Module 1: Preventing Falls in Hospitals—Slide Presentation

Slide 1: Preventing Falls in Hospitals

ADD Hospital Name Here

Module 1

Image: Cover of Preventing Falls in Hospitals Toolkit.

Slide 2: Ice Breaker

Describe an interesting fact about yourself.

Image: Photograph shows a goldfish jumping from one fishbowl to another to join other goldfish.

Slide 3: Compelling Reasons to Implement Program

• Falls are common.
  • They are the most frequently reported incident in adult inpatient units.
  • The rate of falls ranges from 1.3 to 8.9 falls per 1,000 patient days or bed days.
  • Module 5 will discuss how to measure fall rates.

Image: Medical papers labeled “fall risk.”

Slide 4: Compelling Reasons to Implement Program

• Falls increase costs, which are associated with:
  • Increased length of stay.
  • Additional costs ($14,000 on average).
  • Higher rates of discharge to nursing homes.
• Medicare won’t pay for increased costs due to injury from inpatient falls.
• Falls harm patients.
  • 30% to 51% of falls result in injury.
• Many falls are preventable.

Image: Photograph shows a medical provider treating an injured knee.

Slide 5: Compelling Reasons to Implement Program

• Multicomponent fall prevention programs reduce falls.
  • Systematic reviews* show that fall prevention programs result in statistically and clinically significant reductions in fall rates.
  • A 27% to 31% decrease in fall rates was found.

Source: Miake-Lye IM, Hempel S, Ganz D, et al., 2013.

Slide 6: Are You Ready to Change?

• Do organizational members understand why change is needed? (Tool 1A)
• Is there urgency to change? (Tool 1B)
• Does senior leadership support this initiative? (Tools 1C, 1D)
• Who will take ownership of this effort?
• What resources are needed? (Tools 1E, 1F)

Slide 7: Practice Insight

Value of Pre-Assessment Tools

Image: Icon of binoculars.

Slide 8: Implementation Training Objectives

• Educate hospital leadership and Implementation Team on the Preventing Falls in Hospitals Toolkit to facilitate the change process in hospitals.
• Develop hospital-specific action plans for implementing a Fall Prevention Program using the Toolkit.
• Address specific challenges of preventing falls in your hospital.
• Use and adapt the tools and resources to implement the Fall Prevention Program.

Slide 9: Today’s Group Dynamics

• Your Implementation Team Leader (or the designee) will present assessments of your hospital’s current procedures and policies.
• Everyone here plays an important role.
  • We encourage everyone to participate in planning activities.

Slide 10: Today’s Group Dynamics

• Parking lot” to capture your ideas:
  • We’ll try to address your comments. We may need to address them later during the Implementation Phase.
• Much ground to cover today:
  • We will follow the timeframe listed on the agenda.

Slide 11: Implementation Training

The Toolkit focuses on:

• Reducing falls during a patient’s hospital stay.
• Successfully negotiating a change process at your hospital.

Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.”

Slide 12: Preventing Falls in Hospitals Toolkit

Toolkit Sections:

• Is your hospital ready for this change?
• How will you manage change?
• Which practices do you want to use?
• How do you implement best practices?
• How do you measure fall rates and prevention practices?
• How do you sustain an effective Fall Prevention Program?

Image: Cover of Preventing Falls in Hospitals Toolkit.

Slide 13: Toolkit Approach

• The Toolkit is focused on an interdisciplinary approach.
  • This approach pulls staff members from many areas with needed expertise to address the problem.
  • No clinician working alone can prevent falls.
  • Fall prevention requires active engagement of multiple disciplines and teams that care for the patient.

Image: Photograph shows medical providers with patient.

Slide 14: Toolkit Approach

• The Toolkit includes accurate, evidence-based, and effective risk assessments that call for:
  • Critical thinking and clinical judgment.
  • Consistency in approach.
  • Identifying and communicating risk at the earliest possible time.

Slide 15: Toolkit Approach

• The Toolkit focuses on optimizing the effectiveness of interventions by:
  • Tailoring interventions to  address individual risk factors.
  • Assessing their effectiveness.
  • Modifying interventions as appropriate.

Image: Photograph shows medical provider with patient.

Slide 16: Sustainment

“Holding the gains and evolving as required, definitely not going back to the old way.”

Source:  Maher L, 2013; Maher L, 2012.

Image: Photograph of a tree.

Slide 17: When Should We Worry About Sustaining the Gains?

• Actions to ensure sustainability must start at the beginning of a project.
• If you leave it to the end, it will be too late to make any changes that are needed to maximize the potential of sustainability.
• It is very important to ensure that you have things in place from the beginning to achieve and sustain the best improvement outcome you can.

Slide 18: Steps to Sustainability

Your Journey

Managing Change Checklist

Implementation Team composition:

1. ___ Team Leader has been identified and is in place.
2. ___ Sustain: Changes need to become so integrated into existing organizational structures and routines that they are no longer noticed as separate from business as usual.Members with necessary expertise/role have been identified/invited.
3. ___ Linkage to senior leadership has been defined and established.

Team startup:

1. ___ Team agenda and charge are clearly stated.
2. ___ Team has necessary training and resources to get started.

Current state of fall prevention practice and knowledge:

1. ___ Current practice and policies have been systematically examined.
2. ___ Challenges to good practice have been identified at organization and unit levels.
3. ___ Staff knowledge has been assessed.

Starting the work of redesign:

1. ___ Approaches to redesign have been explored and chosen.
2. ___ Gap analysis has been conducted between current practice and recommended practice.

Setting goals and plans for change:

1. ___ Specific goals have been set.
2. ___ A plan for making changes to meet those goals has been initiated.
3. ___ A preliminary plan for sustaining the changes is in place.

Source: AHRQ Preventing Falls in Hospitals Toolkit.

Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.”

Slide 19: Sustaining Change

Sustain: Changes need to become so integrated into existing organizational structures and routines that they are no longer noticed as separate from business as usual.

Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.” The piece labeled "sustain" is highlighted in blue.

Slide 20: High-Reliability Organizations

• High-reliability organizations:
  • Provide consistent performance at high levels of safety over long periods of time.
  • Practice “collective mindfulness,” understanding that even small failures in safety protocols or processes can lead to catastrophic or adverse events if action is not taken to solve the problem.
  • Eliminate deficiencies in safety processes through the use of powerful tools to improve their processes.
  • Create an organizational culture that focuses on safety; they are constantly aware of the possibility of failure.

Source: Chassin MR, Loeb JM, 2013; Chassin MR, Loeb JM, 2011.

Slide 21: Components of Sustainability

Four key strategies:

1. Engage Leadership.
2. Measure Continuously/Evaluate for Change.
3. Collaborate With All Disciplines.
4. Hardwire Practices and Educate.

Slide 22: Leadership Engagement

• High-level senior leadership buy-in.
• Designated fall prevention Implementation Team Leader.
• Designated fall prevention Implementation Committee/ Interdisciplinary Team.

Image: Photograph shows leaders and medical providers seated at a table.

Slide 23: Engage Leaders

It is the right thing to do—patient stories, their stories.

• WIFM: What’s in it for me/them?
  • Cost avoidance estimation.
  • Patient throughput.
  • Turnover reduction.
• Leaders: Alignment of improvement efforts and organizational priorities.
• Senior executives: Rounding on units.

Source:  Duval-Arnould J, Mathews SC, Weeks K, et al., 2012; Waters HR, Korn R Jr, Colantuoni E, et al., 2011

Slide 24: Engage Leaders

• Leadership support:
  • Seek vice president or higher.
  • Engage support for Team’s work.
  • Rounding on unit—be purposeful.
    • Script the rounds.
      • How will the next patient in this unit be harmed?
      • How can I help to remove barriers so that the safety defects we are most concerned about can be better addressed?
      • How well does teamwork occur on this unit?
      • What doesn’t work well?
    • Use learning board as unit’s meeting point.

Source: Sexton JB, 2010

Slide 25: Practice Insight

Increase Leadership Buy-in

Image: Icon of binoculars.

Slide 26: Components of Sustainability

Four key strategies:

1. Engage Leadership.
2. Measure Continuously/Evaluate for Change:
   • Harness the power of local data to drive improvement efforts.
   • Track prevention practices.
   • Learn from defects.
3. Collaborate With All Disciplines.
4. Hardwire Practices and Educate.

Slide 27: Using Data for Continued Improvement

• Continue to collect process and outcome data.
• Set targets for process and outcome data.
• Gather information from defects.
• Use the data to identify opportunities and hardwire practices.
• Share data with:
  • Improvement Team.
  • Frontline staff.
  • Leadership.

Slide 28: Annotated Run Chart

Image: Line graph shows JAH VAMC Med-Surg falls with harm by quarter per 1,000 patient days.

Slide 29: Components of Sustainability

Four key strategies:

1. Engage Leadership.
2. Measure Continuously/Evaluate for Change.
3. Collaborate With All Disciplines:
   • Collaborate with multiple disciplines.
   • Identify physician and nurse champions.
   • Tap into the wisdom of the frontline staff.
4. Hardwire Practices and Educate.

Slide 30: Sustainable Collaboration

• Senior leadership support is important, but change comes most effectively from frontline staff. Tap into their wisdom.
• Multidisciplinary collaboration is essential to carrying out fall prevention.
• Gaining buy-in from all involved results in shared ownership of  positive prevention results.

Image: Photograph shows leaders and medical providers seated at a table.

Slide 31: Sustainable Collaboration

• The fall prevention group should:
  • Continue to meet (or merge with an existing group).
  • Report up through a quality structure.
  • Have a vision with clearly defined goals and an associated Action Plan. (Update every 6-12 months.)
• The Team and its goals should be:
  • Aligned with its organization’s goals of preventing harm.
  • Part of the dashboard.

Slide 32: Components of Sustainability

Four key strategies:

1. Engage Leadership.
2. Measure Continuously.
3. Collaborate With All Disciplines.
4. Hardwire Practices and Educate:
   • Standardize care: prevention practices.
   • Include practices in patients’ daily goals.
   • Train new staff in evidence-based prevention practices.

Slide 33: Resource Needs Assessment

Filled out by Implementation Team Leader with support from hospital supervisors, managers, and administrators.

Images: Icon of a magnifying glass in front of an open book; checklist from Tool 1E: Resource Needs Assessment.

Slide 34: Resource Needs Assessment Results

Team Leaders: Let’s share results of this assessment for your organization.

Slide 35: Team Charge

Implement a Fall Prevention Program within 8-10 months.

Image: Photograph shows a medical provider holding the arm of a patient using a mobility device.

Slide 36: References

• Chassin MR, Loeb JM. High-reliability health care: getting there from here. Milbank Q 2013 Sep;91(3):459-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790522/. Accessed June 16, 2017.
• Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Aff (Millwood) 2011 Apr;30(4):559-68. http://content.healthaffairs.org/content/30/4/559.long. Accessed June 16, 2017.
• Duval-Arnould J, Mathews SC, Weeks K, et al. Using the Opportunity Estimator tool to improve engagement in a quality and safety intervention. Jt Comm J Qual Patient Saf 2012 Jan;38(1):41-7,1.
• Maher L. Starting for Success. Partners In Care Programme: Webcall One. Health Quality & Safety Commission New Zealand. Counties Manukau Health. 2013. https://www.hqsc.govt.nz/assets/Consumer-Engagement/Partners-in-Care-Resource-page/Webex-1-starting-for-success-Oct-2013.ppt. Accessed June 16, 2017.
• Maher L. Welcome to the Partners In Care Webex 6 – 3 October 2012. Health Quality & Safety Commission New Zealand. NHS. https://www.hqsc.govt.nz/assets/Consumer-Engagement/Partners-in-Care-Resource-page/Sharing-Partner-in-Care-Webex-6-Oct-2012.ppt. Accessed June 16, 2017.
• Miake-Lye IM, Hempel S, Ganz D, et al. Chapter 19. Preventing in-facility falls. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville, MD: Agency for Healthcare Research and Quality; March 2013. https://www.ncbi.nlm.nih.gov/books/NBK133389/. Accessed June 15, 2017.
• Sexton JB. Engaging Leaders Webinar. 2010.
• Waters HR, Korn R Jr, Colantuoni E, et al. The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs. Am J Med Qual 2011 Sep-Oct;26(5):333-9.