We work in a small multipurpose service which includes acute, aged care and an urgent care department.
We were concerned about our high falls rate, our increasingly older clientele and our capacity to provide permanent care for residents with dementia, many of whom independently mobile. We have been tracking our falls rates for 5 years and despite being at ninety percent compliance rate with our falls risk screening, our falls rate were continuing to rise.
When we shared this issue at the State-wide Directors of Nursing and Midwifery Forum, Western Health, Sunshine generously shared their positive experience and lessons learnt from introducing a more holistic screening and risk management form. Nursing staff are prompted to ask key questions that identify risks associated with cognition, continence, falls, pressure injury and nutrition. The paper based form provides nurses with simple, evidence based suggestions on how to manage the identified risks. For example if a patient is confused or disoriented a strategy would be to nurse in a quiet environment close to nurses desk. This combined risk screening approach, along with hourly patient rounding have led to decreased falls and pressure injuries and improved patient experience.
Staff from our MPS spent valuable time learning about Western Health’s project and then incorporated its introduction into the work plan of our multidisciplinary change management group. Other improvements introduced at the same time were hourly patient rounding and environmental scans.
Staff were consulted, involved, trained and provided with audit results. We were excited to report back to staff a significant reduction in falls and pressure injuries and improved satisfaction and care experience from patients and their families. We recorded a high (97%) rate of completion of screening and putting strategies into the care plan and into practice (94%) in the latest quarterly compliance audits.
Introducing early interventions related to cognition appear to makes a difference. For example, simple strategies to reduce cognitive stressors may flow on to reduce risk of other issues such as falls, poor nutrition intake and pressure injuries.
Take time to follow the quality improvement/change management principles, for example, data feedback loop.
For more information, contact Kim Griebenow on kim.griebenow@orh.com.au.