Presented by: Angela Greetham, Bay of Plenty DHB at OHSIG 2014, Thursday 11/9/14, Limelight Room 1, 11.15am Video URLs: HQSC on fall prevention: www.youtube.com/watch?v=NdO7JCXJBO4

1. The Rise and Fall of
your Patient
(National Campaign, 2013)
Angela Greetham

2. Reducing Harm From Falls
 Can be life-changing
 Falls prolong hospital stay
 We have a duty of care to prevent harm
 Falls are costly
 20% of older people who # their hip will not
survive after a year
 What can your organisation do?

3. RON AND RENA

4. ACTIVE

5. TRAMPING

6. Routine Operation

7. Bed Rails Left Raised

8. Fall Resulting in # hip
$47,000 cost to repair a hip fracture

9. Return to theatre

12. Reducing Harm from Falls
Key points
 2013 = 253 instances of serious harm from falls, comprising 52 percent of all
SAEs Of these 106 patients suffered a fractured neck of femur (broken hip)
 NZ Injury Prevention Strategy (2010) estimated the cost of falls to be $536m for
treatment and rehabilitation, plus $271m from lost economic contribution and
human costs of $929m
 BOPDHB (2009 –2010) 8 serious harm falls including 2 deaths
 BOPDHB (2011) over 750 reported falls organizationally
 BOPDHB Falls user group implemented
 Organizational multidisciplinary approach
 Following the health quality safety commissions National agenda to reduce
harm from falls

13. So what can we do?
A fall action group was formulated
 MDT participants
 Fortnightly meeting
 Reported to executive level
 Research, research and more research

14. Overview

15. Recommendations
Recommended
 Intentional Rounding
 Staff education
 Online Education
 Patient’s non-slip socks
 Ultra low beds
 Policies reviewed
 Mobility bed cards
Progress
 Completed
 Completed
 Completed
 Completed
 Bed replacement programme
 Completed
 Completed

16. Intentional Rounding
 A systemized, proactive approach to the patient
 Rounding occurs on all patients
 The goal is to provide better than expected care.
 Outcomes of conducting intentional rounding
 Minimise patient falls
 Reduce incidents of pressure ulcers
 Prevent dehydration of patients
(NHS – Hampshire Community Health care)

17. International rounding checks

18. Falls-minimising risk
 Online falls e-Learning package formulated
 Currently on line in Moodle under professional
development
 NHS training package
 2 hours dedicated education time

19. Reviewed
Equipment
 Equipment already was in place, although we did
recognize the need for more low beds (now in action)
 The second finding was not really related to equipment but
was ……………….. (can you guess it?)

20. SOCKS!
Now in stock and cheap!

21. Admission to
Discharge Planner
 Redesigned
 Patient & Family contribution
 Risk Assessment modified
 Simplified LITE assessment tool in place (links to bed chart)
No use if not completed!

22. A – D Planner

23. BED SIDE
MOBILITY
CARDS
same as
the
A-D
simplified
LITE
assessment

24. Policy
Review
 Policy 6.3.5
 Protocol 1
 Simplified
algorithm

25. Patient information brochure
 Redesigned
 Community Liaison Group
redeveloped the Brochure –
highly recommend
 Formatted
 Circulated

26. New Zealand/Australia DHB’s Data Results 2012

27. Baseline audit for the risk assessments for patients aged 75
and over 2012
Green = 90 % or more
Grey =75–90 %
Red = 43- 53%

28. Completed falls risk assessments June 2013 2013

29. Completed falls risk care plan June 2013

30. Completed falls risk assessment over all 2013

31. FALLS RISK CARE PLAN over all 2013

32. Patient fall assessments 2012 = 2013

33. In-patient falls data for Australia & New Zealand 2013

34. Current stats –
Room for Improvement?

35. So what's our role?
How do we make a difference?
 No one thing will make a difference
 We are the role models
 Each area needs a falls “champion”
 Patient individualised assessment
 Forward ideas, duty of care
 Be proactive
“As a leader, you're probably not
doing a good job unless your
employees can do a good impression
of you when you're not around”
Patrick Lencioni
“We can make a difference if we all
work together”
Angela Greetham

36. HQSC video on fall prevention

37. REFERENCES
 Versus Research (2013) National April Falls Quiz results May 2013. Hamilton: Versus
Research.
 Woodhouse, K. (2013). Treating older people. European Journal of Clinical Pharmacology
69(1-S):53-57.
 Statistics New Zealand (2000) Population ageing in New Zealand. Wellington: SNZ.
 Rubenstein L Z (2006) Falls in older people: epidemiology, risk factors and strategies for
prevention. Age and Ageing 35-S2:ii37-ii41.
 Oliver D (2012). Managing risk in older hospital inpatients. Clinical Risk 18(5):161-162.
 Leape LL, Brennan TA, Laird N, et al (1991). The nature of adverse events in hospitalized
patients: results of the Harvard Medical Practice Study II . New England Journal of Medicine
324(6):377-384.
 Cameron ID , Gillespie LD , Robertson M C et al (2012) Interventions for preventing falls in
older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 12
 Gillespie LD , Robertson M C, Gillespie WJ, et al (2012) Interventions for preventing falls in
older people living in the community. Cochrane Database of Systematic Reviews 9.
 Clegg A, Young J, llife S , et al (2013). Frailty in elderly people. The Lancet, 381(9868):752-762.
 Robertson M C & Campbell AJ (2012) Falling costs: the case for investment. Dunedin:
University of Otago.
 Dollard J, Barton C, Newbury J & Turnbull D (2012). Older community-dwelling people’s
comparative optimism about falling: A population-based telephone survey. Australasian
 Journal on Ageing 32(1):34-40.

38. REFERENCES
 Miake-Lye IM , Hempel S , Ganz D A, & S hekelle PG (2013). I npatient fall prevention
programs as a patient safety strategy. Annals of Internal Medicine 158(5-P2):390-397
 Delbaere K, Close JC, Heim J, et al (2010). A multifactorial approach to understanding fall
risk in older people. Journal of the American Geriatrics Society 58(9):1679-1685.
 Osteoporosis New Zealand (2012). Bone Care 2020. Wellington: Osteoporosis NZ.
 Faes M C, Reelick M F, Joosten-Weyn Banningh L W, et al (2010). Qualitative study on the
impact of falling in frail older persons and family caregivers: foundations for an intervention
to prevent falls. Aging & Mental Health 14(7):834-842.
 Health and Disability Commissioner (2009) Code of health and disability services
consumer’s rights. www.hdc.org.nz/the-act--code/the-code-of-rights
 Health Quality & Safety Commission (2013) Making our hospitals safer – serious and sentinel
events 2011/2012. Wellington: HQSC.
 Davis P, L ay-Yee R, Briant R, et al (2002). Adverse events in N ew Zealand public hospitals I :
occurrence and impact. New Zealand Medical Journal 115(1167).
 World Health Organisation (2012) Press release for I nternational D ay of Older Persons. URL:
www.un.org/News/Press/docs/2012/sgsm14535.doc.htm.
 De Raad JP (2012) Towards a value proposition… scoping the cost of falls. Wellington: New
 Zealand I nstitute of E conomic Research.

39. REFERENCES
 De Raad JP. 2012.
 Towards a value proposition... scoping the cost of falls
 Tzeng HM. 2010. Understanding the prevalence of inpatient falls associated with
toileting in adult acute care settings. Journal of Nursing Care Quality 25(1): 22–30
 Wellington: New Zealand Institute of Economic Research.
 Hamblin R. 2013.Working paper. Wellington: Health Quality & Safety Commission.
 Health Quality & Safety Commission. 2013.
 Making our hospitals safer – Serious and Sentinel Events 2011/2012
 Wellington: Health Quality & Safety Commission.
 Osteoporosis New Zealand. Bone care 2020.Wellington:osteroposis New Zealand
 Lamb SE, Jørstad-Stein EC, Hauer K et al. 2005. Development of a common outcome data set
for fall injury prevention trials: The Prevention of Falls Network Europe Consensus. Journal of the
American Geriatrics Society 53: 1618
 Dow B, Meyer C, Moore KJ et al. 2013. The impact of care recipient falls on caregivers. Australian
health review: a publication of the Australian Hospital Association 37
 Young WR, Hollands MA. 2012. Newly acquired fear of falling leads to altered eye movement
patterns and reduced stepping safety: a case study. PloS one 7(11): e49765
 http://www.hqsc.govt.nz/assets/Falls/10-Topics/topic3-risk-assessment-tools-care-plans-
Sep-2013.pdf