The Winnipeg Regional Health Authority’s Deer Lodge Centre is a progressive 431 bed long-term care, geriatric rehabilitation and chronic care facility located in Winnipeg, Manitoba. Several years ago, Deer Lodge staff looked at their falls statistics and their numbers told them that they could do better. They developed policies, protocols and algorithms to address falls risk and implemented a screening process for everyone admitted to the facility. Their fall rates went down close to 30 per cent over three years, but when they looked at the national standards they found there was still room for improvement. In September 2011, Deer Lodge Centre joined the Safer Healthcare Now! Falls Facilitated Learning Series, a six-month virtual program designed to assist organizations working on reducing falls and injury from falls.
“We are using the Falls Facilitated Learning Series to take a look at hourly rounding,” says Daryl Dyck, Clinical Nurse Specialist at Deer Lodge Centre. “On one unit we did a trial of hourly rounding with our nursing staff some 18 months ago, but results were mixed including convincing all staff of the value of this change initiative. We have been able to take another look at hourly rounding and fine tune it.”
“It was recommended that we start small and find a subset in the group we wanted to address,” says Dyck. “Instead of addressing all high risk patients with hourly rounding, we are looking at a small subset of that group. We have selected two different types of units for our trial. On these units we are looking at the high risk fallers who actually had a fall in the last month and are implementing hourly rounding with those. Our numbers are small, but it is going really well. Our goal is to first establish the practice of doing hourly rounding, then expand it to high risk fallers and ultimately extend it throughout the facility. Once expanded throughout the facility we are hoping to see a further decline in our fall rates. ”
Tracy Thiele, Registered Psychiatric Nurse and Project Coordinator at Deer Lodge Centre, says that an inter-disciplinary group has been formed to establish a solid foundation for hourly rounding. “The inter-disciplinary team (occupational therapist, physiotherapist, unit managers, clinical nurse specialists, data specialist) approach has brought some unique perspectives to the table. We have been able to look at different ways of implementing the project on these two units, using some unique tools and dedicating time as an inter-disciplinary team to work on it.”
“The Learning Series has reinforced that taking the time and doing it right is more successful that rushing through a number of change initiatives,” says Thiele. “Because we started quite small, we have had good staff buy-in. We have had situations where staff has self-initiated hourly rounding, recognizing that the resident/patient was at risk for falls and needed to be placed on the program. That is exciting!”
Deer Lodge Centre has implemented a number of measures in their falls program. A Falls Risk Assessment tool is administered for every patient/resident within 48 hours of arriving at the facility. Accompanying that tool is a risk factor checklist that cues staff to look at interventions for those specific risk factors; an algorithm identifies high risk or low risk and the path to follow in terms of interventions, to reinforce the need to have an intervention in place for that risk factor; and another tool helps staff select the appropriate falls related equipment to use. Deer Lodge Centre has also incorporated falls education sessions as part of a yearly mandatory education program for all nurses and healthcare aides.
For more information on ways to reduce falls and injuries from falls, visit this topic www.saferhealthcarenow.ca and click on Interventions.