Intermountain-led HEN
Patient Falls and Mobility Webinar
Held Monday, June 4, 2012
Good afternoon everybody. Thank you for joining us for, now, the third webinar from the Intermountain led hospital engagement network. We’re really excited to have you today. This is Lucy Savitz, the director.
A couple of reminders before we get started with the content: first my apologies for the confusion on the invitation e-mail. We are working on fixing that. Hopefully everybody got the correction Jason Scott sent out on Friday. I think that's probably true for at least those of you who are here with us right now, but we do apologize for that. The other issue that was identified was that if there are a group of you sitting in a room enjoying the webinar together (but there's only one computer being activated), only one person will be able to logon to get their CME or CEU credit. Other people in the room, not with the computer or their own computer, will have to log on separately to do that. Once the webinar is posted, which will at least happen in the next day or two, you can also go to that webinar link to the posting. It will take you to the survey, so you will still be able to get your CME or CEU credits. So we are working through those issues and will try to make it seamless and easy as possible to be sure that everybody gets those credits. If you have any problems with that, please e-mail . That's really the go to place for any questions, concerns, or issues that you face getting access to the materials, and to get your CME and CEU credits.
A couple of other things that I would like to make you aware of is that at www.henlearner.org, which is our website, that's really the home base, if you will, for the content material. On the calendar there, that you can link to from the first page, you will see the date and time of upcoming webinars. Another thing you will see starting to post there are affinity group calls. In response to good ideas that we've received from our participants, there will be a monthly optional call on the 10 topical areas, and they will be introduced as the webinars occur. So you will see after our speaker today completes her talk, on the very last slide, there will be a day of the month, time of the month, and a single contact telephone number for those people who are, for example, today working on patient falls, who can call in and work on and talk about the issues thay are facing, talk about success stories that are having, and any kind of other issues that you might want to discuss related to the affinity group of like-minded people who are working on that same topic.
So please be sure to go to www.henlearner.org and look for more of that information and more on the calendar as a reminder. Another opportunity, even if you've done this already, I encourage you to go to the “sign up to the Stay Connected” Field at the bottom lower right-hand corner of the homepage of www.henlearner.org, and I ask you to please sign up, and there's an open text field which asks you which topics you are interested in. We’re trying to build the database so that we can keep you connected and don't send you too many e-mails. But be sure we send the targeted e-mails. We've been working through a key contact in each of the delivery systems, and that may not be the right person for all of the topical areas, so we’re asking the key points of contact, if there are people in you hospital or health system that you think are interested, please encourage them to go on and sign-up, and then in that open text field, note the area of interest so we get the right thing to the right people at the right time. Again if you’ve done that already, please do it again, and we’ll be sure to get it to you.
The other thing on remind you of is the blog. There is a link to it at the top of the page there's a tab; and if you go to that blog, you’ll find notices that Amy Wuthrich has posted on key events and also new information as it's being posted. There's also an option to request an RSS feed. For those of us who don't that means, we will send you an e-mail when there's a new post to that block—so another way for us to stay connected. If there are items you would like to contribute to that, we would be more than happy to have you do that. You can send those to and, again, that's our major mechanism for communication. We will be posting two “Success Stories” that we've received from pledged hospitals. We’re really happy to report--those will go up next week, and you see that posted in the blog.
And the last item I wanted to note for you is for the hospital contact, the single main point of contact in the hospital. This may not be everybody on the call today. We will be sending out a quarterly survey on needs assessment/readiness so that we can continue to tailor programming and how to best meet your needs and maintain valiant participation. That will be coming out on June 18, so any questions, again, e-mail them to . For more information, please go to our website at www.henlearner.org.
Right now, I am very, very pleased to present our subject matter expert on patient falls. Marlyn Conti is the patient safety leader at Intermountain Healthcare. She has put together a wonderful presentation for you today on how to address this important issue of patient falls. Without further ado, Thank you much Marlyn.
[Marlyn]
Thank you Lucy.
Hopefully this will be an opportunity for us to share, not only what Intermountain has done, but also what other organizations have done. At the end we will have some time for questions and then asking you at the and also what kinds of things you need. We can maybe follow up one of the monthly sessions with additional information. So again, my name is Marlyn. Vicki Spuhler was planning on joining us today. She's the respiratory ICU manager at Intermountain Medical Center, Intermountain's flagship facility. She has been an ICU manager and ICU nurse for many years. She's a seasoned clinical expert as well. So I hope that I can appropriately represent her presentation. She was unable to join us at the last minute. Thank you all for participating. Please take notes, and be prepared for questions at the end.
<<New Slide 00:07:15>>
Okay, so we have no conflict of interest in anything we will be discussing today.
<<New Slide 00:07:23>>
Objectives for today's session include: 1) At the end, you as the participant will be able to list key steps to getting started if you've not already done so. 2) Identify at least three strategies for reducing falls that you can implement at your facility, or region, or hospital, or company. 3) List at least two outcomes and/or process measures to track trends over time to demonstrate your performance improvement.
<<New Slide 00:07:52>>
To get us started, I pulled some of the data that Bruce Bayley has collected from each of the hospitals that have signed on for the engagement network. 42% of the hospitals noted that they had already implemented a falls programs, but that they have had some challenges with that process. 28% reported they had good progress, and 23% reported they had sustained results over time. I would like to think that the Intermountain hospitals reported that they were having sustained results, but since I didn't personally respond, it’ll be interesting to see what those facilities said. We had a few that said they were not structured or just getting started, so about 5% of the facilities will probably want to pay a little closer attention to the “How to get started” information.
<<New Slide 00:08:45>>
The next piece of data that I pulled from the readiness survey was what level of learning the organization has signed on to or committed to. So for the falls subject matter area, 35% of the signed up hospitals expressed their commitment to be an active learner, which means they will participate in all in the webinars and education, and have agreed to submit data. The 30% that are listed as real-time learners, have agreed to participate actively. Data submission is optional. And the passive learner facilities, their expectation is that they will participate it as much as they can in education and process improvement. There is no requirement or even option for submitting data for those folks. So that's just a little bit of the summary of what we've been able to pull out of the initial assessment.
<<New Slide 00:09:45>>
So let's talk about getting started with the fall prevention program. At Intermountain we’ve had a falls program and a falls team, a system levels Falls team, since 1998. We continue to do a refocus on what is our priority and looking at our risk assessment tool, reevaluating, honing, and revising reports and monitors. The last couple of years we've made formal champions for falls, continue to work on care plans, and initiate a plan-do-study-act cycles (PDSA).
So if you’re getting started, the first thing I'd say for an organization is this has to be a priority with administrative support. That means not just verbal support but commitment to resources, employee hours, dollars for equipment, programming time, so that it's really backed up by actions and money and not just, “Yeah this is a great thing to do. Just got do it without a lot of commitment.”
An organizations must have adopted a standardized risk assessment tool. This is the patient risk assessment. It's done by nursing professionals who assess their patient. At Intermountain we assess all patients at admission and a minimum of daily and recommended every shift to reassess the risks and modify the care plan based on that. And of course you cannot manage what you do not measure. Every system must have some kind of monitoring mechanism in place. Intermountain has had a robust event reporting system since the 80s and we use our event reporting system. It is a voluntary system, but all staff members are educated and encouraged and we monitor and report consistently so that we can share the events that are being submitted.
Then we have various sources of reports available online via the www.Intermountain.net website. But our quality and patient safety department data analyst helps us with, and he sitting next to me for this presentation so if I misspeak, you can kick me. But we continue to revise and hone those reports as well. And the fact that the data is embedded in an enterprise data warehouse—so it’s in a data set, a data table, that is accessible by any of the data analyst in the facilities so they can do additional slicing and dicing. And then what we've done and what we've gleaned from the literature was there really needs be what we call “champions.” You call them whatever title you want. Who is the quality falls lead? Who is the champion, the falls experts? The team lead? Or whatever title you want, but there needs to be somebody who has been appointed and is supported by the organization leadership. In both from the literature and from our experience it does you no good to have a nice risk assessment tool and good reports and good structure if it isn't actually implemented inside the patient care plans. We survey to that. We have a robust internal quality survey program for regulatory readiness, and we survey to that process consistently and then whatever you group or team or processes you need to implement some sort of PDSA, PDCA, performance improvement, whatever the nomenclature is that you use in your organization. So that's just getting started.
<<New Slide 00:13:10>>
Now of course there are a lot of resources out there, and I would refer you to the VA Center for patient safety and to IHI.
<<New Slide 00:13:17>>
IHI has a best practice site for falls, and there a lot of organizations out there that have published their success stories as well. IHI also has a falls toolkit. The Centers for Disease Control, CDC, also has a robust falls toolkit, but it's focused on the elderly. And for our intents and purposes today, and for the hospital acquired conditions that we’re trying to reduce as part of the Partnership for Patient and the Hospital Engagement Network, we are focusing on inpatient falls. So patient age is a risk factor, but it's not totally the CDC information. So those are two references. We will link those to the HENlearner website under the falls topic, so you have easy access to those. And those of you that have been working on falls prevention for a while probably already access this information and use it as well. We have an additional literature search and other references as well. That's been submitted to the Institute here. At some point we'll get that posted on the website, as well. AHRQ stated recently—and this was in a document from 2007—that the best falls prevention programs are multifactorial and interdisciplinary. And I thought they stated that very clearly and that’s what we have discovered at Intermountain that you need to be looking at the whole system and processes, equipment, structure, policy, procedure, education from top down to the bottom, and it's got to be interdisciplinary. You can’t have a separate fall prevention program in Therapy, a different one in Nursing Services, and a different one and surgery. It needs to be integrated and collaborative. So that's best practice
<<New Slide 00:14:57>>
So Intermountain started with the falls risk assessment tool. And when we developed it in 1998, we went out and did the literature search, and there's much more evidence out there now around certain tools. Many that you may have heard of—the Morse tool, the Hendrich II, the Schmid, there’s others. Intermountain is really kind of a hybrid of these tools. We have several major components of the Mores and Hendrich tool in our patient risk assessment tool at this point in time. On the right side of the screen is a little timed get-up-and-go test that the VA system uses. And advocate that the primary care providers, the physician, does the get up and go test as part of their inpatient admission process, and that information is used by nursing staff when they do the risk assessment and fall prevention plan.