Reducing Falls at RCHT Trish Prady – Lead Nurse for Quality Safety and Innovation

1. Reducing Falls at RCHT Trish Prady – Lead Nurse for Quality Safety and Innovation Patricia.Prady@rcht.cornwall.nhs.uk

2. “THE FIRST REQUIREMENT OF A HOSPITAL IS THAT IT SHOULD DO THE SICK NO HARM” Nightingale (1863)

3. Aims Understand falls prevention in the Context of the “Safety Thermometer” CQUIN To understand why patients fall Promote the Falls policy and implement the Fallsafe Care Bundle as a method of enhancing patient safety and care

4. How do we change what we do to ensure that vulnerable people in our care are safe from Falls?

5. “Just one of those things that happens in hospital” “Not what you want to happen, but an inevitable part of getting patients mobile” “A normal part of a hospital stay” “Falls are a nurse’s responsibility, not a doctor’s” What do you think?

6. Background – Falls at RCHT The Facts • Falls make up 65% of all reported incidents at RCHT • The majority of falls are on high risk/high dependence inpatient adult wards – Over 90% are on 12 wards (120 per month) • Falls with harm - There have been 20 falls with moderate to severe harm since 1st April 2012 of these 7 people have died as a result of the fall • The Falls action Group attended by a cross section of safety and front line staff, meet monthly to examine current data and progress the falls prevention action plan. • “after my fall I was scared to get out of bed or even reach for my drink” “I was in hospital for another 3 weeks after I fractured my hip”

7. Mapping the changes.. Implementation of trust wide care rounds Period of high activity in the organisation Tool box talk rollout Team learning and documentation review Fallsafe links activity on top 14 wards (wards with highest no of falls Improved data assurance (safety cross roll out)

8. Medical Problems Environmental Confusion Why Do Patients Fall in Hospital? Dementia & Delerium Ward Clutter! Lighting Toileting Food/ fluid Heights Flooring Call Bells CVS Neuro ENT Visual Biomechanical Metabolic Pharmacological

9. PATIENT FALLS Month: Ward: INCIDENT FREE DAY PATIENT FALL MULTIPLE FALLS

10. What Can you Do? • Assess appropriately – Make sure each patient has a prevention plan in place? • Consider the Environment (Clutter, property, obstacles) Keep the environment clear! • Has MF falls assessment been done? (Meds reviewed, urinalysis, glasses, hearing aid available…?) • Appropriate footwear? (Yellow socks as a temporary solution) • Appropriate (Familiar) Walking aid ? • Line of sight – Particularly Dementia Patients • Safe Observation policy – escalate if you are concerned for a patients safety • Falls prevention aids where appropriate • Use of relatives and carer’s to assist you to protect patients. • Increase direct care time – PW keep working at the bedside (reduces patient anxiety) • Team Focus on who is at risk – Safety Briefings • CARE ROUNDING

11. Advantages of Rounding Higher patient satisfaction levels Higher staff satisfaction Reduction in call bell use Reduction in falls and pressure ulcers More effective use of nursing time Cost savings in reducing harms (Meade et al 2006; Gardener et al 2009)

12. Rationale • Provides Reassurance • Prompts Basic care in busy environments • Early response to patients changing condition • Involves the whole team • Promotes Independence While maintaining safety

14. Any Questions??Help and advice on falls preventionTrish PradyExt 3050emailpatricia.prady@rcht.cornwall.nhs.uk