IHM
IQVIA

The problem Preventing inpatient falls has been a problem for the acute sector for many years and is associated with high risk for both the patient and the organisation. Approaches to risk reduction are complex because of the many factors involved and the published advice is plentiful. The challenge is to develop an approach which is both effective and sustainable.

Aintree’s solution Our approach was multi-disciplinary, inclusive (with a focus on engagement) and locally owned by empowered staff; this we achieved through the Aintree Falls Prevention Collaborative. Launched in April 2014, the Collaborative included a multi-disciplinary team (MDT) of nurses (from Health Care Assistants to Matrons), occupational therapists, pharmacists, physiotherapists and doctors. A cohort of Falls Link Nurses and Champions were recruited from existing staff in clinical areas. A series of four meetings were planned over 12 months with key objectives for each and a timeline to develop a ‘Change package’.

The Collaborative used the Model for Improvement to provide a clear aim, structure and Driver Diagram to guide improvement work. The teams were empowered to identify steps to success which reduced falls; these steps were developed and tested using the ‘Plan-do-study-act’ (PDSA) approach. This led to the development of the ‘Aintree Change Package’, implemented in June 2015 and which comprises ‘7 steps to success’;

1: Patient activity boxes – a way of increasing activity for particularly elderly frail patients which enables cohorting when undertaking the activities and supervision

2: The use of Slipper Socks

3: The use of ‘Call Don’t Fall’ signs as reminders to prompt the use of call bells

4: Dignity v Safety – staff are proactive in asking patients about the level of supervision required at toileting

5: Hourly Comfort Rounds

6: The fixing of falls alarm bracket in patient bathrooms – encourages patients to carry the alarm with them at times of high risk activity

7: Education and Awareness of patients, carers and staff

These seven steps were shared and implemented in all clinical areas. Staff use the change package to:-

• Identify what practices already exist in their own clinical area and if further work is required

• Identify and prioritise the first few changes that the team would test

• Plan what other changes will need to take place moving forward Outcomes

In 2014/15 we achieved a full year reduction in falls with harm of 11.5%

We had an aspirational goal to achieve a 15% reduction in falls with harm by the end of March 2016; by December 15 we achieved a 10.4% reduction and we are hopeful of reaching our stretch target by the end of March 2016.

Next steps Embedding change is always a challenge; we have a suite of follow up activities to keep this agenda at the forefront of good practice here at Aintree. Some of the actions include;

– A refresh of the Collaborative during 2016/17

– A thematic review of falls leading to lessons learned and identification of further action

– Reprise of the ‘Call don’t fall’ initiative

– Grand Round education for doctors by the Clinical Lead

Other new developments include:

– Pilot of a ‘SWARM’ approach (adapted from the American Society for the Prevention of Falls)

– Development of a Falls Prevention Passport containing general and individualised information

– Working with the human factors specialist to understand this perspective when applied to falls

– A monthly falls verification meeting with divisional Governance Leads to help improve data feeds

For further information please contact: Jan Dainty, Lead Nurse for Quality & Safety [email protected]   or [email protected] Falls Prevention Nurse Specialist

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