6 P’s: A Fall Prevention Program

1. 6 P’s: A Fall Prevention Program Colleen Dougan, MSN, RN

2. Group convened in 2008 to address fall prevention and pressure ulcer prevention for inpatients Nurses, Nurse Assistants, Clinical Nurse Specialists, Nurse Managers, Nurse Administrators, Physical Therapist, Wound Care Specialist, Physician and Quality Specialist The Road to Fall Prevention

3. Wendy Quinn-Scott, RN, Nurse Administrator Sue Craft, RN, NM MICU Colleen Dougan, RN, CNS, Hematology/ Oncology Catherine Draus, RN, CNS, Cardiology Lynne Freimuts, RN, Quality Specialist Dana Greggs, RN, CNS, Internal Medicine Joanne Guanio, RN, NE, Neurosciences Catherine Jackman, RN, CNS, MICU Mary Kravutske, PhD, Nursing Development Cathleen McCloskey, RN, NM, Neurosciences and Neuro ICU Geri Muller, RN, CNS, DEM Adele Myszenski, Physical Therapist Kathy Raniszeski, Respiratory Therapist Sheila Daley, RN, Neurosciences Rebecca Gregory, RN Katherine Herrmann, RN, Quality Specialist Shereen Patten, RN, NE, ICU Sonalee Shah, MD Nicole Sims, NA Carolyn Taylor, RN, ANM Team Members • Stephanie Schuldt, RN, CNS, MICU • Christine Seigert, RN, Wound Care Specialist • Christine Sotto, RN, NE, Cardiology • Cheryl Stone, RN, Nurse Administrator, Ambulatory • Rebecca White, RN, NM, Internal Medicine

4. Getting to the 6 P’s • Decided that we needed to bundle together the two issues—fall prevention and pressure ulcer prevention • Reviewed literature that detailed other ‘P’ programs • Added to ‘P’ list from HFH incident reviews

5. The 6 P’s • Pain • Personal Needs • Pulmonary Hygiene • Position • Possessions • Place

6. The 6 P’s Program • Dry erase board for every patient • Fall Risk Sun signage • Switch to yellow arm bands/socks • Patient education brochure • Partners in Patient Care ‘Agreements’ • Fall Prevention • Pressure Ulcer Prevention • Medications increasing fall risk identified on MAR

7. The 6P’s Program cont’d • Post-fall debriefing protocol and audit • Employee Education • RNs and NAs attended mandatory classes including videos with scripting • Competency validation at the bedside • Monitoring of Incidence, Compliance and Patient Satisfaction

8. HFH Falls/1,000 Patient Days 6Ps implementation house-wide

9. HFH Falls with Injury/1,000 Patient Days 6Ps implementation house-wide

10. Hospital Acquired Pressure Ulcers > Stage 1 6Ps implementation house-wide

11. Patient Satisfaction: Noise Level In and Around Room 6Ps implementation house-wide, higher score = higher satisfaction

12. Patient Satisfaction: Promptness Response to Call 6Ps implementation house-wide, higher score = higher satisfaction

13. Patient Satisfaction: Staff Sensitivity to Inconvenience 6Ps implementation house-wide, higher score = higher satisfaction

14. Staff Feedback • Do you think hourly rounding has: • Decreased patient falls • Strongly Agree 19.5% • Agree 37.9% • Neutral 25.0% • Decreased falls with injury • Strongly Agree 19.7% • Agree 37.0% • Neutral 26.1% • Decreased pressure ulcers • Strongly Agree 15.4% • Agree 37.8% • Neutral 29.3% • I can incorporate the 6 P’s concepts into my daily practice • Always 50.7% • Sometimes 27.8% • Neutral 15.7% • Feedback given for dry erase boards

15. Staff and Customer Feedback • RN staff were surveyed 1 year after go-live • Family member reported that she was so relieved to really know that her mother was checked on over night • Patient reported that she felt safer knowing that someone was checking on her regularly even if she was asleep • Some patients are bothered by the frequent checking

16. Pilot program in all practice areas Adjust for different patient populations ICU OB/NICU White boards are not a part of the Medical Record Test your materials—dry erase board Engage as many frontline staff as possible Review results frequently Listen to feedback carefully Maintain momentum Share the knowledge Some of 6 P’s reworked Dry Erase Board modified Partners in Patient Care ‘Agreement’ modified On every admission Includes basic information about fall and pressure ulcer prevention and now with infection prevention measures Re-education of the Staff Healthstream for RNs and NAs Results, 6Ps review, reinforce content of conversation, less focus on actual scripting 6 P’s Lessons Learned and Refreshed

17. General Practice Unit Board

18. Intensive Care Unit Board

19. Questions?