Monday, February 24, 2014

Safety key: preventing patient falls

CoxHealth’s falls reduction team tracks data and partners with others to keep patients safe.

On our patient floors, you may have noticed the red stop signs on some doors, indicating a patient who is a high fall risk. You may see staff members with their own gait belts on at all times, in case they need to assist a patient who is at risk for a fall. And you may notice rubber fall mats in place in some patient rooms.

These examples are just a few of the most visible parts of an effort to keep our patients safe by preventing falls. A variety of changes, combined with a heightened awareness of the issue, are going a long way toward improving a safety risk that is a common one for all hospitals.

The project, led by CoxHealth’s falls reduction team, is one of many quality and safety improvements throughout the system that have come about as part of our involvement with the Hospital Engagement Network, or HEN, which CoxHealth joined in 2012. The HEN, which includes the member hospitals of the Missouri Hospital Association, is a collaborative effort designed to address the most common causes of patient harm.

CoxHealth’s success with falls reduction gained national attention last summer, when our program was featured in a video produced by Hospitals & Health Networks Daily.

The project is just one example of how CoxHealth is using collaboration, staff-driven changes and continuous quality improvement projects to deliver quality care and keep patients safe.

“Patient safety is one of our values, and there’s a good reason for that,” says Connie Deck, administrative director of Nursing, clinical services. “Caregivers come to work to take care of patients, not cause harm. We want to do anything we can to anticipate what might harm a patient, and then make sure we prevent that harm.”

The HEN has set a goal of reducing harm to patients by 40 percent and reducing readmissions by 20 percent. For the falls reduction team, this meant reducing falls by 40 percent by Dec. 31, 2013. That was a big goal, especially for an issue like falls, which had been an internal focus in the past.

With so many variables and individual patient circumstances, staff members know that not every fall can be prevented. The team was tasked with creating standardized practices to reduce the chance of falls and limit injuries in the cases when they do occur.

Deck says participation in the HEN was key to formalizing efforts to reduce falls – allowing the team to access data from other hospitals and providing a network with which to share best practices.

“This effort has helped us hone our focus,” Deck says. The standardized measurement required by the project was a powerful step to creating positive change. “We had been measuring, but not in this format and not against others. The HEN project put structure around how we report and let us look at our data in a different way.”

The multi-disciplinary team – made up of physicians, pharmacists, physical therapists, and nursing staff – was able to participate in online discussion forums and Listservs with other hospitals. There, they could see what tactics were successful and they could ask and answer questions from other professionals in the field.

The falls reduction team participated in the HEN’s monthly reporting system, sharing the data they were tracking and looking at what other hospitals in the network were reporting.

“Before we had the HEN group, you would do the old-fashioned literature search to find what other places are doing,” Deck says. While literature searches still play a role, the HEN collaboration allows a real-time look at what is working for other health care providers.

In most cases, hearing from other hospitals validated what the CoxHealth team was doing. Other times, the HEN group offered ways to tweak our approach.

A good example is the use of floor mats, which can be key to reducing injuries when a patient has an unavoidable fall. Some units had tried the mats in the past and found them to be big, bulky and generally not a good fit for their daily work.

In participating in the online discussion, though, the team began seeing other hospitals having success with the mats. Deck says that was enough for the team to revisit the possibility.

When they talked to their counterparts at other hospitals, they learned that the mats in use were significantly different than what CoxHealth had tried in the past. The mats in use elsewhere are smaller and lighter, with beveled edges and reflective tape so they can be easily seen in a dimly lit room.

“There were upgrades to those products that we didn’t know about,” Deck says. “We might not have gone back and revisited those if we hadn’t seen the discussion going on in the Listserv.”

Those mats will be in widespread use at Cox South soon, playing a crucial role in preventing injury in the cases where falls can’t be prevented, such as from a sudden drop in blood pressure.

Throughout the falls reduction team project, the overall trend line for falls at Cox South has been steadily decreasing. By August 2013, CoxHealth met the goal of a 40 percent reduction in falls. Leaders say that improvement resulted from a combination of tactics, large and small. A few examples:

• Yellow bracelets and red socks for those who are a fall risk.

• Widespread use of the fall risk stop sign magnets and a “stoplight” system in rooms that provide a visual reminder of a patient’s risk status.

• Replacing the previous fall risk assessment tool with the Morse scale fall risk assessment tool and its corresponding interventions. The addition of the Cerner Lighthouse platform paved the way to use the scale, which was already in place at Cox Medical Center Branson.

• Addition of the most recent fall risk assessment to the nursing communication page – making it easy to see falls information at a glance.

The team also took a cue from other organizations in devising a way to involve patients and their families in the effort to reduce falls: the “Partnering with the Patient” agreement. The document reminds patients of the risks posed by falls and it reminds them to call for help if they need to get out of bed. Patients sign along with their nurse.

The team has implemented other steps as well, upgrading some safety recommendations to requirements. Previously, it was recommended that gait belts be available for staff use. In practice, though, a belt wasn’t always handy when a patient needed assistance. The falls reduction team made the decision to make gait belts mandatory, to be carried by staff members during their shifts.

The falls project has also led to the development of a standardized method of investigating the root cause if there is a patient fall. Any fall leads to a post-fall huddle, with staff, the patient and family. The huddle provides an immediate assessment of what caused the fall, how it could have been prevented and what actions can be taken to keep it from happening again.

Each week, managers will report on a “drill-down” they do if they’ve had a fall on their unit. Unit leaders look at why it happened, whether procedure was followed and what measures can be put in place to prevent another similar situation.

In addition to the sharing of best practices, leaders say participation in the HEN projects is helping teams use data to drive improvements. For example, Nursing has created a weekly flyer posted in all hospital units that breaks down the current numbers on falls, hospital-acquired conditions, infection rates and more. Deck says having that information front and center keeps patient safety in the forefront of everyone’s mind.

“Staff members care about their patients and they want those numbers to be good,” Deck says. “Staff members know their unit picture and they like having the flyer where they can see how the unit is doing. Every unit has to be successful for all of us to have that overall success. We want to build the overall pride in what we do.”

The wording also makes a difference – the flyer presents the data as “weeks since we have caused harm.”

“That really makes it personal,” Deck says. “Think about your mom, your grandma, your dad, your kids. Do what you would want others to do for your family. That puts a focus on patient safety in a way that numbers alone cannot.”