Embed Size (px)
Citation preview
HRET HIIN Falls Virtual Event
Hit the Wall on Falls? Time to Recalibrate!July 11, 2017
1
WELCOME AND INTRODUCTIONS
2
Erin Craig, MPA, Program Manager| HRET
3
Poll: How did you hear about this event?
How did you hear about today’s virtual event?a.HRET HIIN flyerb.HRET HIIN websitec.HRET LISTSERV d.State hospital associatione.QIN-QIO f.Your organization/colleagueg.Other, please specify
Agenda for Today
4
HIIN FALLS DATA REVIEWVrinda Mahishi, MPH, Data Analyst | HRET
5
Falls Rates
6
LET’S GET FOCUSED! FRAMING THE DISCUSSION
Jackie Conrad, BSN, MBAImprovement Advisor, Cynosure Health
7
SURVEY RESULTS
8
SURVEY RESULTS
9
SURVEY RESULTS
10
SURVEY RESULTS
11
AIMING FOR ZERO: HOW TO DISSECT FALLS PROGRAMS WHEN YOU LOSE MOMENTUM
Amy Hester, PhD, RN, BCDirector of Nursing Research & Innovation University of Arkansas for Medical Sciences Medical Center (UAMS)
12
Amy Hester PhD, RN, BCDirector of Nursing Research and Innovation at University of Arkansas for Medical Sciences Medical Center (UAMS)
• Chief Scientific Officer - HD Nursing, LLC• Financial interest holder
• Falls subject matter expert for two national CMS Hospital Engagement Networks (HENs):
• University Healthsystem Consortium (UHC)
• Ohio Children’s Collaborative
Disclosures
• All studies described in this presentation were approved by an Institutional Review Board.
Disclaimers
• Describe the five types of falls that occur in the acute care setting
• Define the process for falls management in the acute care setting
• Describe material resources used for fall and injury prevention in the acute care setting
• Define patient factors associated with fall related injuries
Objectives
• Falls are the most commonly reported adverse event in hospitals.
• Inpatient fall rates range from 1.4 to 18.2 falls per 1000 patient days.
• A fall without injury costs roughly $4,200
Background-Acute Care
•Injurious falls account for 6 to 44 percent of falls occurring in the hospital
•Approximately 11,000 fatal falls occur in US hospitals annually.
•Falls with injury cost roughly $27,000
Background-Acute Care
The Increasing Problem For Providers/Payors
Total cost to the healthcare system resulting from falls and falls related injuries: $34B in 2013, estimated at $47B in 2020
• The average 200 bed hospital spends $1,000,000+ per year on falls related costs
• The move to “value based purchasing” means hospitals face financial penalties for readmissions (up to 3%) and patient safety metrics
• Falls related injuries account for up to 15% of readmissions in first 30 days
• Falls account for 25% of all hospital admissions from nursing homes, and 40% of all nursing home admissions; 40% of those admitted do not return to independent living; 25% die within a year
19
• Is much about common sense.
• But there is science behind falls and injury management.
• The more you understand the science, the more you can improve your organization’s performance.
Fall and Injury Management
All Falls Matter but There are Different Types
• Anticipated Physiologic-predictable and preventable; caused by mobility factors, cognitive factors, toileting issues, etc.
• Unanticipated Physiologic-not predictable or preventable; caused by seizures, syncopal episodes, cardiac arrhythmias, etc.
• Accidental-not predictable but often preventable; slips and trips which can often be prevented with standard universal fall precautions
• Behavioral-not predictable or preventable; patients acting out
• Developmental-not predictable or preventable; part of normal development
Polling Question
• What types of falls do risk screening tools assess for? a. Anticipated physiologicb. Unanticipated physiologicc. Accidentald. Behaviorale. Developmental
23
The Process for Falls Management
Risk Screening/ Assessment
Care Planning Variance Reporting Benchmarking
Predicting Risk
• Are the anchor of your program.
• Are only designed to predict anticipated physiologic falls.
• Are setting specific.
• Require licensure from developer(s).
• Are typically used by nursing in the acute care setting.
Fall Risk Tools
Are You Screening or Assessing?
– On admission– Change of shift– Change in location– With a significant change in condition– After any fall event
Typical Times to Screen/ Assess
• If your fall risk prediction tool is not identifying the correct patients at risk, you are not intervening on the patients that need your care.
• If your fall risk prediction tool is over identifying patients at risk to fall you are intervening on patients that do not need that care.
Fall Risk Tools
• Cut Scores- The recommended score at which a patient is considered to be at risk for falls
• Inter Rater Reliability (IRR)- The percent of agreement in scoring the risk assessment tool among different caregivers for the same patient
• AUC- Area Under the Curve- Statistic that describes the predictive ability of an instrument where .5 is no ability and 1 is a perfect tool
Definitions
• Sensitivity- Percent of fallers who were correctly predicted to be fallers by the tool.
• Specificity- Percent of non fallers who were correctly predicted to be non fallers by the tool
• Treatment Paradox and Specificity
Definitions
• Check the IRR of your fall risk assessment tool. It should be no less than 80% agreement between clinicians.
• Look at your fall events. Evaluate how many were assessed as being at risk when they fell.– If the percent of your fallers correctly identified as at risk
prior to the fall is less than the published sensitivity of your tool, either your staff are not using the tool appropriately or the tool is not working for your patient population.
– Fall Tool Sensitivity & Specificity Worksheet• Encourage assessment and critical thinking beyond a
score.
Improvement Strategy
Risk Tools
• From our Survey– Morse (1987)– Hendrich II (2003)*– John Hopkins (2007)*– Schmid (1990)*– STRATIFY (1997)– FRASS (1996)**
• Other Tools– Hester Davis (2010)*– Conley (1987)
33
*proprietary **permission required
RAND Review of the Evidence on Falls Prevention in Hospitals 2012: https://www.rand.org/content/dam/rand/pubs/working_papers/2012/RAND_WR907.pdf
Key take aways•Determine if your fall risk tool is adding value•Segregate accidental and anticipated physiological falls•Don’t minimize the patient to a score•Screen to trigger comprehensive assessments
– Rehab evaluation– Pharmacy review– Delirium assessment – B-Cam– Home eval
34
Polling Question
• Do you activate a special care plan or interventions for a patient admitted with injury from a fall? a. Yes – high fall risk precautionsb. Yes - home evaluation and multifactorial
assessment, ie rehab eval, pharmacy reviewc. a and bd. Noe. Not sure
35
Care Planning
Polling Question
• Preventing patient falls is a team sport. What level of interdisciplinary teamwork is present in your fall programa. Nursing is the accountable disciplineb. Nursing has support from rehab or pharmacy c. Nursing has support from rehab or pharmacy,
AND non clinical departments like EVS, biomed, engineering, materials
37
•The purpose of care planning is to keep patients safe and to mitigate the factors causing risk to fall thereby preventing the fall.
•Should be modifiable based on patient needs.
•Can be approached based on level of risk, individual factors or both. This can depend on what information your risk tool provides.
Care Planning
Polling Question
• Do you assess for injury risk or activate injury reduction strategies? a. Yesb. Noc. Not sure
39
•Should include interventions for both fall and injury management.
•Is not Universal Fall Precautions:– Call light/ belongings in reach, bed in low position
and locked, wheelchairs and chairs locked, use non-slip footwear, SR up X2, adequate lighting, clutter free room, educate on level of risk, educate to call for assistance.
Care Planning
Sample interventions based upon assessment
Problem Sample Interventions
Altered elimination Scheduled toileting planKeep urinal within reach
Altered mobility Use gait beltAmbulation orders – up at least 3 x dayDiscontinue tethers – catheters, IV lines ASAPAdaptive equipment accessible
Risk for delirium Screen for high-risk medicationsReview appropriate dosing and timing of medsPursue non-pharma interventionsIncorporate sensory integration – windows open, up in chair for meals
Risk for Orthostatic BP Encourage fluid and nutritional intakeRise slowly
Risk for injury Low bedsFloor matsHip protectorsHelmets/ Protective Caps
• Should inform patient and family not just of the risk to fall but why and also about fall protocols and goals related to care (strokes and fractures)
• Family need reinforcement, too• When documenting family education, it is
helpful to document which family were educated
• Are they: Reliable? Fatigued? Able? Willing?
Family as Partners in Care
• Make sure:– Staff have clear expectations for what education to
provide and where to document it.– Forms are easily available to staff.– You have forms available in all applicable languages.– You have family education forms separate from
patient education forms.– Your staff are providing the education on admission
and reinforcing during patient and family encounters using the teach back methodology
– Teach Back Event Recording– The readability is appropriate for your patients.
Improvement Strategy
• Most accidental falls are caused by extrinsic environmental factors surrounding the patient.
• While accidents are not predictable, many are preventable.
• Falls that result from slips and trips are considered accidental events. You still report them and treat them as any other event from a care perspective, however, the causative factors must be addressed.
Prevention of Accidental Falls
• Care plan documentation should reflect individualization
• Side rail use• Education and re education, material handouts
and archival of those documents• Family presence• When and what material resources are in use• Compliance (ADHERANCE) with instructions
Documentation
• Hip Protectors- briefs and pants• Helmets/ Protective Caps• Floor Matting- bevel vs. non beveled• Low Beds• Lap Belts• Chair Wedges• Footwear-single vs. double sided• Arm Bands• Door Signage• Blankets• Bed Alarms• Enclosure beds• Gait belts• Bedside Commodes• Video surveillance
Material resources used in Care Planning
• Evaluation of the care plan should be an ongoing endeavor of the care team.
• Partner to evaluate whether your interventions are effective and if not, eliminate them.
• Effective interventions should be reinforced and clearly communicated to the team, patient and family.
• As the patient’s condition changes, so too should interventions. This reflects an individualized approach.
Evaluating the Plan of Care
• Look at the current plans of care in your organization: are they up to date? Evidence based?
• What other plans of care collide with your fall care plans?
• How are you approaching fall prevention: level of risk, individual factors, both?
• Does your documentation reflect the care provided?
• Do you have technologies that you could integrate/ interface?
Improvement Strategy
• Do you have EVIDENCE BASED decision support built into your plans of care so that staff are very clear as to when to implement and withdraw the use of material resources?– If not, the use of these resources is variable,
unreliable and results in equipment sitting on the shelf.
Improvement Strategy
• Reassess your current level of equipment.• Reassess the need for different resources.• Fall Carts• Standardize quality reporting and make it a true priority.• Assess the competency of your staff. • Bring the vendor back on a routine basis.• Make sure everyone is at the table for decision making
– Materials Management– Risk Management– Staff– Patients and Families
Improvement Strategy
Key take aways• Create a menu of
interventions• Engage more than nursing• Equip staff with the tools
and equipment they need• Focus on the mitigating
the risk• Patient Family
Partnerships matter – Use “Teach-Back”
51
Zero is Our Goal…..
Questions?
Thank you for your time and your dedication to exceptional patient care.
Polling Question
• What new ideas will you bring back to your organization or unit to recalibrate your falls program?a. Reevaluate our fall risk toolb. Incorporate injury screening and reduction strategiesc. Strengthen my falls care planning processd. Evaluate current fall program materials and equipmente. Involve more disciplines in fall preventionf. Review data for completeness and trendsg. Other
54
Open Discussion
55
BRING IT HOME
56
Erin Craig, MPA, Senior Program Manager| HRET
FALLS CHANGE PACKAGE
57
For more resources on Falls, visit http://www.hret-hiin.org/topics/injuries-from-falls-immobility.shtml
Link to Falls Change Package: http://www.hret-hiin.org/resources/display/falls-with-injury-change-package
FALLS TOP 10 CHECKLIST
58
For more resources on Falls, visit http://www.hret-hiin.org/topics/injuries-from-falls-immobility.shtml
Link to Falls Top 10 Checklist: http://www.hret-hiin.org/Resources/falls/17/falls_checklist.pdf
LISTSERV
• Join the LISTSERV® – Ask questions– Share best practices, tools and resources– Learn from subject matter experts– Receive follow up from this event and notice of
future events
Sign up at http://www.hret-hiin.org/engage/listserv.shtml
59
Upcoming EventsHRET HIIN Readmissions | Reduce Readmissions Fishbowl SeriesJuly 13, 2017 11:00 a.m. - 12:00 p.m. | Register here.
Does your organization have an opportunity to gain new insights and test strategies to reduce readmissions? Join the HRET HIIN on May 25th for the first reducing readmissions "Fishbowl" event where you will watch the process improvement journey of five HRET HIIN hospitals. Listen in as the hospitals create reduction aim statements, focus on their target population and develop their first small test of change to implement in their readmissions reduction efforts.Upcoming Readmissions Fishbowl Series dates:
– August 10, 2017 11:00 a.m. - 12:00 p.m. | Register here.– September 14, 2017 11:00 a.m. – 12:00 p.m. | Register here.
60
Thank You!
Find more information on our website: www.hret-hiin.org
Questions or Comments: [email protected]
61
