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IMPROVING DEMENTIA CARE

- FALLS PREVENTION

Julie Vale 26th January 2010

Respond Deliver & Enable


The Numbers
• 200,000 falls per year in acute, community
and mental health units (NPSA, 2007)
• Nationwide 500 people suffer a # hip
following a fall in hospital
• R,D&E = 1,821 falls in 2009
• Average of 152/month

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The R,D&E story
• Two fatalities Jan – Mar 08
• One pt fell 15-20 times – no action taken
• One pt fell twice in the same night over
bedrails
• Both patients had cognitive impairment
• Culture of normalisation to falls across the
trust and division

Respond Deliver & Enable


Assessment.
• On admission – within 24 hours
• After any ward moves.
• After any change in condition – e.g. patient
becomes unwell or has a fall.
• Routinely on a weekly basis moving to every
72 hours
• Top tip: Beware underscoring

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Risk planning.
• Cohort at-risk patients.
• Bed position – visible and low.
• Footwear.
• No bed rails.
• Refer to OT and Physio – for falls assessment and
planning.
• Keep area clean and tidy – remove obstacles.
• No commodes left by bed.
• Communication to team – highlighting risk.
• Document all actions and processes followed.

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Intentional Rounding Checklist
• Leadership intervention – test of change re
development of falls checklist/bundle
• Targeted formal falls education
• Intentional round every hour for patients
with falls risk score >20 Intentional rounding provides the
• Checklist with key quality questions visible presence of nursing staff
on the ward and patients and
• Verbal feedback from staff, patients carers have commented on it
improving their experience while
and carers in hospital:
• Positive results with decrease in falls “ I feel safe”
across directorate and Trust “ I didn’t realise I
had
dropped my call
bell”
“ Nurses are saying
theyRespond
have Deliver & Enable
time to care”
Intentional Rounding Checklist
For patients with a falls risk score of 20 or if any degree
of cognitive impairment please enter either ‘A’ = Hospital No. ………………….
Name: …………………………
achieved or ‘V’ = variance in columns. Record reason for DoB: …………………………..
variance and action taken overleaf. This patient requires Affix patient label here
observation every ....... hour …..... minutes.
DATE: TIMES

1. CONTINENCE
Do you need to go to the toilet?

2. PAIN
Do you have any pain?

3. ORIENTATION – fully alert=FA;


mildly confused/disorientated=MC;
severe confusion/disorientation=SC; asleep=A

4. POSITION / COMFORT
Are you comfortable?

5. DRINK / MOUTHCARE
Would you like a drink?

6. CALL BELL WITHIN REACH


If you need me, please press this button

7. BED RAILS DOWN

8. BED TO THE LOWEST POINT TO THE FLOOR and


underbed light on at night

9. IS THERE ANYTHING ELSE I CAN DO


FOR YOU BECAUSE I HAVE THE TIME?

INITIALS

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Principles and Lessons Learned
• Round >20 or if any degree of cognitive impairment/confusion
• All questions need to be asked in order
• Patients need to be rounded every hour over 24 hour period
• If patient asleep over night, when they
wake, restart the clock
• Don’t stop if they haven’t fallen!
• Draft training package and targeted
education vital for success
• Its more than managing the falls risk
… patients feel cared for
• Build in audit cycle for sustainability
• Clinical champions
• Be relentless in approach

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Respond, Deliver & Enable
10/1/09 13/1/09 17/1/09 25/1/09
admitted to admitted to transferred routine falls
RD&E from medical to another reassessed
Hay House ward Falls ward not as 34 IR not
assessment reassessed commenced b
score 23

2/2/09 7/2/09 14/2/09 16/2/09


routine falls routine falls routine falls routine falls
reassessed reassessed reassessed reassessed
as 33 IR not as 33 IR not as 33 IR not as 33 IR not
b commenced commenced commenced commenced c

Time____

24/2/09 2/3/09 Event

routine falls routine falls 2/3/09 Supporting


reassessed reassessed Fall Information
as 33 IR not as 33 IR not
d commenced commenced
Incident

CRP 92 1/3/09

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Results
Total number of inpatient falls in 10 medical wards
April 2008 to July 2009

Number of falls
Special Cause Flag
C
60

50

40

30

20
Individual Value

10

31/03/08
21/04/08
12/05/08
02/06/08
23/06/08
14/07/08
04/08/08
25/08/08
15/09/08
06/10/08
27/10/08
17/11/08
08/12/08
29/12/08
19/01/09
09/02/09
02/03/09
23/03/09
13/04/09
04/05/09
25/05/09
15/06/09
06/07/09
Date

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Kenn Ward – Slips, trips and falls
Kenn in-patient slips, trips & falls SPC Chart (Apr-08 to Dec-09)

10

-2

-4

-6

Week Beginning

Volume UCL Median LCL

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Very High Risk
Some patients risk cannot be adequately
reduced despite all of the above actions.

1. Risk assess and document any actions.


2. Alert your Matron and Senior Matron if
patients remain at very high risk.
3. Consider 1:1 special
4. Consider using hip protectors
5. Reassess and document change on a daily
basis.

Respond Deliver & Enable

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