HRET HIIN Falls Virtual Event

Transcription

1 HRET HIIN Falls Virtual Event Preventing Falls: Goodbye Bundle, Hello Care Plan! September 12,

2 WELCOME AND INTRODUCTIONS Radhika Parekh, MHA, Program Manager HRET 2

3 Fall Awareness Day is coming September 22,

4 Webinar Platform Quick Reference Mute computer audio Today s presentation Chat with participants Download slides/resources Register for upcoming events 4

5 Poll: How did you hear about this event? How did you hear about today s virtual event? a. HRET HIIN flyer b. HRET HIIN website c. HRET LISTSERV d. State hospital association e. QIN-QIO f. Your organization/colleague g. Other, please specify 5

6 Agenda for Today 6

7 HIIN FALLS DATA REVIEW Vrinda Mahishi, MPH, Data Analyst HRET 7

8 Falls Rates 8

9 Jackie Conrad, BSN, MBA, CIC Improvement Advisor, Cynosure Health LET S GET FOCUSED! FRAMING THE DISCUSSION 9

10 Poll: Tell us about your falls protocol Does your organization s fall protocol include an individualized fall prevention plan specific to each patient s risks factors? Yes No Not Sure 10

11 IMPLEMENTING AN EVIDENCE-BASED FALL PREVENTION PROGRAM: Fall T.I.P.S. (Tailoring Interventions for Patient Safety) Megan Duckworth Center For Patient Safety Research and Practice Brigham And Women s Hospital Boston, MA 11

12 Fall T.I.P.S. (Tailoring Interventions for Patient Safety) 2 year mixed methods study funded by Robert Wood Johnson Foundation: Qualitative phase: why do hospitalized patients fall? what interventions are effective and feasible in hospital settings? Randomized control trial: to test a fall prevention toolkit designed to address issues identified during qualitative phase Supported by the Robert Wood Johnson Foundation, Dykes PI 12

13 Qualitative Findings Communication related to fall risk status and the plan to prevent falls is highly variable. Fall prevention plans designed based on risk status, not individual risk factors for falls. Inconsistent communication across team members is a barrier to fall prevention collaboration and teamwork. Non-nursing team members do not view fall risk assessment/plan in medical record. Inadequate, incomplete, or incorrect information at the bedside (i.e., generic high risk for falls signs are not useful). All stakeholders (care team members, patients and family members) must work together to prevent patient falls. 13

14 The Fall TIPS Toolkit Requirements 14

15 The Fall TIPS Toolkit: Risk Assessment and Tailored Plan Fall risk assessment Tailored plan

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17 Findings Patient falls were significantly reduced on intervention units. There were fewer falls in intervention units than in control units Patients aged 65 or older benefited most from the Fall TIPS toolkit No significant effect was noted in fall related injuries

18 Fall Prevention Lessons Learned Strategies and tools to facilitate the 3-step fall prevention process will prevent patients from falling!

19 Fall Prevention Lessons Learned Fall TIPS reduced falls by 25% but >90% of falls are preventable what happened? Why did some patients with access to the Fall TIPS Toolkit fall? What factors are associated with falls in younger patients? What factors are associated with falls in older patients? Secondary analysis of fallers (cases) n=48 and 144 matched controls exposed to the Fall TIPS toolkit* Found that in all cases, planned interventions were not followed consistently by the patient (most frequently) or the nurse i.e., Out of bed with assistance How do we get patients to CONSISTENTLY follow their fall prevention plan? Dykes PC, I-Ching EH, Soukup JR, Chang F, Lipsitz S. A case control study to improve accuracy of an electronic fall prevention toolkit. AMIA Annu Symp Proc. 2012; 2012:170-9.

20 Poll: Tell us about your falls protocol Does your organization s fall protocol include patient engagement? Yes No Not Sure 20

21 Rationale for Patient Engagement in 3-Step Fall Prevention Process Facilitates patient understanding of personal fall risk status and the plan to prevent a fall. Promotes patient understanding of their role in fall prevention. Facilitates patient (and family) partnership in ensuring that the plan is carried out consistently. A common reason why patients fall is that planned interventions are not followed consistently by the patient (most frequently) or the team* *Dykes PC, I-Ching EH, Soukup JR, Chang F, Lipsitz S. A case control study to improve accuracy of an electronic fall prevention toolkit. AMIA Annu Symp Proc. 2012; 2012:170-9.

22 Laminated Fall T.I.P.S. Tool John 05/12/2016 1

23 Implementation Framework for Spread Key Components: Set-up expectation for change Involvement of peer champions Continuous monitoring and feedback Framework for Spread: helps participants consider implementation requirements, develop a communication plan, and design strategies to promote adoption by staff.

24 Poll: Champions Does your falls program utilize champions? Yes No Not Sure 24

25 Laminated Fall TIPS: Pilot Study Results Fallsper thousand patient days Average Fall Rate 2015 vs with Average Fall TIPS Completion In Press: Dykes PC, Duckworth M, Cunningham S, Dubois S, Driscoll M, Feliciano Z, Ferrazzi M, Fevrin F, Lyons S, Lindros M, Monahan A, Paley M, Jean- Pierre S, Scanlan M. Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit. The Joint Commission Journal on Quality and Patient Safety Percent of Fall TIPS complete Falls with injury per thousand patient days Average Fall TIPS Completion Pre-intervention mean fall rate: 3.28 Post-intervention mean fall rate: 2.80 Fall TIPS Adherence: 82% Pre-Fall TIPS Fall Rate: 3.28 Post Fall TIPS Fall Rate: 2.80 Pre-Fall TIPS Injury Rate: 1.00 Post Fall TIPS Injury Rate:.54 Average Fall Rate with Injury 2015 vs with Average Fall TIPS Completion Percent of Fall TIPS complete Average Fall TIPS Completion Pre-intervention mean fall with injury rate: 1.00 Post-intervention mean fall with injury rate: 0.54

26 Poll: Surveillance Does your fall protocol include auditing of fall prevention process measures? Yes No Not sure Examples of Fall Process Measures: Fall Plan initiated within 4 hours of admission Fall agreement posted Patient able to describe personal fall risks and plan Fall or mobility plan updated on whiteboard Fall plan discussed in bedside report Assistive device accessible Pathway uncluttered 26

27 Overcoming Barriers* to Adoption and Sustainment Barriers to Adoption of Evidence- Based Fall TIPS Toolkit Lack of Awareness Lack of Familiarity Lack of Agreement Lack of Self-efficacy Lack of Outcome Expectancy Inertia of Previous Practice External Barriers 27 Strategies for Overcoming Barriers Leverage existing governance structures to hold Fall Prevention Week Peer feedback from champions and leaders; just in time training Emphasize the evidence behind Fall TIPS; remind staff that tailoring the plan relies on clinical judgment Encourage questions and provide additional coaching Share data outcomes with staff; display posters displaying protocol adherence and fall rates Implement random audits to ensure workflow and cultural change around engaging patients in 3-step fall prevention process Investigate non-adherence to the protocol- there may be an environmental barrier like a lack of dryerase markers! *Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA : the journal of the American Medical Association. Oct ;282(15):

28 Evidence-based Fall Prevention Recap Most patient falls are preventable An evidence-based fall prevention program includes the following components: Universal fall precautions 3-Step Fall Prevention Process: Fall risk assessment Tailored fall prevention care planning Consistent implementation of the tailored care plan Post fall management Implementation requires a continuous quality improvement, interdisciplinary, team-based approach

29 Open Mic 29

30 Reactions from the Field 30

31 Fall TIPS Implementation tool kit Fall TIPS Implementation Protocol Fall TIPS Instruction Sheet for Nurses Power Point Training Slides Fall TIPS tool for printing and laminating 31

32 Implementation Must Haves Organizational support Involve practice council and unit nurses Recruit Champions Train all involved staff on tool and risk assessment Track progress weekly Completion of tool within 24 H and every day Tool accurate and up to date? Days since last fall Provide Continuous feedback to staff 32

33 Poll: Gaging Interest Is your team interested in piloting the Fall TIPS tool on a small scale in your organization? Yes No Maybe 33

34 Feedback for Next Steps Please use the chat box to tell us what implementation support would help you to pilot the Fall TIPS tool. 34

35 Next Steps to Access the Tool Assemble your falls or mobility team Review the article and the tool Identify a leadership champion Identify pilot testing unit Identify a staff champion Register to receive the toolkit: here Attend the follow up Fall TIPS Event on October 19, Register here 35

36 BRING IT HOME Radhika Parekh, MHA, Program Manager HRET 36

37 9/22 Fall Awareness Day Resources Patient Resources Clinician Resources NCOA.org STEADI.gov 37

38 9/22 Fall Awareness Day Activities Sample Activities Fall Awareness Table with materials for patients and clinicians (NCOA.org and STEADI.gov) Fall Games Falls Bingo, Crossword puzzles and Word Find (stopfalls.org) House of Horrors how many fall risks can patients, staff and visitors find in a room set up? Organization or Community Proclamation Community Screenings for Fall Risk, Balance and Strength Assessment, Medication Review Disseminate STEADI resources to primary care providers 38

39 FALLS CHANGE PACKAGE Link to Falls Change Package: For more resources on Falls, visit 39

40 FALLS TOP 10 CHECKLIST Link to Falls Top 10 Checklist: ecklist.pdf For more resources on Falls, visit 40

41 LISTSERV Join the LISTSERV Ask questions Share best practices, tools and resources Learn from subject matter experts Receive follow up from this event and notice of future events Sign up at 41

42 Upcoming Events HRET HIIN Diagnostic Stewardship Virtual Event Topic: Diagnostic Error Webinar: September 19, :00am - 12:00pm (CT) Diagnostic errors come in many flavors, but over diagnosis - when you label someone with a condition they don't really have - often causes more harm than it is intended to prevent. Diagnostic stewardship is an emerging set of principles and methods to reduce avoidable diagnostic errors. During this interactive webinar, hear from leading national experts on diagnostic stewardship that describe an emerging literature and pragmatic ways to prevent the waste of time, energy, money and ultimately harm to patients that occurs all too often in hospitals. Bring your topics and questions to ask the experts. This webinar is valuable for QI, clinical laboratory, nursing and physician leadership - diagnostic stewardship is definitely a team sport. Register 42

43 Thank You! Find more information on our website: Questions or Comments: 43