One aged care provider’s initiative to reduce the number of falls by residents is proving very successful.
In 2015 Oceania Healthcare developed and implemented a programme to lower the number of sentinel events (falls with fractures) in its South Island aged care facilities. The plan was designed to reduce the total number of falls which would in turn reduce the number of sentinel events occurring. In the period from 1 June 2015 to 31 May 2016, Oceania achieved a 20 per cent reduction in total falls in the South Island and a 13 per cent reduction in sentinel events. One facility reduced its number of falls by half after implementing the programme.
Susan Mountier, Oceania’s clinical and quality manager for the South Island and project manager for the company’s Falls Prevention Programme, began by training the clinical managers and RNs on how to assess individual residents’ needs and create specialised care plans that help prevent the incidence of falls. A structured process called intentional/routine rounding (IR) was introduced.
IR involves the staff adopting specific behaviours and carrying out regular checks on individual residents at set intervals (typically hourly). During these checks, staff perform scheduled tasks or observations with the resident that help to mitigate the factors that are likely to lead to falls. The checks include monitoring pain, checking positioning, attending to toileting needs, assessing and attending to the resident’s comfort, and checking the environment for any risks to the resident’s comfort and safety. The round ends with the closing words: “Is there anything else I can do for you – I have time.” It also includes a statement about when the resident can expect a staff member to return.
Another factor that is also very beneficial in reducing falls is ensuring that the appropriate equipment (i.e. perimeter mattresses, low beds or bed levers) is available at all sites and is being utilised.
Regular exercise is important in the prevention of falls, but keeping residents motivated to engage in activities can be a challenge. As part of the Falls Prevention Programme, facilities are encouraged to offer at least five group exercise sessions per week. To help keep the exercises varied and fun, an activities blog has been created where activities coordinators can share their ideas. The blog is supplemented with regular email communications promoting some of the most creative or popular ideas.
Increasing staff awareness for all staff has had a huge impact on reducing falls. Awareness of who is at risk, times of day that residents are more at risk of falling, and planning the carers’ duties around this is very important.
To increase awareness, falls prevention notice boards have been set up at nurses’ stations and in staff rooms. These notice boards clearly display statistical information around vitamin D prescribing, sentinel events and number of falls, along with information on interventions to prevent falls.
Each month, a highly visible, colour-coded poster is put up on the notice board at each facility and updated every day showing the number of falls (a figure coloured in red for each fall that occurred) and the number of days without falls. This helps staff to focus on the day or shift they are working on and motivates them to better the current record of days without falls.
Ongoing monitoring and support is vital, and Susan Mountier continues to compile falls statistics each month and send out monthly email bulletins to all clinical managers with information on falls prevention.
The response rate to a recent survey sent out to all Oceania clinical managers about the Falls Prevention Programme clearly demonstrates their enthusiasm and commitment to continuing to reduce the number of falls.
Based on this feedback and the outstanding results achieved in the South Island, Oceania has set a goal of reducing falls by a further 10 per cent across all its facilities nationwide over the next year.