Improvement Charter for RQHR Palliative Care Services Home Care

Team Name: /

RQHR Home Care FOG (Feet on Ground)

Team Members: /

Palliative Home Care Sub-Committee: Bev Cross, Carol Hepting

RQHR Home Care : Linda Voss, Lorna Kathol, Debbie Ponscak, Linda Picot, Vicki Demerse, Cara Christain, Glenda Popowich, Tricia Murray, Brenda Federko, Colleen Lundeen, Tamara McDermit

Team Leader: /

Connie Fiorante

Team Sponsor: /

Lori Tulloch

WHAT ARE WE TRYING TO ACCOMPLISH? /

Purpose of Project

The purpose of the project for RQHR Palliative Care Services (PCS) HomeCare is to reduce/decrease falls and injury from falls by 20 % by the end of March 2012.
Scope & Boundaries
The team will:
- Assume that all clients requiring palliative care in the home setting are at higher risk for falls due to: increasing age, cancer diagnosis, contributing medications, general weakness and poor performance status (Draper et al, Eastern Palliative Care.
- Monitor Palliative Home Care Clients for number of incidents reported as falls using the number of actual falls reported through EMSreports and RQHR Confidential Occurrence Reports.
Improvement Objectives
  • All mobile clients with referral to OT will have Home Safety Checklist completed.
  • Environmental and client assessment of risk for falls will trigger interventions aimed at reducing falls.
  • PCSFall Prevention Strategy will involve a team-focused approach including education about fall risk and fall prevention to all members of the interdisciplinary PCS Team and the client and his/her family.
  • Improved tracking and documentation regarding falls utilizing a Fall Tracking Sheet &/or improved reporting of falls through Confidential Occurrence Reports
.
HOW WILL WE KNOW A CHANGE IS AN IMPROVEMENT? / Measures
  1. Minimal data re fall in HC available
  2. Arrange prospective study by RQHR EMS commencing Sept. 2011.
  3. On admission 100% of clients will have brief risk assessment to screen for previous falls.
  4. 100% of mobile clients referred to OT will have Home Safety Checklist completed.
  5. Fall Prevention Education Pre and Post Education
Questionnaire to team
members / Current Performance
1. Currently, all clients admitted to Home Care by PC Coordinator or Home Care Nursing are asked about history of falls as part of the admission data base. (This question currently has no time definer attached to it i.e. history of fall in last 90 days)
2. >90% of Palliative Home Care clients are assessed by OT and receive education regarding mobility, fall reduction strategies, recommendations re mobility aids and modifications to home to enhance safety.
3.TLR assessment identifies need for mobility assistance and aids
4. HHA report difficulty with transfers/ambulation / Goals
  1. Education to all Palliative Care Services team members re risk factors,fall prevention, PCSFall Prevention Strategy (Algorithm)
  2. Standardize screening question on admission to identify palliative care clients at higher risk for fall
  • Have you had a fall in the last year? Yes  No
  • Number of falls in the last four weeks_____
  1. Increase team/client awareness and reporting of falls through Fall Tracking Sheet
  2. Implement Post Fall Huddle at weekly Team Rounds – triggered by Occurrence Report or increase in fall incidents
  3. Review “What To Do If I Have a Fall”(client education sheet), with client/family if client has history of falls
  4. Utilize Post Fall Problem Solving Tool at Post Fall Huddle to pinpoint appropriate interventions and referrals aimed at reducing falls and creating a safer environment.

WHAT CHANGES CAN WE MAKE THAT WILL RESULT IN IMPROVEMENT? /

Change Concepts and Ideas to Test

Trialed Fall Log: 5 palliative patients slated for daily home health aide visit week of June 27- July 4, 2011. HHA will ask client if they have had a fall since previous visit. PDSA Cycle 1 re utility of Fall Log. Abandoned in favor of FallTrackingSheet .
OT using the RQHR HC Home Safety Checklist and is adapting this form to ensure it captures the needs of our patient population.
Every team member of multidisciplinary team will receive education around fall risk, prevention and review of PCS Fall Prevention Strategy. Will administer Falls Prevention Education Questionnaire- two questions pre & post education session
Using Maple Leaf on chart as indicator of fall risk.
Implement 3 standard questions to be asked by any team member when leaving a client with a higher risk for falls:
Do you have your Lifeline or cordless phone with you?
Do you have the phone number to call if you need help?
Do you need anything before I leave?
These questions will be put in the front of in-home chart in business card pocket protector to remind all team members to ask before leaving the client’s home
Trial use of Post Fall Problem Solving Tool (Providence Place) at Post Fall Huddle weekly Team Rounds
HOW WILL WE MANAGE THE IMPROVEMENT PROJECT? /

Principles for Working Together

- Working sub- group of RQHR Home Care FOG from RQHR Palliative Care Services
- PCS formed Falls Prevention Group including Director, Senior Manager, Home Support Manager, OT, Program Development Educator and QI Manager. Group meets biweekly to develop and implement a fall reduction/prevention strategy

Roles & Responsibilities

Program Development Educator to provide one hour education session to all team members commencing July 2011 Content of Education to include:
  • Provincial and National Statistics- personal and economic cost of falls
  • Consequences of Falls
  • Fall Prevention in Palliative Care
  • Risk factors for falls
  • Review Algorithm outlining PCS approach to Fall Prevention for 3A and Home Care
  • Review new documents Falls Tracking Sheet, Home Safety Checklist. Post Fall Problem Solving Tool, 3 Questions Card for HC

Review Schedule

Mid July 2011- evaluate Fall Log
End of August 2011 - review progress with education
End of December 2011- review data (re Occurrence Reports, Post Fall Problem Solving Tool) & staff feedback
End of March 2012

Key Dates

Education to team completed by end of October 2011

Author:

Bev Cross RN

Program Development Educator

RQHR Palliative Care Services Team

Date: July27, 2011

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