Project:PDSA Cycle – Edmonton Zone, Home Living, Geriatric Team Multidisciplinary Falls Assessment Tool

Date: January 10, 2012

PDSA Cycle Reporting Form

  1. What are we trying to accomplish? To which goal/aim does this link?

To implement the newly-developed Geriatric assessment tool and ensure that it serves the purpose of identifying clients who are at risk for falling or who have experienced falls. Identifying gaps in knowledge can help the team to amend the assessment tool to capture this information.

  1. How will we know that a change is an improvement? What will our measurementstrategy be? How does this link to our overall measurement and performance monitoringstrategies?

The team members will demonstrate satisfaction that the initial assessment provides an accurate picture of the client’s present fall history and risk for future falls. Measurement strategy will be qualitative via general discussion and feedback during case conferences. This process fits with our overall Geriatric Team’s ongoing establishment of its processes.

  1. What changes can we make that will result in an improvement? How does this PDSAlink to other PDSA’s that we have planned?

The team will continue to evolve its assessment processes to fully explore the history of falls and risks for future falls. A future PDSA may involve the introduction of a new intervention through Meditech or a change to the problem list the team is presently using.

PLAN (November 17)

What is our hunch that we that would like to test out?
The Geriatric Consult Team’s new assessment tool will help the team to identify clients at risk for falling and with a history of falls.
What do we expect to happen?
The assessment tool will identify factors putting clients at risk for falls.
The tool will also assist in prioritizing and directing the team’s interventions.
How will we measure progress?
After completing of the assessment, the tool will be successful if the team has been able to identify major risks and causes of falling, as well as gaps where information was not adequate.
Is this a pragmatic, realistic, learning cycle? Anything else we need to do?
Yes. Identification of gaps can help to direct future PDSA cycles.

DO (Date of Do:_November 17 to December 31______)

Carry out the plan and document the actions
Initiate the new assessment tool for the next five clients
Chart review to gather information related to falls
Talk with the client lead to identify positive and negative comments about assessment with regards to falls
Record the data
Working sheet to identify risk factors and how they are being addressed for each client
Record team members’ comments on usefulness of tool and questions left unanswered

STUDY (Date of Study:__January 10______)

Reflect on what happened
Due to an unexpected increase in the number of referrals, ten client files were reviewed instead of five.
Feedback from the team indicated the TUG and SPLATT provided adequate screening for falls, but that the information gathered was very basic. For clients who had a history of falls, there were gaps in the information collected in the assessment tool. There was a lack of integration of the multifactorial elements contributing to falls, and an inability to find information easily. A suggestion was made to flag medications that may be contributing to falls. Other gaps in information included interpretation of the meaning of balance scores with respect to falls risk, and identification of environmental contributors to falls. The client would also benefit from an analysis of the body systems that may be contributing to falls.
What does the data suggest?
The data suggest that while the assessment tool may presently be identifying those at risk for falls or those who have had a fall in the recent past, a more comprehensive, integrated analysis of factors contributing to these falls would be beneficial. This may take the form of a separate falls assessment tool or a different approach to identifying the client’s problem list.

ACT (Date of Act:____Jan 15-March 15______)

What have we learnt from this test of change?
We have learned that falls are the domain of many disciplines, not just the typical rehab professions. The client will benefit from an interdisciplinary, multisystems approach that identifies specific factors contributing to falls. While our present process of screening seems to be adequate, an additional process may be required for those who demonstrate a history of falls.
What will we do differently as a result? What next?
The team will revise our present problem list to address specific factors or systems contributing to falls. The Falls committee will explore interventions in Meditech that will align with Home Living assessments of falls. The team will continue to approach falls with an interdisciplinary focus. The client’s overall well-being will be considered, with attention to a continuum of achieving medical stability prior to addressing rehab needs, then considering referrals to external resources.