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www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Alberta Health ServicesContinuing Care ServicesHome Care, Geriatric Consult TeamEdmonton, Alberta, Canada
Who We Are
• Home Living Program consists of Home Care, Day Programs, and several specialty programs
• Home Living serves 32,725 unique clients annually in Edmonton Zone
• Geriatric Consult Team was created in August, 2011, in part to provide assessment and treatment of clients who have a risk or history of falls
• 64 clients have been served as of February 29, 2012
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Objective of Learning Series
• Think critically about how the Geriatric Consult Team will achieve improvement in falls screening, falls prevention, and injury reduction
• Learn strategies of sustainability and integrate into falls improvement plans within overall Home Living Falls Risk Management Strategy
• Develop skills to sustain practice change for prevention of falls and injury reduction
• Actively participate in data submission to SHN Falls Intervention and network with other teams in the national Falls Facilitated Learning Series (FFLS)
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Working Team
Team Lead: Deb Payne, Manager, Quality Initiatives and Program Support
Team Sponsor: Dennie Hycha, Director, Home Living
Team Members: Shelley MacGregor, Area Manager, Geriatric Consult Team
Erin Meikle, Professional Practice Leader, PT, Home Living
Jennifer Russill, PT Amarjit Mann, PT
Sandy MacLean, OT Sharon Weleschuk, OT
Kelly Frazer, TA Richard Flierl, TA
Sharon Storey, RN Winona Mondor, RN
Susan Haggerty, Pharmacist Lesley MacGregor, NP
Joshua Running, NP Laura Murray, Recreation Therapist
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Falls Facilitated Learning Series
Changes tested to dateChanges Implemented Result Facilitators/Barriers
Community Care Access (CCA) completes 3 screening questions on intake to Home Living • Have you fallen in the past 90 days?• If so, how many times?• Does fear of falling limit your activities?
94% of clients referred had falls screening on intake.
Facilitators: • Script is provided to all CCA staff –
approach is standardized• CCA staff were early adopters of
Home Care Falls StrategyBarriers:• None
Falls screening by Home Living Case Manager
Partially working. Facilitators: • Falls Strategy is now a provincial
initiative• Strong leadership locally and
provincially• Completion of Phase I resulted in
creation of Geriatric Consult Team, moving more to client focus
Barriers: • Organization-wide transition from
paper to electronic documentation system (Meditech)
• High workload of Case Managers
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Falls Facilitated Learning Series
Changes tested to date
Changes Implemented Result Facilitators/Barriers
Geriatric Consult Team Assessment Tool including SPLATT•SPLATT questionnaire provides details about circumstances around fall (Symptoms, Previous falls, Location, Activity, Time, and Trauma)
Partially working. Facilitators: • Ease of administration of SPLATT• Background knowledge of Phase I to
guide team• Knowledge and support from Falls
Risk Management Implementation and Evaluation Committee
• Standard of Care for client falls is currently being piloted
Barriers: • Evolving processes for Geriatric
Consult Team to assess falls or falls risk once screening is positive; awaiting Standard of Care
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Baseline Measures
• A chart review of Geriatric Consult Team clients was conducted in September, 2011
• Geriatric Consult Team adopted FFLS goals for study period
Actual Goal from Team Charter
Percentage of Falls Causing Injury 30% 24%(reduce by 20%)
Percentage of Clients with Complete Falls Risk Screening on Admission 90% 100%
Percentage with Documented Falls Prevention/Injury Reduction Plan 70% 100%
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Falls Facilitated Learning Series
Client GroupHome Living clients referred by Case Managers to Geriatric Consult Team
Study Period September 1, 2011 to January 31, 2012
Clients assessed and admitted to Geriatric Consult Team
43
Study Population
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Falls Facilitated Learning Series
• Clients referred to Geriatric Consult Team are often already experiencing falls or have a significant risk of falls
• Geriatric Consult Team has no influence over the number of clients who have experienced a fall causing injury on admission to the team
• Assessments may be delayed due to:• Client availability• Team availability• Increase referrals to Geriatric Consult Team
• Monthly reporting does not provide trend data, only episodic data
Factors Affecting Monthly Data
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Falls Facilitated Learning Series
• Continue to visit new clients as soon as possible and include falls screening on initial visit
• Aim to complete documentation about falls history and risks in a timely manner
• Review reporting periods to mitigate effect of delayed assessment
• Identify cases where external factors delayed falls screening
• Periodic review with Geriatric Consult Team and peers to discuss processes to work towards relevant data collection and best practice
• Create standardized template and database for reporting of Geriatric Consult Team clients’ falls
Ensuring Quality Data
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Geriatric Consult Team Feedback: Falls
• 18 out of 64 clients have experienced a fall while under the care of Geriatric Consult Team from inception to February 29. 2012
• Geriatric Consult Team is aware of the need to collect data about number and circumstances of falls in addition to Home Living falls reporting system
• Family members and Home Care Case Managers report high satisfaction with Geriatric Consult Team’s interventions
• Geriatric Consult Team members appreciate the benefit of an interdisciplinary approach to falls
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
• Geriatric Consult Team evaluated its current comprehensive initial assessment tool to determine its usefulness in falls screening and evaluation
• PDSA cycle determined that the assessment tool in combination with the screening questions and SPLATT was an adequate screening tool, but additional targeted assessments should be explored for further evaluation of falls and falls risk
• Geriatric Consult Team is exploring documents available in Meditech to assist in interdisciplinary assessment of falls
• Geriatric Consult Team is working in collaboration with Falls Risk Management Implementation and Evaluation Team to standardize interventions for clients at low and high risk for falls
Plan, Do, Study, Act (PDSA) Cycle
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Falls Facilitated Learning Series
• Competing priorities in Alberta Health Services
• Geriatric Consult Team is a new entity, therefore, its processes and assessment forms are evolving
• Uncertainty amongst Geriatric Consult Team members as to how to proceed following falls screening
Sustaining Falls Improvement: Barriers
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Falls Facilitated Learning Series
Sustaining Falls Improvement: Facilitators
• Strong support of Alberta Health Services, Senior Management, and Falls Risk Management Implementation and Evaluation Committee
• Involvement with Canadian Falls Prevention Curriculum has provided Canadian content and is evidence informed
• Geriatric Consult Team is a small, interdisciplinary group of experienced professionals who can directly impact the multifactorial reasons clients fall
• Geriatric Consult Team has the opportunity to create new processes without the change management challenges that occur in a larger organization
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
• Ensure timely assessment of clients, completeness of falls screening and appropriate, interdisciplinary evaluation of falls
• Fully implement Standard of Care for falls
• Determine an evaluation tool for Geriatric Consult Team clients who acknowledge a history of falls
• Develop database and tracking form for Geriatric Consult Team to record clients’ falls
• Collaboration with Falls Risk Management Implementation and Evaluation Committee
Sustaining Falls Improvement: Moving Forward
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Falls Facilitated Learning Series
Sustaining Falls Improvement: Key Insights
• FFLS was beneficial in initiating discussion on a Standard of Care for falls
• Participating in FFLS has reinforced that falls are a universal problem and Geriatric Consult Team has benefitted from other teams’ knowledge
• Process needs to be straightforward and implemented by all team members
• Initial Geriatric Consult Team’s success is facilitated by team members visiting clients frequently and responding in a timely manner
• FFLS process has provided insight into Geriatric Consult Team’s role in Home Care at large
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
Sustaining Falls Improvement: Advice to Teams
• Keep working team small
• Focus on one problem at a time
• Align with larger organizational goals and find supportive leaders in management
• Learn from other teams’ success and challenges
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
6 Month Post FFLS Sustainability Plans for Falls Improvement
Goal Description Action Person Responsible Metrics Targeted Completion
100% of clients will have falls screening completed on intake to Home Care
3 falls screening questions
Community Care Access Monitor completion of screening through chart audits
Annual process evaluation
100% of Home Care clients will have falls risk screening by Case Manager on initial assessment
Completion of FROP-COM in Meditech
Home Living Case Managers
Meditech chart audits Annual process evaluation
Implement organization-wide Standards of Care for falls
Compile data based on pilot project to develop Standards of Care
Falls Risk Management Implementation and Evaluation Committee
TBD April 2012
Develop Standard of Care for referral to Geriatric Consult Team based on risk stratification
Determine criteria for high-risk clients that will indicate referral to Geriatric Consult Team; establish process for screening and assessment
Geriatric Consult Team, Falls Risk Management Implementation and Evaluation Committee, Program Support Manager
TBD Fall 2012
www.saferhealthcarenow.ca
Falls Facilitated Learning Series
6 Month Post FFLS Sustainability Plans for Falls Improvement
Goal Description Action Person Responsible Metrics Targeted Completion
Geriatric Consult Team to determine effective falls assessment tool
Review assessments available in Meditech
Geriatric Consult Team and Meditech support personnel
Qualitative review by Geriatric Consult Team
April 2012
100% of clients will be screened for falls risk by Geriatric Consult Team on initial assessment
Repeat 3 falls screening questions and administer SPLATT
Geriatric Consult Team Meditech and chart audits
Quarterly data collection; annual process evaluation
100% of Geriatric Consult Team clients will have falls prevention/ injury reduction plans
Establish plans when creating problem list based on assessment
Geriatric Consult Team Meditech and chart audits
Quarterly data collection; annual process evaluation
Reliably record falls of Geriatric Consult Team clients
Establish tracking form for Geriatric Consult Team clients re: falls
Geriatric Consult Team Database to monitor frequency of falls post-assessment
April 2012; quarterly data collection
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Falls Facilitated Learning Series
Deb Payne, MScHPManager, Quality Initiatives and Program SupportPhone: (780)-735-3354Email: [email protected]
Jennifer Russill, BScPTPhysical Therapist, Geriatric Consult TeamPhone: (780)-408-5973Email:[email protected]
Contact Information