By: Christine Gillevet RN, MDS Quality Manager and Susan Roberts RN, BScN, MHS, ADOC
Lanark Lodge, Perth
Falls prevention is a priority at Lanark Lodge. While we have many strategies in place for our residents, we were still seeing our fall rates increase. One of our 2018 late career initiatives was to review our Falls Program and identify new approaches to help reduce falls and associated injuries. This was spearheaded by Eady May Bowes, one of our late career RNs, with the support of Christine Gillevet, RN, our MDS Quality Manager.
Eady May and Christine decided to first review the RNAO Clinical Best Practice Guidelines for Preventing Falls and Reducing Injuries from Falls. Next, they reviewed the Falls Gap Analysis we did with our Long-Term Care Best Practice Coordinator. We had met many of the recommendations but we could still do more. They spoke with the management team about the recommendations they planned to work on, in order to get leadership support for facility-wide implementation.
To raise awareness about falls prevention, our team created and posted falls prevention posters around our facility. They also developed a new falls prevention pamphlet for residents and families. The Scott’s Falls Risk Screening tool was built into our documentation system, PointClickCare, with permission from Vicky Scott. Our registered staff was trained to complete this screening tool.
Keeping in mind the importance of inter-professional collaboration, we worked with our pharmacist to complete medication reviews, following the BEERS criteria. We focused on medications that could increase the risk of resident falls. Our physician prescribed Vitamin D for all frequent fallers. Eady May was even able to locate a volunteer TAI CHI instructor to hold sessions with our frequent fallers!
In the resident neighbourhood chosen for the pilot project, we implemented many safety strategies. Resident washrooms now have a laminated poster with pictures of all the resident safety equipment. The specific equipment required by a resident, is circled, using an erasable marker. Staff in other neighbourhoods was eager to get these washroom posters. Two brightly coloured washable tapes have been placed on the back of toilets and on the floor behind the toilets, to assist with depth perception. Beds are lowered to the appropriate height and this height is marked on the wall at the head of the bed. Posey mats, Hipsters and Gripper socks are used to help prevent fall injuries. We also purchased a ‘Head Halo’ from a company that makes protective headgear for curlers, to help protect a resident from head injuries. These safety strategies are updated regularly in the care plans.
All resident falls are discussed at the time of the fall. An assessment of causal factors is reviewed and documented. Falls are also discussed at our daily management meeting, our weekly restorative meeting and at our quarterly Falls Committee meeting. During the quarterly meeting, our physiotherapist assistant, Miranda Moore, provides a clock pie graph for each resident neighbourhood. This graph shows when falls are occurring, to increase awareness of the high-risk times for falls.
The physio assistant and our Nurse Practitioner, complete a root cause analysis, if a resident falls for a third time. They document their findings on a Post Falls Assessment template, which was created in PointClickCare. They also provide recommendations for the inter-professional team to implement. One recommendation we implemented was putting a label on walkers to remind residents to put on the brakes.
Hourly safety and comfort rounding was introduced the week of May 7, 2018 as a pilot project, in one of our resident neighbourhoods. Susan Roberts, one of our new ADOCs, provided direction and support. Eady May held education sessions for all staff. She clearly explained that rounding is not the sole responsibility of PSWs. It is important that ALL staff participate in hourly rounding, in order to successfully implement and sustain this practice change.
An hourly rounding sign off sheet was developed and posted in the conference room weekly, by the registered staff. A form for staff to complete when taking a resident out of the neighbourhood was also developed and posted with the sign off sheet. Our ADOC keeps these documents for data collection. The care plan indicates if hourly rounding is being used as a falls prevention strategy and all near falls are documented in our risk management module.
Staff from every department, clinical and non-clinical, was assigned a specific hour for rounding. They located each resident and ensured that their needs were met. They also addressed any safety hazards and made sure safety equipment was within the resident’s reach.
Staff signed off their hourly round and documented how many potential falls or safety issues were intercepted. In the early days of the trial, our ADOC provided regular reinforcement of key messages. She provided further education and follow up to clarify expectations and promote accountability. Our ADOC took on a visible, participatory role. She modeled these expectations by completing her own daily assigned rounding. She also discussed with staff, the required actions to address near misses.
The number of near misses intercepted by our hourly safety and comfort rounding was shared with staff, management, and the Council of Family and Friends. We also included these successes in our resident and family newsletter. Acknowledging successes really helped to get staff buy in and improved staff engagement.
Early on, staff in the pilot neighbourhood saw the benefits of hourly rounding. Without any prompting, they started to get the word out to the other neighbourhoods and the seed was planted. Buy-in and enthusiasm grew. In less than two months, by the end of June 2018, hourly rounding went facility-wide, with the support of our two other ADOCs, Allison Fournier and Nicole Warren.
It is very exciting to see the results of our team efforts. Our fall rates are definitely decreasing. We have had some stretches where there were no falls in more than 10 days! More than 30 falls and/or safety concerns were intercepted in each of the four resident neighbourhoods. Consistent completion of hourly safety and comfort rounding really works! We are still in the early stages of full implementation. Looking at opportunities for ongoing quality improvement in processes, data collection and documentation will be very important.
Implementing the RNAO falls best practice guideline has improved resident care and outcomes. It has also empowered and engaged our staff. We look forward to continuing our quality improvement work. This falls prevention initiative would not have been as successful without the collaboration and commitment of our late career RN, our MDS Quality Manager and ALL of our dedicated staff and leadership. One of our core values at Lanark Lodge is ‘Together We’re Better’ and that, we are!
- About Lanark Lodge –
Lanark Lodge is an accredited, municipal long-term care facility with 163 residents, in Tay Valley Township, which is in LHIN 10 – Southeast Ontario. To request copies of documents developed, or for further information, please contact the LTC Best Practices Program at LTCBPP@RNAO.ca.