For the past eight months, 40 Canadian healthcare teams from acute, long-term care and home care settings, have been participating in the Safer Healthcare Now! Falls Facilitated Learning Series (FFLS) to learn, implement and adopt sustainability concepts to support their falls prevention and injury reduction improvement strategies. Safer Healthcare Now! has co-partnered with the Registered Nurses’ Association of Ontario to help teams implement sustained practice change and measure improvement in falls and injury from falls at the participating sites.
Kateri Memorial Hospital Centre located in Kahnawake, Quebec joined the Falls Facilitated Learning Series to help refocus their fall strategies and rebuild the momentum at this 43-bed First Nations community hospital. “We participated in the Falls Collaborative in 2009, however we started to notice an increase in falls,” says Marla Rapoport, Manager of Rehabilitation Services at Kateri Memorial Hospital Centre. “The Learning Series came along at the right time and we saw this as an opportunity to reenergise. We felt that the sustainability component would provide us with newer strategies that would help to further engage and motivate our staff.”
The hospital had a core group in place to evaluate falls strategies however those representatives had a more administrative focus. Although there was a Nurse Manager, Occupational and Physiotherapist on the team, these clinical professionals did not work with the high risk fallers on a day-to-day basis. For the Learning Series they had the opportunity to take a more hands-on approach when nine frontline providers (including six personal care workers, a physiotherapist, a nurse practitioner, home care nurse, activities coordinator and quality improvement staff) volunteered to participate as part of their FFLS team. “It is really important to have frontline workers to spearhead your improvement efforts and be the champions on the unit,” says Rapoport. “They were such a store full of knowledge and the feedback they provide is really valuable.”
Rapoport says that although they pride themselves with having great communication, in every area of the hospital when there is a problem, the underlying issue is always communication. During the Learning Series, the team came up with a number of change concepts to test, including reinstating a walking program, huddles, improved collaboration between departments, a footwear audit, and a chair and bed alarm audit with a review of equipment and clients using the alarms. They also wanted to share their learnings with the community and Rapoport says that she now gives presentations on falls to anyone who will listen to her and by sharing this information, it helps everyone.
The footwear audit provided some interesting insight; they found shoes that did not fit, old shoes that did not provide support, and some clients only wear slippers. The staff is now in the process of going back to the families to let them know that their loved ones need new shoes and preparing information on purchasing proper footwear. “We can’t prevent all falls, but we want to minimize injury,” says Rapoport. “Our mandate is to be restraint free and we want our patients to have the best quality of life possible. Our focus is to decrease the risk of injury and keep our clients mobile. The more active they are, the better the prognosis and the better they will do.”
Rapoport says that change takes time and teamwork. The frontline workers are being brought into the discussion when someone falls to help determine what strategies would work best for that individual. The frontline workers appreciate having a voice and these group huddles help to confirm thoughts and ideas for change.
“Safer Healthcare Now! has really helped us to reenergise,” says Rapoport. “It is our place to go for new ideas, best practice guidelines and information on new technologies. The Learning Series provided an opportunity to hear what other healthcare providers from across Canada are doing and to learn that we were not the only ones having problems with sustainability. We have to focus on sustainability to keep the momentum going; that is our challenge.”