Leveraging Partnerships for a Community-Based Fall Prevention Strategy. Central LHIN and York Region Public Health.

Transcription

1 Leveraging Partnerships for a Community-Based Fall Prevention Strategy Central LHIN and York Region Public Health October 11, 2017

2 Presentation Outline Shared Fall Prevention Mandate Home and Community Care fall assessment and data reports Least restraint approach to care Collaborative education strategy Partnering to develop local and regional strategies Key learnings regarding fall prevention 2

3 What is a Fall? Unintentionally coming to rest on the ground, floor or other lower level with or without an injury Scott, V. (2012). Fall Prevention Programming Over one-third of assessed home care clients were at risk of falling, which represents more than 55,000 patients. Falls Joint Report, CPSI, Accreditation Canada, and CIHI,

4 Falls in Ontario In one year, falls in adults 65+ led to: 100,000+ emergency department visits 20,000+ hospital admissions $1 billion in direct costs 2,000+ lives lost 4 Parachute, Electronic Resource Allocation Tool (ERAT), 2010

5 How It All Started Shared Fall Prevention Mandate: Provincial Seniors Strategy Living Longer, Living Well (2010) Central LHIN Quality Improvement Plans (QIP) Ontario Public Health Standard and Performance Indicator - fall prevention 5

6 Central LHIN s Falls Quality Improvement Plan (QIP) Objective: To reduce falls among long-stay home care patients Measure: Percentage of adult long-stay home care patients that have a fall on their follow-up RAI-HC assessment Goals/Activities: 1. a) Spread the identified best practices for falls prevention screening tools with service provider organizations and Central LHIN staff b) Embed a consistent communication approach to share results from the screening tools 2. Develop and proactively identify patients with medications that may potentially contribute to falls 6 6

7 Central LHIN Quality Improvement Plan Data 7

8 Medication Management and Fall Analysis: Background and Objectives 1. Falls are dangerous for patients how do we prevent or limit them? 2. What is the effect of medication and their contribution to falls? 3. What studies have been performed to investigate the risk of falling with specific types of medication? ü Identify medication trends that may have contributed to patient falls, based on empirical data q Provide recommendations for health service providers to help prevent or reduce the risk of future falls 8

9 Analysis Objectives Analyzed empirical data based on patient history from our Rapid Response Nurse team, focusing on 3 key factors: 1. Number of medications taken 2. Classes of medications administered and their potential drug interactions 3. Time of day the medication was administered Determined the correlation between these factors and the likelihood that they contributed to patient falls 9

10 Number of Clinically Important Drug to Drug Interactions Antidepressants and 2+ other CNS active drugs (104) Peripheral Alpha-1 Blockers + Loop diuretics (102) Pa,ent Count Benzodiazepines and 2+ other CNS-active drugs (45) Osteoporosis + No Vitamin D (45) 31 Narcotics and 2+ other CNS-active drugs (31)

11 Key Results and Outcomes 11 # of medications per patient Time of administration Drug - drug interactions Polypharmacy is evident within our patient population The average number of medications per patient is 11 Optimal arrangement of drug administration schedules can help mitigate falls risk by having significant effect on a medication s efficacy, adverse effects and ultimately a patient s adherence to therapy Identified 14 key time of administration errors that can increase falls risk Drug interactions resulting in additive or synergistic adverse effects contributes to falls Identified 12 key drug-drug interaction that can increase falls risk

12 Least Restraint Philosophy: Approach to Care Electric Low Bed Prior to 2014 Equipment rental and owned options: electric & manual regular hospital beds April 2014 Introduction of electric low bed and falls mat owned Electric Low Bed Falls Mat January 2015 Introduction of least restraint policy 12 March 2016 Electric low bed and falls mat rental options and increased owned beds

13 Full and Partial Rail Utilization Total Number of Active Patients with Full Rails Total Number of Active Patients with Partial Rails 13

14 Central LHIN RAI Reports: Equipment and RAI Data Replicate Report for Active Patients with Partial Rails 14

15 New: Low Electric Hospital Bed Report 15

16 Multi-Faceted Education Strategy Patient and Family Fall Prevention Resources Centralhealthline.ca: Fall Prevention Fall Prevention Month: Scenario and Video Falls Video - Youtube 16 Intranet Sites Webinars and Case Study Discussion Face-to-Face Education Reflective Practice & Critical Thinking

17 Collaborative Partnerships Central LHIN Home and Community Care collaborates with: Ø Hospitals, long-term care homes and retirement homes Share resources and provide fall prevention and least restraint education Ø Service Provider Organizations Develop and implement QIP Change Ideas Collaborate on fall prevention education Share fall prevention and least restraint resources Ø Healthy Aging Working Group 17 Ø Ministry-funded Group Exercise Classes and Fall Prevention Programs Complete RAI assessments for program participants

18 Collaborative Partnerships Continued The Goal: q Working towards the creation of a Central LHIN-wide Fall Prevention Strategy ü LHIN Collaborative Integrated Falls Prevention Framework and Toolkit ü Healthy Aging Working Group ü Establishment of the Fall Prevention Strategy Committee 18

19 Summary and Reflections: Key Learnings Implement a multi-pronged strategy to shift practice, Everyone has a role to play! Utilize an integrated and collaborative education strategy Provide ongoing patient, family and caregiver education Awareness of patient values and cultural backgrounds, which influences individuals choice Increased focus on reducing injuries from falls 19

20 Next Steps Continue to use data and fall reports to support practice and process adjustments Collaborate on educational activities and share resources Continue to review risk event data, identify trends and implement improvement activities aligned with QIP goals Track and promote increased e-referrals to group exercise classes and fall prevention programs Take a coordinated approach to Fall Prevention Month campaigns Continue working towards a Central LHIN-wide integrated Fall Prevention Strategy 20

21 Fall Prevention Resources 21

22 Presenters Contact Information Debbie Barton: Susan Bonomo: Jessica Ng: Jennifer Wright: 22

23 Questions? 23