Staff at Grace Hospital cut inpatient injuries due to falls

Staff at Grace Hospital cut inpatient injuries due to falls

Winnipeg Health Region
Wave, January / February 2011

A new program designed to enhance patient safety has helped Grace Hospital cut its inpatient falls rate by more than half, hospital officials say.

Colleen Bytheway, Clinical Projects Manager, says changes in the way nurses interact with patients helped reduce the falls rate at the hospital from seven per 1,000 to less than three per 1,000. The falls rate on one specific medical unit decreased from 15 in February to zero in June. Every other unit that had implemented the model has also seen a decrease in the number of falls from March to July.

"That's huge," says Bytheway in reference to the reduction in falls.

The dramatic improvement follows the hospital's decision to implement the Hendrich II Fall Risk Model. Developed in Indiana by Anne Hendrich, a nurse who made falls prevention her business, the program is recognized in the United States by the Joint Commission on Accreditation of Health Care Organizations (JCAHO).

Under the program, nurses changed the way they assessed patient risk. Nurses on 10 acute care units at the Grace used to assess patients for risk of falling once a week. Now they do it every shift. "Fall risk for acute care patients can change. Assessment and intervention are essential. We can't predict all falls, but we can reduce the risk," says Bytheway.

The model has only been implemented by one other hospital in Canada, located in Ontario. "They have had good success. There really was nothing on falls in acute care in Canada. It is a huge area for development."

The program underway at Grace is just one example of how the Winnipeg Health Region is working to reduce falls at hospitals, personal care homes and other facilities throughout the city.

"Falls are a serious problem for our patients and residents," says Kaaren Neufeld, Chief Quality Officer for the Winnipeg Health Region. "We recognize that, and we are working on a number of fronts through the Regional Falls Prevention Leadership Committee to bring leading practices for falls reduction and injury prevention to every point of care delivery."

The Region is not alone. While most health-care authorities across the country have some type of falls prevention program, efforts are underway to strengthen them as part of new hospital accreditation requirements for 2010-2011.

At the Grace, Bytheway started looking at ways to enhance the hospital's 20-year-old program in 2008. "I looked at many studies. Most studies discussed interventions not applicable to acute care."

When Bytheway discovered the Hendrich II Fall Risk Model, she was happy to find the whole package, including online training for hospital staff. She pitched the model to the hospital's senior management, convincing them it was worth the cost to implement an American program. "They went for it."

Next, a multidisciplinary working group with representatives from various hospital disciplines met on a regular basis in order to work out the details of implementation.

Among the challenges were finalizing a legal agreement with the U.S.-based company, and meeting privacy laws when providing staff e-mail addresses to the company for training purposes.

Mandatory training for nurses started last February. Nurses from 10 units successfully completed the training that required passing a test. Health-care aides attended classroom training. New hires complete the same training as part of their orientation every month.

"It's about constant, common practise," says Bytheway. "Grace Hospital is a leader in acute care with this program. We are doing all we can to reduce the risk of falls."

As part of the program, nurses and health-care aides work in collaboration with physiotherapists and occupational therapists to develop a plan for each patient. Housekeeping, diagnostic imaging and other staff members are also aware that a patient is at high risk of falling because a yellow caution sign is posted at the head of their bed, on their chart, on their kardex, and chained to their walker or IV pole. As well, posters in every patient's bathroom encourage them to call not fall, and fall prevention pamphlets and posters are displayed around the wards.

"It's key to get staff to understand that we can mostly predict who can fall and we can work together and do all we can to prevent it. Now that we have implemented it, the challenge will be to keep it moving, to keep fall prevention in mind always," says Bytheway.

Using the Hendrich II Fall Risk Model costs the Grace Hospital $6,000 a year but that is only a fraction of the $18,000 to $30,000 cost for the average hospital stay for one hip fracture caused by a fall. "Up to 50 per cent of patients can die from a hip fracture. This injury is a serious risk to many of the elderly. Elderly people who fall are also at risk of serious head injury. Many of our patients are older adults."

Lessons from the program at Grace are being shared with hospitals in Winnipeg through the Regional Falls Prevention Leadership Committee. Likewise, other programs and sites are experimenting with ways to reduce falls and will share their findings with the committee.

Staff at personal care homes are also looking for new approaches to enhance safety. "Falling is a huge problem for our population," says Luana Whitbread, one of two clinical nurse specialists in the Region's Personal Care Home Program. "It can be a recurring problem. We may not stop all falls but we can try to minimize injury."

There are about 5,700 residents in the Region's 38 personal care homes. Their average age is about 85. These people are almost always elderly and frail, and are in the highest risk group for falls and injuries.

The Region's personal care homes report an average of 18,000 falls per year. But it is important to note that only one per cent of reported falls result in major injury, and the Region has a strategy for mitigating injuries from falls.

In 2007, a working team was created to determine how to address the issue of falls within personal care homes. One of the goals was a standardized approach to enhance the good work that what was already being done in many of the personal care homes. The falls working group developed a clinical practice guideline that offers personal care homes current best practices. They also developed a standardized way to respond to falls, and a post-fall protocol, which provided consistent measures to follow once a resident has fallen. The falls prevention strategy advises staff of what they can do in order to help prevent and minimize injuries from falls.

Among the changes was an increase in the awareness of the value of fall risk assessments. Now when a resident comes into a personal care home, they are assessed for their risk to fall within 24 to 48 hours. Factors such as history of falling, medications, mobility, cognitive status, and more are considered. The score is recorded and interventions developed to create a plan of care for the individual.

As well, if a resident falls, or any of the factors change, the plan is reviewed, changes are made as required, and all staff caring for the person are advised of what to do. "We would like to prevent as many falls as possible, and reduce injuries where prevention may not always be possible," says Whitbread. "We need to keep thinking about falls, especially with our resident population. We need to assess residents and plan our care and change our plans when necessary in order to keep those at risk of falling safer."

For example, if a resident is mobile, ensuring the person wears proper shoes, lives in a safe, clutter free environment, and takes Vitamin D and important medications is crucial. "What people do to prevent falls at home can be done here, adapted for our population and our environment. We try to offer resident-centred care, which means our approach and plan of care is not the same for everyone."

In the New Year, there are plans to develop an informative brochure for families of personal care home residents. As well, Regional clinical practice falls prevention guidelines will be introduced for acute care, long-term care and the community.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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