LESS RESTRAINT LESS FALL PROJECT

IN KH

Hospital Authority Convention 2017

Oral Presentation, F 2.1 KHCND APN Joanna LAI 1

2

If you disagree...

let’s implement Less Restraint Less Fall

3

Preparation work in

2014

Started Literature

review

Interviewed patients & involved staff after falls

for 3 months

Reviewed the current fall preventive

measures / devices

Reviewed the falls’ underlying causes &

common factors from 2012 to 2014

Listed out those high fall rate and PR rate’s clinical wards

Discussed with others professional in

a multidisciplinary approach

4

Suggested Interventions from Literatures Establish a restraint reduction committee Ensure a multidisciplinary collaboration Educate staff and families Identify the restraint high usage areas as the

target areas and implement the program Establish a supportive/ consultation team to

work with the nursing staff Develop and implement an interdisciplinary

restraint assessment form Scheme a restraint-free care training program

Kwok T et al. (2012) & Anonymous. ProQuest (2000)

Offer bed alarms as one of the PR alternative measures

5

Before we

start

Time

Scope

Resource

Quality Risk

Stake-holders

Communication

Copyright © 2017 Knowledge Century Ltd. 6

1. Formed a Multidisciplinary Work Group

• Leaded by GM(N)

• Lobbied COS of REH, DM of PT and OT to form a work group to target less restraint less fall

• Met for sharing and discussion every 3 months at the beginning

7

2. Acknowledged the Risk on Less Restraint

• Predicted that may has an upward number of falls afterwards • Reassured frontline staff may increase falls when try to release PR & coped with their stress • Should keep patient safety

Could decrease fall rate?! Or...

Release of PR

.

O T P T

8

3. Safeguarded Quality Care & Patient Safety regarding Fall Prevention

• Strengthened a multidisciplinary approach – All recruited patients should be referred PT & OT to

reinforce the patients’ in hospital training and education on fall prevention

– Case doctor would pay more attentions on drug effects that causing dizziness / drowsiness / muscle weakness / instability / hypotension / bradycardia

– Ward nurses would focus on intermittently PR release, bed arrangement, fall preventive device applications, and education on fall prevention

• Developed a record & flow chart to guard frontline staffs through the project

9

4. Kept Well Communication with Stakeholders and Frontline Staffs

• Shared data & discussed with

multidisciplinary members at

half-yearly meetings

• Provided on-site support to

frontline staffs by CND staff

thrice per week

• Initiated interdisciplinary round

monthly 10

5. Report on Project’s Progress

•To frontline staffs, supervisor & members – Timely

– Promptly

– Appropriately

•To evaluate the PR & fall rate half-yearly 11

-

Demographic & Cognitive Data of the Recruited Patients

No. of Patients (from Mar 2016 to Feb 2017) A Ward B Ward

Total samples for analysis 52 59

Successfully off PR before the patient discharged

16 (30 % success)

19 (32 % success)

Range of Age 57-93 65-100

Ratio of Male & Female 39:13 (75% Male)

40:19 (68% Male)

Range of Glasgow Coma Scale 7 - 15 (mean: 13.5)

12 - 15 (mean: 14)

Range of Mini Mental State Examination / Abbreviated Mental Test

1 - 29 / 0 - 4 (mean: 14 /2)

2 - 24 / 2 - 6 (mean: 15 / 4)

Range of Functional Independence Measure

24 - 126 (mean: 59.8)

19 - 102 (mean: 62)

12

0

10

20

30

40

50

60

70

80

0%

5%

10%

15%

20%

25%

30%

35%

Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17

A: Prevalence PR Rate B: Prevalence PR RateA: No. of Total Patients B: No. of Total PatientsA: Trendline of Restraint Rate B: Trendline of Restraint Rate

Pre

vale

nce

PR

Rat

e (%

)

No.

of T

otal

Pat

ient

s

Monthly Prevalence PR Rate (checked by CND staff)

A ward Average:

23.3%

B ward Average:

23.7% 13

Monthly Prevalence PR Rate for Fall Prevention

(checked by CND staff)

0

10

20

30

40

50

60

70

80

0%

10%

20%

30%

40%

50%

60%

70%

80%

Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17

A:Prevalence PR Rate for fall prevention B:Prevalence PR Rate for fall preventionA: No. of Total Patients B: No. of Total PatientsA: Trendline of Restraint Rate B: Trendline of Restraint Rate

Res

trai

nt R

ate

(%)

No.

of T

otal

Pat

ient

s

14

/l//////////////

Comparison of Annual Prevalence PR Rates for Fall

Prevention at KH (self-reporting)

Ward May 2014 (before the

project)

May 2015 (before the

project)

Mar 2016 – Feb 2017 Monthly Average

(checked by CND staff)

Lesser Prevalence PR Rate for

Fall Prevention

A 92.9% 93% 44.2%

B 47.4% 77.6% 28.2%

15

Different Fall rates of Both Wards from Mar 2016 to Jan 2017

0.81 0.82 0.84 0.82

1.17

1.35

0.66

0.27

0.84

1.00 0.97

1.83

1.66

0.23

0.78

0.99

1.47 1.55

1.01

0.26

0.49

0.74

0

1

2

Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Previous Year Fall RateFall RatePrevious Year Fall Rate TrendFall Rate Trend

Fall

Rat

e, %

16

Post Fall Severity Index (SI) from Mar 2016 to Feb 2017

SI 1 (6)

67%

SI 2 (2)

22%

SI 3 (1)

11%

SI 4 (0) 0%

Patients Recruited in the Project

SI 1 (26) 61%

SI 2 (15) 35%

SI 3 (1) 2%

SI 4 (1) 2%

Non Recruited Patients

SI 1 SI 2 SI 3 SI 4

17

18

Acknowledge MR S Y KWAN, KCC DGM(N) / KH GM(N) DR Jennifer MYINT, KHREH COS DR Kenneth CHUNG, KHREH AC MS Olga MA, KH DOM(RM&E) MS K H TING, KHREH DOM(R&E) MR Walen LEUNG, KHREH RN MR Timothy WONG, KH SNO2 (NS&A / Q&S) MR K P PANG, KH WM (PSY) MS Alice LEUNG, KHREH WM & 2A Ward colleagues MS K H CHEUNG, KHREH WM & 3A Ward colleagues DR Serena NG, KHOT DM DR Rosanna CHAU, KHPT DM DR Bobby NG, KHOT SOT MS Irene CHAN, KHOT OTI MR Robert TANG, KHOT PTI MR S YEUNG, KHCND EA1

19

References Anonymous. (2000). Fall Prevention without Restraints: A Project:: Long Term Management Care. Nursing Homes.49 (2), 38-41. Dyck, D., Thiele, T. & Kebicz, R. (2013). Hourly Rounding for Falls Prevention: A Change Initiative. Journal of Creative Nursing, 19 (3), 153-158. Gulpers, M. J.M., Bleijlevens, M. H.C., Capezuti, E., et al. (2012). Preventing Belt Restraint Use in Newly Admitted Residents in Nursing Homes: A quasi-experimental Study. International Journal of Nursing Studies, 49 1473- 1479. Hennessy, C. H., McNeely, E. A., Whittington, F. J., et al. (1997). Perceptions of Physical Restraint Use and Barriers to Restraint Reduction in A Long-term Care Facility. Journal of Aging Studies, 11 (1), 49-62. Kwok, T., Bai, X., Chui, M. Y.P., et al. (2012). Effect of Physical Reduction on Older Patients' Hospital Length of Stay. Journal of American Medical Directors Association, 13, 645-650. Lai, C. K.Y., Chow, S. K.Y., Suen, L. K. & Wong, I. Y.C (2013). Reduction of Physical Restraints on Patients during Hospitalization / Rehabilitation: a Clinical Trial. Asian Journal of Gerontology & Geriatrics, 8 (1), 38-43. Lai, C. K.,Y. Chow, S. K.Y., Suen, L. P. & Wong, I. Y.C. (2011, July 5). The Effect of a Restraint Reduction Program on Physical Restraint Rate in Rehabilitation Settings in Hong Kong. Rehabilitation Research and Practice, pp.1-9. Mccabe, D. E., Alvarez, C. D. & Mcnulty, R. (2010). Perceptions of Physical Restraints Use in the Elderly Among Registered Nurses and Nurses Assistants in a Single Acute Care Hospital. Journal of Geriatric Nursing, 32 (1), 39- 45. Shorr, R. I., Chandler, A. M., Mion, L. C., et al. (2012). Effects of an Intervention to Increase Ved Alarm Use to Prevent Falls in Hospitalized Patients. Annals of Internal Medicine, 157 (10), 692-699. Tolson, D. & Morley, M. (2012). Physical Restraints: Abusive and Harmful. Journal of American Medical Directors Association, 13, 311-313. Tzeng, H. M., Yin, C. Y. Anderson, A. & Prakask, A.(2012). Nursing Staff's Awareness of Keeping Beds in the Lowest Position to Prevent Falls and Fall Injuries in an Adult Acute Surgical Inpatient Care Setting. Journal of Medical- surgical Nursing, 21 (5), 271-274. Zwijsen, S. A, Depla, M. F.I.A., Niemeijer, A. R., et al. (2012). Surveillance Technology: An alternative to Physical Restraints? A qualitative Study among Professionals Working in Nursing Homes for People with Dementia. International Journal of Nursing Studies, 49 212-219.

20

21