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Queensland Health's Program Falls and Pressure Injury Prevention
> Looking at Queensland Health's program > Improvements being made > Directions/What's next > Consumer perspective
Queensland Health's Program Falls and Pressure Injury Prevention
Kate Smith, Manager - Patient Safety Quality Improvement Service, Programs Team, Queensland Health Barbara Pollard, Consumer and Falls Prevention Advocate
> reduce falls and harm from falls > reduce pressure injuries > support HHSs to meet National Safety and Quality
Health Service Standards > develop and sustain practical, cost effective
patient safety improvement tools > Advise, influence and evaluate statewide
direction, > support the implementation of evidence based
practice
PROGRAM'S PURPOSE
> 1 % reduction in hospital admissions due to
falls, over a five-year period, economic analysis indicates over 700 falls could be prevented, saving $6 million and freeing up almost 6,000 bed days*
> Reduction in-patient falls
> reduce pressure injuries prevalence to <10% *Stephen Begg from Economic Analysis Unit (2010)
GOAL
QUEENSLAND
• Total population - 5 million
• 3.5 million in SE QLD
• 2.3 million in Brisbane • 187 state health
facilities
• 2000km distance from Brisbane
• Levers
Na*onal Safety and Quality
Health Service Standards and
Na*onal Guidelines
Hospital and Health Services – Service Agreements – State
KPI
• Deliver
Statewide Clinician led Collabora*ves
Consumer and Pa*ent Engagement
Hospital and Health Service Working Groups
Clinicians with a porIolio
• Receive
Clinicians and Service Providers deliver preven*on and management
Those ‘at risk’ pa*ents, residents, clients & consumers
Na*onal Top Down approaches E’s of injury
preven*on
Statewide E’s of injury preven*on
Engagement
BoRom Up Approach
PIPC FIPC
HHS HHS HHS HHS HHS HHS HHS HHS HHS
Spread
and Re
ach
Clinical Nurse Consultants /Por7olio holders
Local working groups /commi=ees
Front line clinicians
Consumers, pa@ents, residents, clients
Consulta*on clinicians
and consumers
Incidents
Evidence
Strategies
Implement Evaluate & Audit
Repor*ng
Revise
Safety and
Qua
lity Cycle
Queensland Health's Program
9
Nursing Workforce and Skill Mix
HCSAB (facility); Hand Hygiene
Medica@on Incidents
Blood Transfusion Incidents (Facility)
Pressure Injuries
Australian Commission on Safety and Quality in Healthcare – National Standards
Falls
Nurse Sensi@ve Indicator Data – pressure injuries by stages and temp category
Nurse Sensi@ve Indicator Data – falls and falls injury
QUEENSLAND PRESSURE INJURY PREVENTION
ADVISORY PANEL
The Collabora@ve
THE COLLABORATIVE
> Formed in 2006 in response to 2003 state-wide audit analysis revealing a prevalence of 14% hospital acquired pressure injuries
> 23 members following EOI > Multidisciplinary: consumer, senior nurses, specialist
nurses, clinical nurses, allied health, orthotics, medical, equipment funders, patient safety reps, program manager
> Public and private facilities > Community and inpatient sectors > Rural, regional and metropolitan representation
Every person at the table had passion for PI prevention
OBJECTIVES
Supporting QLD health services with: > Education > Equipment review > Review and expansion of resource guidelines for
use across the state and the health continuum > Standardise risk assessment tool > State-wide prevalence audits > User and data friendly reporting tool > Research > Keep resources current > NSQHS standards, accreditation support, iEMR
WHAT HAVE WE DONE: EDUCATION
> Brochures > Train the Trainer forums in regional
centres > Forums > Satellite Education broadcasts > Lanyard cards > Posters > Electronic training modules > Resource library development > Consultation support > Videos
TOOLS AND RESOURCES
WHAT HAVE WE DONE: EQUIPMENT
> Special grant of $1.5 million to change all mattresses in QLD Health to pressure relieving/reducing. Private facilities also participated in the upgrade
> Medical Aids Subsidy Scheme reviewed and changed prescribing criteria for community based equipment
> Participate in Standard Offer of Arrangement reviews for mattress, bed etc.
WHAT HAVE WE DONE: GUIDELINES
> Qld guidelines 2004 > Special health groups’ fact
sheets – bariatric, spinal, paediatric, operating theatre
> Pan Pacific guidelines 2011
> International guidelines
WHAT HAVE WE DONE: ASSESSMENTS
> Risk assessment > Standardise the risk tool recognising each
facility’s requirements > Develop forms for use
> Skin assessment > Pressure injury assessment
> rework educational material with the change to categorisation of pressure injuries
WHAT HAVE WE DONE: AUDITS
> Yearly state-wide patient safety audit QBA– risk assessment, skin inspection, pressure injury, reporting
> Review data collected to direct the collaborative’s focus and support local facilities
WHAT HAVE WE DONE: RESEARCH
> Recently welcomed Fiona Coyer, Professor of Nursing to the collaborative
> Collaborative members have contributed to PIP research – Dr Merrilyn Banks extensive contribution to the impact of nutrition in pressure injury
> Literature review: effective ways to educate and target nurses
WHAT HAVE WE DONE: OTHER
> Electronic medical record > Incident reporting tool > Activity Based Funding > QBA – pressure injury component > National Standards > Assist specialty areas to develop/ adapt tools to meet
their needs > Ongoing development of educational material > Other organisation linkages
WHAT WE HAVE ACHIEVED The statewide inpa*ent hospital-‐acquired pressure injury prevalence has decreased from 14% in 2003 to 4% in 2015
OUR FUTURE
> Develop tools to assist with management of Pressure
Injury
> Continue to build and strengthen community – QLD health
interface
> Empower consumers: PIP@home information
> Continue advocacy on the vital importance of Pressure
Injury Prevention
> Continue to provide education opportunities
THE FUTURE
> All staff able to correctly:
> Assess every client/ patient
> Identify skin conditions (not just
PI)
> Manage any PI encountered
> No hospital acquired pressure
injuries in our service
ACKNOWLEDGEMENTS COLLABORATIVE
Acknowledgements Falls Champions
> 2001-2006: Stay On Your Feet WideBay older people - changed beliefs falls preventable, discussing falls with health professional, local activities to address risk factors esp. physical activity,
> 2006: Falls Injury Prevention Program Patient Safety
> 2006: Joint work plan between acute & public health
> 2007: Change in branding, Statewide Falls Injury Prevention Collaborative
> 2008: Queensland Stay On Your Feet® Community Good Practice Guidelines
WHAT HAVE WE DONE: PROGRAM
WHAT HAVE WE DONE: PROGRAM > 2009: Queensland Stay On Your Feet®
Community Good Practice Guidelines Toolkit
> 2010 - 2012: April Falls Day – to April No Falls month
> 2010: Statewide planning consultative > 2010: meta-analysis strength and balance
for falls prevention in 40-64 years olds
> 2007: Non-‐slip socks -‐ bare feet provide beRer slip resistance than non-‐slip socks,
encouraged to mobilise in appropriate, well-‐fiang shoes whilst in hospital
> 2008: Low Low beds no significant difference in the rate of falls per 1,000 occupied bed days between interven*on and control group wards ader the introduc*on of the low-‐low beds
> 2008-‐2009: Area Falls Safety Officers (AFSO) reached 60% of QH areas, workforce training new guidelines, falls preven*on ac*on plans developed across the con*nuum
> 2010: Falls and Fractures – analysis of 33,000 hospital falls focus older female pa*ents 80-‐ plus years falls while walking increased risk of fractures
> 2010: Falls Fact sheets, deaths, ambulance, ED presenta*ons, rate and cost falls, deaths, trauma, costs of hospitalisa*ons
hRps://www.health.qld.gov.au/stayonyourfeet/collabora*ve/fipc-‐research.asp
WHAT HAVE WE DONE: INTERVENTION RESEARCH
WHAT HAVE WE DONE: RESEARCH > 2010: Risk factors for serious head injury HI -‐ falls due to fain*ng, while
standing or walking, falls in the bedroom, in seclusion rooms, and falls between 12:00 and 13:00. associated with increased odds of serious HI
> 2011: Falls Specialist Officers (FSO) working in Queensland hospitals to deliver educa*on, training and support to frontline staff on best prac*ce strategies for falls preven*on. Increase use of screening, interven*ons and beliefs falls prevented
> 2011: Falls clinics – hospital clinic reduced falls 55%, injurious falls 38%; community clinic reduced falls by 60%, injurious falls 70%
> 2011/2012: Integra*on Safer Prac*ce – Whole Person, Whole Team, Holis*c Healthcare
> Implement of Falls assessment and care plans, Post fall clinical pathway
> Model policy and implementa*on standard, statewide strategy
hRps://www.health.qld.gov.au/stayonyourfeet/facts/sta*s*cs.asp
> 2012: Pa*ent experience built into on-‐line educa*on
> In-‐hospital brochure
> Statewide training for proven interven*ons
> Otago Exercise Programme , 150 trained, 1-‐14 programmes being offered, 117 clients, @ 6 months increased strength balance, reduced falls, cost $427 per client (reduce)
> Safe Recovery Program-‐ trained across the state set up evalua*on framework,
> Queensland Bedside Audit
> Hospital and Health Service Plan Ac*vity Based Funding KPI of 70% compliance with falls assessments and care planning
> 2010/11 controlled clinical trial called the Falls Tools Trial, increase iden*fica*on risk factors and sta*s*cally significant increase in interven*ons
hRps://www.health.qld.gov.au/stayonyourfeet/
WHAT HAVE WE DONE: INTEGRATION
LOCATION AT TIME OF INJURY, HOSPITALISED QLD FALLS, 2000-2009: 65+YRS
%
QIEP Falls Program 2001- 2004 + 2004
HACC Statewide Stay On
Your Feet®
PSC Falls Injury Prevention
Program
-
5,000
10,000
15,000
20,000
25,000
2005
/200
6
2006
/200
7
2007
/200
8
2008
/200
9
2009
/201
0
2010
/201
1
2011
/201
2
2012
/201
3
2013
/201
4
2014
/201
5
Epis
odes
Year
Episodes of Care for Falls, Age 65+
-
500.0
1,000.0
1,500.0
2,000.0
2,500.0
3,000.0
3,500.0
4,000.0
2005
/200
6
2006
/200
7
2007
/200
8
2008
/200
9
2009
/201
0
2010
/201
1
2011
/201
2
2012
/201
3
2013
/201
4
2014
/201
5
Rat
e pe
r 100
,000
Pop
ulat
ion
Year
Rate of Falls per 100,000 Population, Age 65+
The Queensland Bedside Audit (QBA) is an annual bedside audit undertaken in Hospital and Health Services (HHS) within Queensland.
Queensland Bedside Audit (QBA)- Inpatient: Falls prevention indicators - 2012 to 2015 - only comparable results across audits are presented
Con
tent
ar
ea Indicator Indicator abbreviation
2012 indicator**
2013 indicator*
2014 indicator*
2015 indicator*
% of patients who had the nurse call system within reach Nurse call within reach
90% 88% 91% 92%
% of patients screened for history of falling on admission Risk screened 77% 79% 80% 84%
% of patients assessed for risk of falling on admission Risk assessed 78% 78% 80% 83%
% of risk assessed patients who were documented at risk of falling At risk^^ 67% 67% 69% 71%% of patients documented at risk of falling with a multifactorial falls prevention plan
At risk with falls prevention plan
77% 80% 87% 86%
% of patients assessed for risk of falling who had a mobility aid that was within reach 65%*** 70%***
Not collected
Not collected
% of patients assessed for risk of falling with documented evidence of the level of supervision or assistance required for mobilisation
Risk assessed with level of supervision/assistance required to mobilise documented
93% 92% 93% 92%
% of patients who reported receiving information on how to prevent falls
Reported receiving information on preventing falls
Not collected
60% 62% 66%
% of patients who reported being involved in developing a falls prevention plan
Not collected
52%***Not
collectedNot
collected
Falls
pre
vent
ion
WHAT HAVE WE DONE: AUDIT
QBA RESULTS
Statewide results from 2012 to 2015 showed that:
> Falls screening on admission and falls risk assessment on admission improved by 7% (77% to 84%) and 5% (78% to 83%) respec*vely.
> These sta*s*cally significant results indicate a concentrated mul*disciplinary effort that focuses on a culture of pa*ent safety and improved quality outcomes for pa*ents.
OUR FUTURE
> Support HHSs to meet NSQHS standards 10 Preventing falls and harm
from falling and the transition to the new standards
> Education for both Health Professionals and Patients in Hospital settings
> Reduce functional decline – focus on exercise e.g. Otago Exercise
> Programme and patient education on discharge planning
> Promote and support research activities in falls injury prevention
> Resource development and maintenance, QBA support, Be Safe, Stay On
Your Feet®
To deliver the right strategies with the right intensity to the right people
at the right time resulting in a effective targeted response to reduce
falls
These articles and air time had the potential to reach a total audience of 183, 054. Social Media – Facebook reach 28,985
WHAT HAVE WE LEARNED
Multi-level coordinated approach > Persistence, Patience, Positiveness > Collaboration > Communication > Champions and executive leadership – top down/bottom up > Flexibility > Integration/Embedding > Dedicated capacity (short term) > Pre-packaged > Maintenance and sustainability – ongoing access to updated
materials > Focus and targeted > Implementation can be achieved with limited funding
NEW FOCUS
> Comprehensive care
> The final version 2 of the NSQHS Standards is scheduled for release in late-2017.
> Late 2017 identify gaps in resources provided by the Commission and what’s available QH
> 2018 – systematically address the gaps in resources, tools to support HHS
> Assessment to version 2 of the NSQHS Standards is planned to commence from 1 January 2019, with flexible transition arrangements for the first round of health
DIRECTIONS / WHAT'S NEXT
> Determine WHO we are assisting
> Determine WHAT assistance is required
> Determine HOW the assistance can be delivered
> Maintain momentum, integrate with existing programs and sustain the right components, engage clinical leaders
All within:
> Budget constraints
> Resource constraints – staff, time, mechanisms
> Time availability of the collaborative members and other specialists
> Constant changes in organisational structures and priorities Bradley, E H, Webster, TR, Baker, D, Schlesinger, M, & Inouye, SK. After Adoption: Sustaining Innovation A Case Study of dissemination the Hospital Elder Life Program. Journal of American Geriatrics Society, 2005:
53:1455-1461
