Southern Hospitals Network Falls Prevention Initiatives
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1 Southern Hospitals Network Falls Prevention Initiatives Christine Quinn - Medical Stream Clinical Systems Manager Gaye Sykes - Quality Manager Port Kembla Hospital
2 Background. Medical Stream Falls Working Party + 2. Port Kembla / Coledale Falls Working Party (Both operational since 2005) Merged and expanded to become 3. Southern Sector, SESIAHS Falls Working Party
3 Medical Stream Working Party encompasses representation from: Wollongong Hospital: B8 Inpatient Renal Unit CCU / SACCU B7 Medical / Acute Geriatric Ward Cardiac Diagnostics Centre C4 Neuroscience Ward C3 Medical Ward Nuclear Medicine Endoscopy Unit Medical Ambulatory Care Ward Renal Dialysis (Helensburgh to Nowra) Department of Respiratory Medicine Clinical Decision Unit Shellharbour Hospital: Medical Ward Medical Respiratory Ward Special Care Unit Renal Dialysis Unit Kiama Hospital: Medical Ward Bulli Hospital: Bulli Acute Geriatric Unit Geriatric Day Unit Illawarra Diabetes Service (Helensburgh to Milton)
4 Medical Stream Falls Working Party Initiatives Analysis of contributing factors for falls Developed NIHG Falls Prevention Policy / Procedure Purchase of Lo-Lo Beds 2 wards at TWH Trial of stand-up alarmed pressure pads for the wards Falls Prevention Program Info Brochure for new staff Falls Prevention equipment Trade Display
5 Falls Assessment Tool: On Admission: Score patient according to criteria. If total score > 3 implement High Risk for Fall Protocol If patient scores 3 or more on assessment tool, implement the following protocol. ACTIVITY PROTOCOL SCORE Mobility Ambulates independently Uses assistive devices Requires assistance to ambulate Unable to ambulate or transfer Eliminate Independent with elimination History of nocturia/incontinence Requires assistance with elimination Medications No high risk medications Antihypertensives/aperients/ diuretics/anticonvulsants/ Antiparkinsonian/benzodiazepines/psychotropics Sensory Nil sensory deficits Status Mental Status Age Visual, Audio, sensory deficit Alert & oriented Periodic/Nocte confusion History of confusion The Risk Assessment is to be completed at least once daily whilst the patients are in hospital Other Falls Prevention Strategies include: Maintenance of load bearing exercise as a routine part of lifestyle eg. Tai Chi, walking. Assessment of mobility, balance and gait among those with early symptoms of contributing diseases Maintenance of a diet with adequate calcium and vitamin D Maintenance of BMI at levels that provide adequate bone density, but below that which leads to cardiovascular risks Assessment of the fall risk impact of medications and where necessary management of medication intake Routine maintenance of visual acuity Home modifications that reduce the risk of fall injury Treatment for acute and emerging chronic conditions should be assessed to ensure that it does not lead to long term, increased risk of fall injury in later years. FALLS CAN BE PREVENTED! NIHG Falls Prevention Program SHN Reporting Falls Using IIM s: All falls and near misses are reported using the electronic software program called IIM s (Incident Information Management System). If you require training on how to use this system, please discuss this with your NUM / HOD. Developed by NIHG Medical Stream Falls Working Party July 05 Staff information brochure
6 Dark room Muscle spasm Medical Stream Working Party Analysis of contributing factors Medical Stream - Contributing Factors for Falls 6/5/05-5/7/ Cognitive impairment / Confusion Non-co mpliance with asking for assistance Socks No safety straps on chairs / commodes Staff busy Unassisted by staff Tired / lack of sleep Unsteady gait Brakes not applied on commode Legs gave way Dizziness Hypotensive Urgency to go to toilet Lost balance Slipped on bathroom floor Climbed over bed rails Walking briskly Bed rails down Sitting on a cushion & slipped Hypoglycaemia Urine bag leaking / slipped on wet floor Misjudgement of distance to bed / chair Item not within reach eg. urine bottle Contributing factors Incidence
7 Port Kembla & Coledale Falls Working Party Founded in rehabilitation wards and aged care ward between the two hospitals Multidisciplinary team with medical input Regularly teleconference meetings Formed to standardise practice
8 Port Kembla & Coledale Falls Working Party Initiatives Falls Prevention Procedure Falls Risk Assessment Tool (modified Schmid Tool) Preventative Maintenance Program and Register Manual Handling Flip Charts across all 4 wards Annual Falls Education Program Falls Prevention information in different languages Falls information provided prior to admission to Rehab.
9 Manual Handling Flip Charts Mobility Assessment
10 Lite Gait Equipment A hydraulic hoist system used to assist manual handling and safety of dependant patients to learn to sit, stand and walk during rehabilitation. Benefits include: risk of patient falls Risk staff manual handling injuries Ability for patients to participate in mobility practice
11 Port Kembla Hospital Outpatient Falls Screening Clinic Pilot program providing services to patients from Towradgi to Dunmore. Run by Domiciliary Physiotherapists Referrals from PKH Specialists or Physiotherapists (internal) Interventions include: Falls Screening (Lord Falls Screen Short Tool); TUAG; home mobility assessments; home safety checklist/falls prevention; education; equipment prescription; exercise prescription and referral to other support services.
12 Port Kembla Hospital Outpatient Falls Screening Clinic Outcomes to date include: 47 clients have been assessed between April 2005 and August 2006 Fallscreen reviews are conducted at 6 months, since November 2005 Of 0 reviews undertaken, 7 had an improved Falls Risk Score and 3 were worse
13 Southern Hospitals Network (SHN) Falls Prevention Working Party Formed in 2006 Representation from hospital and community health services between Milton to Coledale, including Population Health Multidisciplinary team Teleconference meetings to remote sites Formed to establish a coordinated approach to falls prevention across the Sector
14 Aim of the Southern Hospitals Network (SHN) Falls Prevention Working Party To work collaboratively with services across the Southern Sector, SESIAHS Establish a coordinated approach to falls to falls prevention Develop and implement strategies that ensures a reduction in the incidence of falls & injury resulting from falls. Community Health Community Acute Hospital Services Population Health Programs Aged Care Facilities Rehabilitation
15 Initiatives of Southern Hospitals Network (SHN) Falls Prevention Working Party Standardised Staff Information Brochure Falls Prevention Developed SHN Falls Prevention Policy Draft two year Business Plan
16 Business Plan Overview ( ): Two year plan Incorporates strategies outlined in the NSW Health PD2005_353 & the SESIAHS Falls Prevention Plan Includes recommendations from working party programs eg. Manual Handling flip charts, staff information brochure Ideas for the plan were generated from a SWOT Analysis
17 Business Plan Sample Key Strategies Standardise Falls Prevention Education Program Develop annual Falls Prevention promotion e.g. April Falls Day Co-ordinated approach to use of Validated Falls Risk Assessment Tools Develop links with Community Health and Population Health programs Explore funding opportunities for equipment and AIN Patient Observer programs
Southern Hospitals Network Falls Prevention Initiatives. Gaye Sykes - Accreditation / Quality Manager Wollongong Hospital
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