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