Falls Prevention Project

Description

Patient falls are the most commonly reported incidents in the HSE. In patient falls in any age group can have far reaching impacts for example increased length of stays, significant physical health decline and psychological / social consequences. In Louth County Hospital, the patients in Stepdown Unit are at high risk of falls due to conditions such as Dementia, impaired mobility and poor safety awareness. In order to reduce falls the nursing team initiated a QI initiative involving continence planning and nursing hand over.

Aim of Initiative

To reduce the rate of inpatient falls on the Stepdown Ward unit from 4 to 3 per month by July 2023. resulting in a reduction of SRE serious reportable events ie. Fractures.

Who is it aimed at

This initiative is aimed at the identified high falls risk patients who are mobile independently with walking aids or patients who require assistance of 1- 2 staff members with mobility aids such as Sara steady. Patients who are full Hoist mobility were not included in this project.

3 Steps critical to success

1. Analyzing data collected through falls related incidents of the previous year, allowed us to identify areas within our ward that had the greatest amount of falls but also the times of same.
   once the highest risk area was identified we began small with 4 patients within an 8 bedded room every two weeks extending the project by 2 patients to include 14 patients.
   our Aim is now to include our entire ward profile of 25 patients with future planning to roll out QI on other hospital wards.
2. Staff engagement- encouraging and educating staff on the uptake of the project was vital in obtaining positive results from the QI, but also in obtaining accurate data.
   Staff feedback was obtained on there thoughts, ideas and collectively we aggreged to commence a 2 hourly continence plan for patients who are deemed a high falls risk. High volumes of falls were identified when staff were on their breaks, post patient meals. We encouraged assisted mobility with continence promotion pre and post meals.
3. Hand over time also identified as a high risk time, same has now been split in the morning giving more staff to visualize and assist the patients between 7am and 8am.

3 Challenges in Planning / Delivery

1. We originally had commenced our initiative in May 2022.
   with our QI being based on physical activity in the reduction of Patient Falls.
   Due to 2 xCovid 19 outbreaks and a norovirus outbreak staff were exceptionally burnt out and uptake of the QI was poor.

   Our team met and reevaluated our aims and set out our Current QI

2. Engaging Multidisciplinary teams to complete documentation if they mobilized or toileted a patient. We aim to record all mobilizing and toileting on the Sskin bundle to get an overall picture of how often we are toileting and moving the patients on the program.
3. patient profile has a major affect on QI and patients with behavioral problems. Alongside some staffing issues due to sick leave and burn out. The knock on effect of this is we use some relief staff that would not of been familiar with our patients or our QI. We try to get the information passed on through the handover daily to combat this issue.

3 Outcomes / Benefits

1. Our QI has focused on the positives rather than the negatives. In the health service majority of the time emphasis is put on the negative, example there were 5 falls this month. We have tried to have a more positive outlook on this project identifying our near misses. example, this month there were 5 falls but we also prevented 21. When staff can see the impact they are making visually on a safety cross it increases uptake and engagement of the staff and boosts moral. In turn increasing patient safety and promoting patient independence with continence.
2. We have reduced our falls from highest 9 per month to 2 per month.
3. Other areas of patient care that are improving is reduction in pressure ulcer development due to increased mobility
   Patients confidence and stability in mobilizing has improved.
   There has also been a cost saving result as patients are becoming more continent resulting the reduction of incontinences wear use.