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8/14/2019 Improving dementia care falls prevention
1/12
Respond Deliver & Enable
IMPROVING DEMENTIA CARE
- FALLS PREVENTION
Julie Vale 26 th January 2010
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The Numbers
200,000 falls per year in acute, communityand mental health units (NPSA, 2007)
Nationwide 500 people suffer a # hipfollowing a fall in hospital
R,D&E = 1,821 falls in 2009
Average of 152/month
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The R,D&E story
Two fatalities Jan Mar 08 One pt fell 15-20 times no action taken
One pt fell twice in the same night over bedrails
Both patients had cognitive impairment
Culture of normalisation to falls across thetrust and division
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Assessment.
On admission within 24 hours After any ward moves.
After any change in condition e.g. patientbecomes unwell or has a fall.
Routinely on a weekly basis moving to every
72 hours Top tip: Beware underscoring
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Risk planning. Cohort at-risk patients. Bed position visible and low. Footwear. No bed rails. Refer to OT and Physio for falls assessment and
planning. Keep area clean and tidy remove obstacles. No commodes left by bed. Communication to team highlighting risk. Document all actions and processes followed.
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Leadership intervention test of change redevelopment of falls checklist/bundle
Targeted formal falls education
Intentional round every hour for patients
with falls risk score >20 Checklist with key quality questions
Verbal feedback from staff, patients
and carers
Positive results with decrease in fallsacross directorate and Trust
Intentional Rounding Checklist
Intentional rounding provides thevisible presence of nursing staff on the ward and patients andcarers have commented on itimproving their experience whilein hospital:
I feel safe I didnt realise Ihad
dropped my callbell Nurses are saying
they havetime to care
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Respond Deliver & Enable
Hospital No. .Name: DoB: ..Affix patient label here
For patients with a falls risk score of 20 or if any degreeof cognitive impairment please enter either A =achieved or V = variance in columns. Record reason forvariance and action taken overleaf. This patient requires
observation every ....... hour ..... minutes.DATE: TIMES
1. CONTINENCEDo you need to go to the toilet?
2. PAINDo you have any pain?
3. ORIENTATION fully alert=FA;mildly confused/disorientated=MC;
severe confusion/disorientation=SC; asleep=A
4. POSITION / COMFORTAre you comfortable?
5. DRINK / MOUTHCAREWould you like a drink?
6. CALL BELL WITHIN REACHIf you need me, please press this button
7. BED RAILS DOWN
8. BED TO THE LOWEST POINT TO THE FLOOR andunderbed light on at night
9. IS THERE ANYTHING ELSE I CAN DOFOR YOU BECAUSE I HAVE THE TIME?
INITIALS
Intentional Rounding Checklist
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Principles and Lessons Learned Round >20 or if any degree of cognitive impairment/confusion All questions need to be asked in order Patients need to be rounded every hour over 24 hour period If patient asleep over night, when they
wake, restart the clock
Dont stop if they havent fallen! Draft training package and targetededucation vital for success
Its more than managing the falls risk patients feel cared for
Build in audit cycle for sustainability Clinical champions Be relentless in approach
Respond, Deliver & Enable
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10/1/09admitted toRD&E fromHay House
13/1/09admitted tomedicalward Fallsassessmentscore 23
17/1/09transferredto anotherward notreassessed
25/1/09routine fallsreassessedas 34 IR notcommenced
2/2/09routine fallsreassessedas 33 IR notcommenced
7/2/09routine fallsreassessedas 33 IR notcommenced
14/2/09routine fallsreassessedas 33 IR notcommenced
16/2/09routine fallsreassessedas 33 IR notcommenced
24/2/09routine fallsreassessedas 33 IR notcommenced
2/3/09routine fallsreassessedas 33 IR notcommenced
CRP 92 1/3/09
2/3/09Fall
b
c
d
b
Time____
Event
SupportingInformation
Incident
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Results
Number of falls
0
10
20
30
40
50
60
Date
Special Cause Flag
Total number of inpatient falls in 10 medical wardsApril 2008 to July 2009
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Kenn Ward Slips, trips and fallsKenn in-patient slips, trips & falls SPC Chart (Apr-08 to Dec-09)
-6
-4
-2
0
2
4
6
8
10
Week Beginning
Volume UCL Median LCL
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Very High Risk
Some patients risk cannot be adequatelyreduced despite all of the above actions.
1. Risk assess and document any actions.2. Alert your Matron and Senior Matron if
patients remain at very high risk.3. Consider 1:1 special
4. Consider using hip protectors5. Reassess and document change on a daily
basis.