The Standups

1. The Standups Bathroom Assistance Routine for Residents at high risk for a fall

2. Background • 129 bed Long Term Care Home, including a 49 bed secured unit and 2 respite beds • This project was chosen to see if there was a correlation between the resident’s need to use the bathroom and resident falls Saskatchewan Falls Collaborative

3. Aim • LSCH will reduce the number of falls in the home by 20% by March 31, 2012. LSCH will reduce the number of injuries related to falls by 30% by March 31, 2012 • LSCH will implement 100% of the Safer Healthcare Now Falls Intervention in the home by March 31, 2012 Saskatchewan Falls Collaborative

4. Goals and Objectives • Increase staff awareness around falls to validate the significance of proactive/preventative fall reduction. • To involve the care team in determining the correlation between the bathroom assistance program and a reduction in the number of falls for specific residents. • To see a decrease in the number of falls for this specific population of residents.

5. Team Members Luther Special Care Home • Brenda Kuffner • Ami Johnson • Marilyn Cooper • Doreen Moreau • Paulette Kress • ad hoc member, Donalea Augustine Saskatchewan Falls Collaborative

6. Results • It was determined that the two hour window with the toileting schedule for the residents was not specific enough. This time frame did not provide enough information to determine whether a resident that had fallen had been assisted to the toilet before or after the fall. • Upon further study of this PDSA cycle, it was decided that this particular method would be discontinued and another would be developed that would be more beneficial in determining a direct correlation between the bathroom assistance program and a decrease in the number of falls for specific residents. Saskatchewan Falls Collaborative

7. Changes Tested • Originally, the falls team chose residents to trial in a bathroom assistance routine. The results were that without staff buy-in, the schedule in the resident’s bathroom was not getting filled out. Compliance was a barrier. Saskatchewan Falls Collaborative

8. Changes Tested • Early in the falls strategy implementation, a celebration was planned with care team. This was an opportunity to review the types of falls and to look at the significant decrease in the number of falls. • Staff were then invited to participate in choosing the residents they felt would benefit most in a bathroom assistance routine.

9. Lessons Learned • Care team buy-in is necessary to implement a plan successfully. • There must be a simple means of checking compliance. • The inclusion of care teams in decisions related to the residents that they care for elicits greater participation from the care team. Saskatchewan Falls Collaborative

10. Next Steps • Continue to address the correlation between when falls occur and when a resident was last assisted with elimination. • The care team will meet after a resident has had a fall to complete the fall record together to discuss any possible changes to the plan of care. Saskatchewan Falls Collaborative

11. Next Steps continued • The Nurses will keep a log for falls that will be updated during the care team discussion. Specific information in the log will include when the resident was last assisted to the bathroom.

12. Next Steps continued • This new PDSA Cycle will have four distinct advantages • Encourages and strengthens the Team approach. • Ensures that incident reports are done accurately and with detail. • Encourages accountability of regular toilet assistance. • Increases awareness that for specific residents there may be a significant correlation between bathroom assistance and falls.