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Fall Prevention Activities in WA Health: A State and Tertiary Hospital
Perspective
Khye Davey Senior Physiotherapist (Falls) Royal Perth Hospital South Metropolitan Health Service
Outline
SQuIRe and Community of Practice Falls Risk Management Tool Blended learning Data for improvement Auditing, technology and engagement Falls team experiences Where to next?
SQuIRe Safety and Quality Investment for Reform
(SQuIRe) program Strengthen the Department of Health’s
clinical governance and patient safety management systems Delivery of safe, high quality, evidence-
based health care to patients and the WA community
SQuIRe The Safety and Quality in Healthcare and
Health Finance Division provide policy and financial support for the SQuIRe Program respectively 8 clinical governance standards The Health Services are responsible for
the delivery of the SQuIRe Program and clinical care Project officers and clinicians
Community of Practice Groups of people who share a concern, a set of
problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis
Consists of SQuIRe falls project officers medical, nursing and allied health Public and private Metropolitan and country
Falls Risk Management Tool
Developed from the Falls Risk Assessment Tool Pragmatic approach with ownership PDSA cycle Used by most sites across the state Lessons learnt thus far
Blended Learning Combining lectures, workshops, hands on
clinical, and electronic learning Meeting the demands of a changing
workforce Variety of opportunities for staff Recognising our gaps
Advantages of an eLearning Adjunct Accessibility and flexibility Ease in updating content Learning styles Ease of distribution Standardisation of content Accountability
Data for Improvement Driven by the Office of Safety and Quality Shift in thinking for the uninitiated Are we adding value to the patients journey? Each system is perfectly designed to give the
results it is getting Weighing yourself 10 times a day wont help lose
the weight Is the current process capable of meeting the
goal Enumerative statistics versus analytical statistics
Data for Improvement Most inefficiencies are the result of measureable
variations in a process Asses the stability of a process Expose and reduce significant sources of
variation- common cause vs special cause Avoids over reaction Moves toward more productive conversations An interdepartmental, cross functional team
approach is often the most effective means of identifying process problems
Ward level changes
Data for Improvement
Individual control charts - Swiss army knife of charts 3 second rule Limitations
need enough data points seasonal variation Too low an average Often lack of familiarity
Data for Improvement
0.00
2.00
4.00
6.00
8.00
10.00
12.00
Jul-0
7
Oct-07
Jan-0
8
Apr-08
Jul-0
8
Oct-08
Jan-0
9
Apr-09
Jul-0
9
Oct-09
Jan-1
0
Apr-10
Jul-1
0
Oct-10
Jan-1
1
Apr-11
Jul-1
1
Oct-11
Jan-1
2
Apr-12
Jul-1
2
falls
/100
0 O
BD
Auditing, Technology and Engagement Aim to improve efficiency and usefulness
of audits iPad and survey monkey Small trial success Hospital wide deployment for all audits
Modified state wide audit tool Compliance and patient profiles Information on
Falls assessment Management plan Bedside implementation
Evaluation
Auditing, Technology and Engagement
Benefits so far Access for a variety of staff Education opportunities Quicker Rapid feedback Increased accuracy Increased information Ownership
Auditing, Technology and Engagement
Falls Team Experiences
Clinical consults and clinical interface Education Monitoring standards Project management Facilitating change
Where to Next? Improving older patients’ safety in WA
hospitals Specifically reducing falls in rehabilitation
units Research Question Can providing falls prevention education to cognitively intact older patients in addition to usual care reduce rates of falls on rehabilitation units?
Where to Next?
SHRAC funded project with SQuIRe and CoP support Clinical leads - Hill, Waldron, Haines,
Etherton-Beer, McPhail, Ingram, Flicker Area Leads - Carr, Simpson, Kitchen,
Fletcher, Seymour CoP members
Intervention Multi site clustered trial Multi-media education – DVD /workbook Trained health professional follow-up Structured progression through education
content Usually 2 to 4 sessions Commence January 2013 End data collection January 2014
Outcome Measures
Falls rates ( falls and injurious falls) on site wards Sub group analysis of cognitively intact
patients Economic analysis – cost of education
vs cost per faller – modelling of data