Team Awesome Last Mountain Pioneer Home Strasbourg

1. Team AwesomeLast Mountain Pioneer HomeStrasbourg Fall Reduction in Long Term Care

2. Last Mountain Pioneer Home • 39 bed Long Term Care Facility • Owned and Operated by Saskatoon Health Region • We have often been frustrated by our fall rate and wondered if there was something more we could be doing • We felt this was a good opportunity to learn from others and try some new ideas Saskatchewan Falls Collaborative

3. Aim • To reduce falls by 20% by March 2012 • Goals: • To not only reduce falls but also to reduce injury from falls by 15% • To complete a fall risk assessment for all newly admitted residents, quarterly, following a fall, and after a significant change in status • To create a Falls Care Plan with interventions for all residents that have been identified as being “At Risk” • To reduce restraint use by 50% Saskatchewan Falls Collaborative

4. Team Members Connie Fuessel, Manager Jennelle Schermann, Clinical Leader Christine Lofgren, Administrative Assistant Val Burgess, Unit Assist Irene Black, LPN Roxey Gordon, SCA Natalie Bishop, OT Sherri Hubick, RN Faith Mohr, SCA Arlee Hogbin, SCA Julie Wildeman, PT Peggy Gwillim, NP Sarah Flavel, Pharmacist Saskatchewan Falls Collaborative

5. Results Data Accuracy Before starting any initiatives, our team felt that we really needed to be able to trust our data. We needed to know that the reports were being submitted accurately into our electronic system so that the reports generated from it could be trusted. As such our first PDSA cycle involved implementing a fall log. Now we not only can account for the falls and whether a report has been done, but also we have information such as the report number, date of fall, nurse reporting, who fell, and the location of the fall easily at our fingertips. We even went one step further and started to create a visual map of the location of the falls. With this we could begin to see patterns in our fall rate. Saskatchewan Falls Collaborative

6. Injury Reduction • Fall Mats: Going into this project, we owned 4 fall mats which were not being widely used. With the increased awareness due to this initiative not only were we suddenly now using those mats, but needed more. So, we purchased 5 more fall mats. We were also fortunate enough to have SHR provide us with another 3 fall mats. This brought us to a total of 12 mats. A new type of fall mat was being offered by SHR, and since we felt we could make use of even more fall mats, we requested 5 more. These have not arrived yet, but we are looking forward to being able to start using them. • Vitamin D: Studies have shown that Vitamin D reduces falls and the injury from falls. We discussed this with our Nurse Practitioner and all of our residents who are mobile have been prescribed Vitamin D • Hip Protectors: We are part of the SHR hip-protector trial and are currently trialing hip-protectors for 11 residents. • Room Assessments: Resident rooms are now assessed for fall hazards on admission and quarterly in conjunction with their MDS assessment. An assessment of different areas of the facility is done quarterly to assess any fall hazards. In May our percentage of falls causing injury was 26.67%. By September and continuing into October this percentage had been reduced to 0. We have noticed a jump in the injury rate again over the past couple of months and in January we were showing an injury rate of about 11%. We noticed that this is happening with new residents and suspect that more attention needs to be given to minimizing fall risk when residents are newly admitted

7. Fall Risk Assessment We have gone from doing absolutely no Risk Assessments to completing Scott Risk Assessments for all residents upon admission and in conjunction with our MDS Assessments. Care Planning is done for every resident with a change in the Risk Score. We are also implementing Risk Assessments with change in status and post fall.

8. Saskatoon Health Region-LTCLast Mountain Pioneer Home Fall Rate Percentage of Falls Causing Injury FRA completed on Admission Percentage of Residents with completed FRA following a fall or Change in Medical Status Percentage of “At risk” Residents with a Documented Falls Prevention/Injury Reduction Plan 11-Oct-14 Saskatchewan Falls Collaborative: Reducing Falls Reducing Harm in LTC and HC 8

9. Changes Tested PDSA Cycle 1: Our first PDSA Cycle involved ensuring accuracy of our data. We implemented a fall log. PDSA Cycle 2: We implemented a Room Assessment to be done by SCA’s when a resident is newly admitted to the facility and quarterly in conjunction with the MDS cycle. To implement this effectively we felt we needed to educate special care aides not only about the Room Assessment but the Falls Initiative, the Scott Tool, and Falls Interventions. An education session was held on Oct. 14, 2011. PDSA Cycle 3: The Scott Risk Assessment was implemented for all residents upon admission, quarterly with the MDS Assessment, post-fall, and with a significant change to medical condition. Care Planning is done with any change in Fall Risk Score. This is largely being done by the Clinical Leader but will be rolled out to all Nursing Staff following their education session scheduled on Dec. 1, 2011. PDSA Cycle 4: We have trialed all residents that qualified and that were agreeable for hip-protectors. We had some difficult with obtaining the right sizes but this has been remedied now. We have no data to support that this has reduced injury but we trust that it has. PDSA Cycle 5: We plotted individual resident fall rate from the time of the trial until the present as well as the location of the falls. We learned that it wasn’t a handful of particular residents falling in the beginning but was spread amongst a number and that the reduction in the fall rate really did seem to correlate to the initiatives we had begun to implement. We also learned that our recent spike in fall rate was largely due to a large amount of admission in December and January and that many of the falls were happening with these new residents. Therefore, we think we need to do a better job of minimising fall risk amongst our newly admitted residents. We also found that most of our falls are happening in resident rooms. PDSA Cycle 6: As a result of learning that the falls were happening in resident rooms, we decided to do a PDSA on implementing the three questions. The three questions will be typed up and posted above the light switch in resident rooms as a reminder to care staff. Saskatchewan Falls Collaborative

10. Lessons Learned • Importance of Accurate Data: We found that there was no point starting any changes until we could show that our changes resulted in improvement. The only way to do this was through documentation and accurate data. • Importance of Staff Education and Buy In: We found that we could implement all the changes we wanted, but until front-line staff are made aware and are motivated to change, there will be very little change. This increased awareness alone has been pivotal in reducing our fall rate. • We felt that we could not just focus on reducing falls and felt that resident quality of life and the right to live at risk must also be considered. Therefore, many of our initiatives involved not trying to prevent falls as much as trying to prevent fall injury. But what we found was that by trying to reduce injury, we surprisingly ended up reducing fall rate also. • Plotting individual fall rate on a graph and a floor plan really helped to identify patterns and areas of concern. We learned that we really needed to pay attention to the falls happening in resident rooms and pay extra attention to our new residents to minimise their fall risk Saskatchewan Falls Collaborative

11. Next Steps Our next steps will be to try to reduce our fall rate and injury from falls by: • Working at minimising fall risk amongst newly admitted residents by implementing interventions promptly and by encouraging care staff to give these residents an extra amount of supervision and attention for their first few weeks at our facility. • Woking at reducing falls in residents rooms by encouraging care staff to ask the following three questions before leaving the room: are you having any pain? do you need to use the bathroom? is there anything else you need before I go? Saskatchewan Falls Collaborative