Working Together to Improve Patient Safety...Innovations in Fall Prevention. My Hope: My Goals. Challenges

Transcription

1 Workig Together to Improve Patiet Safety...Iovatios i Fall Prevetio Pat Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAAN Nurse Cosultat Former Associate Director, VISN 8 Patiet Safety Ceter Former Associate Chief for Nursig Service/Research My Hope: Chage practice beyod usual care of prevetio ad protectio Geerate Cofidece i Chage Embrace Iovatio Ispire Successful Implemetatio pquigley1@tampabay.rr.com My Goals Challege ad Ispire you to add precisio through the use of AvaSys to your patiet safety practices ad redesig fall prevetio cliical practices to protect patiets from Ijurious Falls as your orgaizatio s Primary Outcome Challeges What are the challeges for ipatiet facilities 4 1

2 Patiet Harm remember the ews? IOM: To Err Is Huma, Shapig the Future of Healthcare (1999) 48,000 perhaps as much as 95,000 die each year i hospitals as a result of medical errors that could be prevet Dr. J. James 2013 Update Provided updated estimate of patiet harm Examied studies MDs had to cocur o fial adverse evets the classify the severity of harm True umber of premature deaths associated with prevetable harm estimated at more tha 400,000/year Serious harm fold more commo tha lethal harm Patiet Safety America, Housto, TX. A ew, evidece-based estimate of patiet harms associated with Hospital Care (2013). Joural Pt Safety, 9: Coclusios Epidemic of patiet harm i hospitals must be take serious if to be curtailed Fully egage patiet ad their advocates durig hospital care Systematically seek the patiet voice i idetifyig harms Trasparet accoutability for harm Itetioal correctio of root causes of harm Do you agree? The actio ad progress i patiet safety is frustratigly slow These estimates cause outcry for overdue chages ad vigilace We ca do better 2

3 Falls: The Big Picture > 1millio patiet falls occur aually 20% of all hospital ipatiets i US least 1X durig hospital stay 30% result i ijury 10% result i serious ijury fracture, head trauma Over 95% of hip fractures are caused by falls Patiets >75 years ow comprise 22% of hospital admissios Falls at Bedside Agig Hospital Populatio: % of the ipatiet hospital populatio i the US was 65 years of age ad older amog whom 19% were ages 75-84, ad 9% 85 ad older Levat, S., Chari, K., & DeFraces, C.J. (2015). Hospitalizatios for patiets age 85 ad over i the Uited States, NCHS Data Brief. No Available at: hppt:// 3

4 Fial 2014 AHRQ Natioal Scorecard Data o HACs Where are we? Chage i HACs, (Total = 3,097,400) 2.4% decrease i falls but more work to do 2,750 lives saved but we ca save more Natioal Scorecard Estimates from Medicare Patiet Safety Moitorig System, Natioal Healthcare Safety Netwo Healthcare Cost ad Utilizatio Project. Targeted Itervetios Prevetio + Protectio + Surveillace Prevetio The act of prevetig, forestallig, or hiderig Plus Protectio Shield from exposure, ijury or destructio (death) Mitigate or make less severe the exposure, ijury or destructio Plus Surveillace Detectio 5 Essetials to Protect from FRI Programmati c Shift Assess to protective itervetios Chage i assessmet structures: add risk for FRI ad Hx of FRI You ca protect patiets from ijurious falls Chage i itervetios : Evirometa l Redesig Orgaizatio al Support 4

5 2007 JCAHO Stadard: Fall Prevetio Program Establish a Fall Prevetio Program Evaluatio Itervetios Educate Staff Educate Patiets ad Families Program Evaluatio Sept 28, 2015: TJC Setiel Alert: Prevetig Falls ad Fall Ijuries Suggestios from TJC Lead efforts to raise awareess of the eed to prevet falls resultig i ijury Establish a iterdiscipliary falls ijury prevetio team or evaluate the membership of the team i place Use a stadardized, validated tool to idetify risk factors for falls Develop a idividualized pla of care based o idetified fall ad ijury risks, ad implemet itervetios specific to a patiet, populatio or settig Suggestios co t Stadardize ad apply practices ad itervetios demostrated to be effective, icludig: A stadardized had-off commuicatio process Oe-to-oe educatio of each patiet at the bedside Coduct post-fall maagemet, which icludes: a post-fall huddle; a system of hoest, trasparet reportig; tredig ad aalysis of falls which ca iform improvemet efforts; ad reassess the patiet Coduct a post-fall huddle Report, aggregate ad aalyze the cotributig factors o a ogoig basis to iform improvemet efforts. Shiftig From Reducig Falls to Protectig from Fall Related Ijury Itegrate Ijury Risk /History o Admissio Implemet Uiversal Ijury Reductio Strategies Implemet Populatio-Specific Fall Ijury Reductio Itervetios 5

6 Hospital Falls: D. Oliver, et al. Falls ad fall-related ijuries i hospitals. (2010, Nov). Cliics i Geriatric Medicie. 30% to 51% of falls result with some ijury 80% - 90% are uwitessed 50%-70% occur from bed, bedside chair (suboptimal height) or trasferrig betwee the two; whereas i metal health uits, falls occur while walkig Risk Factors: Recet fall, muscle weakess, behavioral disturbace, agitatio, cofusio, uriary icotiece ad frequecy; prescriptio of culprit drugs ; postural hypotesio or sycope Most effective, fall prevetio itervetios should be targeted at both poit of care ad strategic levels Best Practice Approach i Hospitals: Implemetatio of safer eviromet of care for the whole patiet cohort (floorig, lightig, observatio, threats to mobilizig, sigpostig, persoal aids ad possessios, furiture, footwear) Idetificatio of specific modifiable fall risk factors Implemetatio of itervetios targetig those risk factors so as to prevet falls Itervetios to reduce risk of ijury to those people who do fall (Oliver, et al., 2010, p. 685) Itervetios: Fall ad Ijury Prevetio Program Fall risk Maagemet Program Falls Coordiator Goal Settig Evidece-based risk assessmet tool ad detailed maagemet strategies Tailored Care Pla based o assessmet ad PT, OT, Medical ad Specialist Referrals Redesiged use of sigage Fall ad Ijury Risk Reductio Limits to Sciece Failure to Differetiate Type of Fall Accidetal Aticipated Physiological Uaticipated Physiological (Morse 1997) Failure to Lik Assessmet with Itervetio 6

7 What ca we chage to move faster? Curret Itervetios are Not Workig Curret situatio: Over-reliace o Fall Risk Screeig Isufficiet Risk Assessmet Lack of Differetial Diagosis: Pathophysiology Uderlyig Fall Risk Factors Udetermied Rage of Severity Do t kow vulerability Level of Risk Uderstad that just about everyoe is at risk for a fall Let s STEP UP our game! Set ad be accoutable for achievig bold goals. I our care: No oe dies from a fall No oe breaks a hip Mitigate or elimiate patiets' modifiable fall risk factors Prevetio Patiets are still fallig Uiversal fall precautios are isufficiet Plus Protectio Patiets are still gettig ijured Staff are reluctat to adopt fall ijury itervetios Plus Surveillace Most Falls are still Uwitessed Over-reliace o bed alarms PROTECTION: Protect from Ijury Protectig Patiets from Harm Our Moral Imperative Biomechaics of Fall- Related Ijuries Uderstadig the rate of splat ad its impact o ijury 7

8 Falls from High Bed: Foot First Falls from Low Bed: Foot First Bedside Mats Fall Cushios Summary of Results Feet First Fall from Bed bedside fall cushio Floor Mat Floor Cushio No Floor Mat fall over top of bedrails: ~40% chace of severe head ijury No Floor Mat, low bed (No Bedrails): ~25% chace of severe head ijury Tri-fold bedside mat Roll-o bedside mat Soft Fall bedside mat Low bed with a Floor Mat: ~ 1% chace of severe head ijury 8

9 Techology Resource Guide: Bedside Floor Mats Hip Protectors Bedside floor mats protect patiets from ijuries associated with bed-related falls. Targeted for VA providers, this web-based guidebook will iclude: searchable ivetory, evaluatio of selected features, ad cost. Hip Protectors Examples Hip Protector Toolkit This web-based toolkit will iclude: prescribig guidelies stadardized CPRS orders selectio of brads ad models sizig guidelies protocol for replacemet policy template lauderig procedure stockig procedure moitorig tools patiet educatio materials provider educatio materials 9

10 Moderate to Serious Ijury: A, B, C, S Those that limit fuctio, idepedece, survival Age Boes (fractures) Bleeds / AtiCoagulatio (hemorrhagic ijury) Surgery (post operative) 37 Uiversal Ijury Prevetio Educates patiets / families / staff Remember 60% of falls happe at home, 30% i the commuity, ad 10% as ipts. Take opportuity to teach Remove sources of potetial laceratio Sharp edges (furiture) Reduce potetial trauma impact Use protective barriers (hip protectors, floor mats) Use multifactorial approach: COMBINE Itervetios Hourly Patiet Rouds (comfort, safety, pai) Examie Eviromet (safe exit side) Age: > 85 years old Educatio: Teach Back Strategies Assistive Devices withi reach Hip Protectors Floor Mats Height Adjustable Beds (low whe restig oly, raise up bed for trasfer) Safe Exit Side Medicatio Review 10

11 Boes Hip Protectors Height Adjustable Beds (low whe restig oly, raise up bed for trasfer) Floor Mats Evaluatio of Osteoporosis Bleeds/AtiCoagulatio Evaluate Use of Aticoagulatio: Risk for DVT/Embolic Stroke or Fall-related Hemorrhage Patiet Educatio TBI ad Aticoagulatio: Helmets Wheelchair Users: Ati-tippers Surgical Patiets Pre-op Educatio: Call, Do t Fall Call Lights Post-op Educatio Pai Medicatio: Offer elimiatio prior to pai medicatio Icrease Frequecy of Rouds It is time to Thik out of the Box 11

12 Use of Video Surveillace Patiet Egagemet Fail Teach Back Able to get out of bed Cogitively Impaired Impulsive Assisted Toiletig Over estimate abilities (NOT At Risk for Falls) Where Surveillace is Needed Patiet Room Hallways Diig Rooms Shiftig: All Natioal Guidelies From Reducig Falls to Protectig from Fall Related Ijury. Itegrate Ijury Risk / History o Admissio. Implemet Uiversal Ijury Reductio Strategies. Implemet Populatio-Specific Fall Ijury Reductio Itervetios. Add Patiet Egaged Surveillace Rehabilitatio Nursig Article Sequetial Cohort Study 15 video moitorig uits o high risk uits bed ipatiet rehab hospital 12 moths Outcome reduced average hospital rate of falls 6.34 / 1000 hospital patiet days to (t (31) = 2.034, p=.0496) Brai Ijury Uit: falls / 1000 hospital patiet days to 6.87 falls/1000 pt days (t(18)=2.647, p=0.16) Coura, M., Fusco-Gessik, B., Wright, L. (2016). Improvig patiet safety through video moitorig. Rehabilitatio Nursig, 0:

13 Other Fidigs 95 itervetios every 24 hours 28 falls by patiets o video moitorig over total of 3,641 patiet-days 37 falls for o-moitored patiets over 5,788 patiet days Note: did ot limit falls to those uder surveillace Nursig Ecoomic$ Article Prospective Descriptive Study Durig the itervetio phase, video moitorig was implemeted o three ursig uits. Te to twelve patiet were moitored each day based o ursig assessmet of high fall risk combied with some level of cofusio. Fall Reductio Results: Statistically sigificat decrease i falls by 35% (p<0.0001, 95% CI) Baselie (9 moths) Itervetio (9 moths) Falls Fall Reductio 85 Results 53 Total Statistically Pt Discharges sigificat decrease 5,109 i falls by 35% (p<0.0001, 5,041 9% CI) Fall/Pt discharge 1.7% 1.1% Votruba, L., et al, Video Moitorig to Reduce Falls ad Patiet Compaio Costs for Adult Ipatiets, Nursig Ecoomics, July/August AvaSure Holdigs, Ic. All rights reserved. Process Outcomes Telesitters redirected patiets 5,413 times (avg 10xs / shift) 828 patiets moitored 13 had a fall (avg moitor 2.5 days) 4,213 patiets ot-moitored 40 falls Aualized avoidace of 37 falls / year for the 3 itervetio uits Avoided $52,000-$87,000 fall cost Combied with reduced sitter use, saved $77,200- $112,000 / year Patiet Outcomes Reduced Falls (True Positive) Reduced Falls with Ijury Reduced Sitter Usage Elimiatio of Alarms 13

14 Additioal Outcomes Shift i Nursig Beliefs: Nursig culture ca shift ad trust ad use ew techology to improve patiet safety ad outcomes Real-time Surveillace decreases oise, stimulatio ad alarms, ad icreases rest ad sleep Real-time Surveillace provides better focus for ursig practices as the observers are more fully preset Falls ca be preveted beyod the bedroom, such as to the day room, the hallway The Beefits of Video Moitorig Data: Motivates staff towards results Utilizatio data at your figertips to help with chage maagemet Iforms cliical decisio-makig Optimizes operatioal maagemet of video moitorig program Evet ivestigatios Staff resposiveess (respose times, alarm fatigue data) Begis to provide isight ito what causes falls ad other adverse evets 2015 AvaSure Holdigs, Ic. All rights reserved. Solutios Solutios are are ot ot always always obvious obvious Push the Easy Butto for Gettig Support ad Buy-I 14

15 We are all here to help... Ad if I ca help you more, I m oly a away Questios ad Commets? pquigley1@tampabay.rr.com Discussio I hope this helps! 15