time
Add to New Employee Orientation
Update Unit Handbooks or Facility Web Site
Competencies
Include not only ability of the operator but the SOP for
cleaning.
How will you accomplish this?
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Other Considerations
Keep list/spreadsheet of where products are distributed.
Shift rounds to ensure equipment is “turned on” check for
patient sabotage!
Maintenance and inventory checks -how will that get
done?
Fall Prevention
Assessment
– Universal Fall Precautions
– Care planning – Arm bands
– Signage for high risk for
injury
– Other
– Report/Assignment
sheets/Handoffs
– Intentional Rounds every hour-
– Environmental Rounds as discussed.
– Video Monitoring
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Bundling
Moderate to High Risk –most Vulnerable Fallers
– The right interventions that combine
– Prevention
– Detection
– Protection Items
Fall Detection
Alarms– Chairs
– Pull cord alarms
– Voice activated alarms
– One arm seat belt alarms
– Sensor mats- light weight
– Bed– Pull cord alarms
– Mattress sensor mats– Large
– Small
– Light Weight
– 6 month pads
– Built in bed alarms
- Bathrooms– Call system attachment
Toilet seat alarm
– Clips on Emergency Cords?
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Fall Detection
Floor/Door Alarms� Floor Mat alarms
� Cordless Motion Detecting Beams over bed
� Passive Infrared Alarms on beds
� Pull cord alarm to doors
Wander Detection Devices� Placement
� Wrist/ankle
� Wheelchair
Video Monitoring
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Connecting Patients, Familiesand
Healthcare Providers
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Value PropositionThe product suite offers unique value to care providers and patients
Administration
• Increase patient safety
• Avoid frivolous lawsuits
Nurses
• Monitor multiple patients
• Alert patient movement
Doctors
• View patients remotely
• Provide access to patients
Patients
• Access broadband
Internet from bed
• Enjoy movies and
on demand
Families
• Contact patient
from home
• Foster collective
peace of mind
Patient Service
Products
• Net View™
• Movie View™
• Greetings &
Orientation
• Room Service
• Shopping
• Satisfaction
Surveys
• Education
• PatientView
• BabyVIew
Clinical Products
• NurseView™
• SecureView™
• PhysicianView™
• FacilityView
• EquipmentView™
• Virtual Bed Rails™
• Ulcer Management
• ProcedureView
• Video Bed Board
• Pat Activity Boards
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Virtual Bed Rails
The colors above are designed to measure movement in & out of zones as well as movement within.
The upper portion of the bed is handled different from the bottom. Moving an arm will not trigger and
alarm. Moving a leg out of the bed will.
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If an event happens (fall, near fall, etc) immediately document the occurrence and forward that to a secure location
Fall Management - Record
Fall Management - Investigate
Review Fall Incidents
Were Virtual BedRailsarmed?
Was the fall risk scored correctly?
When did the fall occur?
When was the fall recorded?
How fast did nurses respond?
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Fall Management - Investigate
Review Fall Video
Why did this patient fall?
What could we have done
to prevent this fall?
Was the staff effective in
preventing the fall, or
preventing further injury?
Fall Management - Evaluate
Evaluate Falls by Site and Risk Level
Which units are
experiencing the highest
rate of falls?
Are we using VBR
effectively?
Is our fall risk measurement
effective?
Where do we need to improve?
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Levels of Detection
Ambulatory
– Wander detection devices/Monitors
Partially Ambulatory
– Bed/Chair Alarms/Monitors
Non Ambulatory/Bed rest
– Bed Alarms/Monitors
Fall Protection
Mattresses-beveled edges
Floor mats-size? – Length
– Thickness
– Beveled edges
– Non-slip/Hygienic
– Night time glow strip
Flooring– Color
– Padding
Helmets– Hard
– Soft
– Reusable
– Available for PRN use
Hip pads– Soft pads and hard shell
– External
– Undergarments
– Sweat pants and shorts
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Hip Protectors
Poll Questions
Do you teach patients with osteoporosis or history of hip
fracture about hip protectors?
Do you offer hip protectors to patients?
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Fall Protection continued
� Low Beds
� What is the patient’s
height and right level?
� Wheel chair
� Size/features
� Brake extensions
� Anti -tippers
� Front and
� Back
� Auto Brakes?
– Chairs/cushions’
– Right height
– Right cushion
– Anti slip materials
– Seat lifts
– Toilet Seat elevation/lifts
– Swing Away grab bars
Resources
Alimed Catalog: www.AliMed.com
Care View: www.Care-view.com
Carroll Healthcare Low Beds:
www.carrollhospitalgroup.com
Comfortex Landing Strips: www.comfortex.com
Swing away grab bars: www.Elcoma.com
Hill Rom Low Beds: www.hill-rom.com
Hip Savers: www.hipsaver.com
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Resources
Sammons Preston Catalog: www.pattersonmedical.com
Plum Enterprises Helmets/Hip Pads:
www.FallsSafety.com
Posey: www.posey.com
Satech Floor Mats: www.satechinc.com
Span America: contoured mattresses:
www.spanamerica.com
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Questions?50
Raise your hand
Use the Chat
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Assignments for Session 4
Test one new intervention
Attempt to acquire one new piece of equipment for
integration into your patient care environment
Explore at least 2 patient education resources about new
safety equipment that you just learned about
Assess compliance with injury risk assessment on 3-5
admissions
Volunteers?52
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Expedition Communications
Listserv for session communications:
– To add colleagues, email us at [email protected]
Pose questions, share resources, discuss barriers or
successes
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Next Session
Wednesday, March 13, 1:00 PM – 2:00 PM ET
Session 4 – Interventions to Prevent Falls and Fall Injury Part 2
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Office Hours
All are invited to spend 30 minutes with Pat Quigley for additional Q&A
2:00-2:30 PM ET
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