IHI Expedition: Preventing Your Patients from Injurious Falls

IHI Expedition: Preventing Your Patients from Injurious Falls

Session 7 Chat Log

BethSnitzer:How many beds does SRMC have?

Pam Pshea:SRRMC has 123 beds

Cory Meyers:Does anyone use video surveillance on individual high-risk for fall patients?

Lisa MacDuff:Kathy Woodard - does your year run from April to March?

Catherine Brennan:What is the difference between staged/intentional vs. noncompliant

Pat Quigley: Hi... The first three types of falls are from Dr. Morse. In the VA, we defined intentional (behavioral) falls, as those due to behavioral causes. We considered intentional falls as unpreventable, as we can't control behavior - however, is so important that we will have an urgent team meeting after. Our definition of fall includes Unintentional.

Kathy Barbay:What criteria do you use to categorize a fall as intentional?

Kathy Benjamin:What is your patient population - i.e. geri/adult? And what is your total census?

Catherine Brennan:There is still an issue related to the “assisted to the floor" even when one is being managed by 2 staff members and gait belts etc... but is just too weak to walk as far as they thought they could

BethSnitzer:Sonya, How do you address the issue of pt privacy with video surveillance?

WendyLim:what is the patient to nurse ratio if you do an hourly fall rounding with 15min checks?

Kayla DeVincentis:Thanks for presenting, Kathy! Great report-out!

Kaiser Permanente Mary Lowe:Kathy, I worked at a 300 bed psyche hospital and we resolved our issue about counting intentional falls by adopting the WHO definition of a fall which stipulates it as unintentional.

Pat Quigley:data presentation and analysis, Kathy's approach is right-on! First analyze ALL Falls, as you have to have a starting point - the aggregated fall rate. Then, analyze falls by type of fall (accidental, anticipated physiological, unanticipated physiological, and intentional). Next analyze falls for the repeat fall rate, and you can continue with % of pts who fall, severity of injury, etc... but, have to get to fall rate by type of fall. Great work! Pat

Pat Quigley:Here is the VA's definition of a fall: Fall Definition - Loss of upright position that results in landing on the floor, ground, or an object or furniture, or a sudden, uncontrolled, unintentional, non-purposeful, downward displacement of the body to the floor/ground or hitting another object like a chair or stair; excluding falls resulting from violent blows or other purposeful actions.

WendyLim:Does anybody know what 'PCT' stands for?

Pat Quigley:PCT: Patient Care Technician

Donna Patey:Patient Care Technician - usually a nursing assistant

Maureen Greene:patient care technician

Wendy Lim: We call ours- HCAs (Healthcare Attendants)

Donna Patey:This patient agreement would be stronger with the MD signature as well!

Pat Quigley:Rather than an MD signing the agreement, would it not be more meaningful to have the MD talk with the patient with the nursing staff present to discuss safety? Even with an MD agreement, the hospital has legal responsibility for the patient's safety from preventable harm.

Kayla DeVincentis:Thanks Nina and Glen!

Pat Quigley:Nina and Team, how do you deal with patients with cognitive impairment? They could not participate in the agreement... So, do you have inclusion criteria for who participates in the agreement? and also, what happens when a patient or family says "no" to signing the agreement? Has that happened? Pat

Carla Hall:Our intent with our agreement is not to negate liability, but to encourage the patient to think before getting up and we will encourage family's signature as well so they are aware to use the call button and not try to help the patient get up.

Donna Patey:Are the agreements done before surgery?

Katie Westman:Would love to see the AIM statement from the FRAT group!

Carla Hall:Our agreement is based upon a video available on our TYGR system. The patient watches the video when they are admitted to the floor and they basically sign a documented they watched the video and agree not to get up without calling first.

Pat Quigley:So, before the agreement, do you have a knowledge test and a skills test to make sure the patient can and is a full partner in the fall prevention program before signing the agreement? Pat

Tabatha Bowers:falls per shift...is this per day or the trending over the month?

WendyLim:To Carla Hall: Would you be able to share your video with us?

Pat Quigley:Nancy, did you implement environmental changes too to reduce and protect patients from injury - such as reducing risk of trauma and lacerations? Pat

Carla Hall:The nurse does a review and if the patient is unable to view or to sign, we have the family watch the video and sign in - whoever will be staying with the patient. We may not can get every patient to sign, but again, the intent is simply to educate the patient and family, not to put blame on the patient if they do get up and fall or negate our liability. It is used as an educational tool. I'll have to see if I can get a copy of the video, it is on our TYGR system that has multiple videos available.

WendyLim:hi Carla, thank you!! Your hospital's concept is something which we would like to explore and adopt in the Asian context for the patient's and their family members

KellyWilson:we have a falls video that we use- I can send the name to the group later

Catherine Brennan:Thank you Kelli that would be helpful

Pat Quigley:To Nina and Carla, I would still build in a knowledge and skills test - grounded in Health Literacy.. and continue to evaluate knowledge and skill (not just at the time of admission). Would be a comprehensive patient education program for patients and caregivers. Pat

Carla Hall:Thank you.

Kayla DeVincentis:Thanks Nancy! It's amazing what your team has done in a short period of time!

Catherine Brennan:Could you send the Post Fall Peer Review Form to the group please Thanks

Amit Mohan:How many beds are on your unit or hospital? We are impressed with your numbers.

Ryan Huff:Do you have an assessment form for the 1:1 monitoring? How do you assess the need for 1:1?

Eileen Lilian:How do you ensure that 2 hour elimination needs are met? Was there a chart to document this initiative?

Catherine Brennan:What is your benchmarking score in your Gero-Psch unit?

Judith Mitchell:We would love to know where you are finding your data to compare the geri-psych fall rates to know that you are below the standard...

Judith Mitchell:We have a geri-psych unit and we cannot find national data to compare our unit to.

Simone Gordon:In one of the links that Pat referenced some weeks ago, there were benchmarks for specific unit types.

Catherine Brennan:WE can't either that is why I was asking I do wish that we had a National Benchmark for Psych

Pam Pshea:Great presentations. Lots of take aways. Thank you

Kathy Duncan:Great to hear about all the great work!

Jane Dresselhaus:To Dawn and Diana, Would be interested in the information you have for gero psych fall benchmarks. Can you post them on the blog later?