When the Canadian Red Cross (Ontario Community Health & Wellness programs) decided to participate in the Canadian Patient Safety Institute's Falls Prevention Audit, they knew it would be a valuable process; however, as they moved through the initiative they were surprised at the results. As an outcome of the initiative, changes were made to a number of existing Red Cross fall prevention processes to help strengthen their recognition of modifiable fall risk factors and effective management of clients identified to be at risk for a fall.
As Red Cross started implementing the audit process they identified a number of audit criteria that in accordance with the Safer Healthcare Now! definitions were beyond the scope of their program services. As a result, Red Cross worked with a representative from the Patient Safety Metric team to develop customized definitions that aligned with the scope of their services. This effort supported a more meaningful and relevant analysis for the Red Cross, making the Falls Audit a valuable endeavour.
The Canadian Red Cross does not provide nursing services; therefore, they utilized the audit to evaluate the fall prevention processes associated with their Ontario Attendant Outreach and Assisted Living programs, targeting high risk seniors and adults with physical disabilities. Information was gathered from all fall events and then entered into the Patient Safety Metric system as one bulk Assisted Living program.
"We thought taking a provincial approach would provide us with more robust information rather than focusing on one program site, as the information would have been very limited," says Jody Hales, Director of Quality Assurance & Risk, with the Canadian Red Cross Community Health & Wellness programs. Jody was a recent speaker at Canada's Virtual Forum, sharing their experience as an early Safer Healthcare Now! adopter.
The Canadian Falls Prevention audit was scheduled for the month of April; however, the Red Cross continued to measure their falls prevention and management process until the end of September. "We wanted at least six months of data in order to effectively evaluate our falls prevention framework," said Jody. "During that timeframe, we were able to complete and submit a total of 125 fall audits."
In order to compile the data, information was collected from Red Cross client safety event reports. Red Cross Coordinators and Supervisors were engaged in the process when additional information was required. The Red Cross Safety Event Management process encompasses client safety events that occur outside of service, during service and incidents that occur as a result of service. During the time period of the audit there were no result of service fall incidents; the audit results were reflective of client fall events that occurred outside of service.
Hales says that they were very pleased with the audit results because it showed considerable strength in their fall prevention processes but also identified areas for improvement. For example, 90.5 per cent of their clients had a fall assessment completed and prevention plan developed. They also found that 61 per cent of the falls recorded did cause some level of client injury.
"We take a holistic approach to client safety" said Jody. "We cannot determine a standard of safety independently of clients' perspective. Perceptions of risk and safety are often varied; therefore we need to collaborate through a lens of education, negotiation and mitigation to help clients make informed decisions about their safety and care. We also understand that at times clients, their family and/or caregivers may choose to live at risk, and we must respect that right."
The Canadian Falls Prevention audit results will be shared with the Red Cross senior leadership team and regional directors. Results will also be communicated to frontline staff and volunteers, through their quarterly newsletter. "It is important to involve our staff and share audit results with all levels in the organization so that people have a better understanding of why processes change and the value of participating in such initiatives," says Jody Hales.
"When you are providing care and services to a vulnerable population you have a paramount responsibility as it relates to client safety," says Jody Hales. "As individuals continue to receive the care and support they need to safely age in place, there needs to be greater recognition of the role of the home and community support service sector in client safety. By expanding the focus of client safety with home and community support services, which support instrumental activities of daily living, improved health outcomes for clients will be achieved."
Access Jody Hales' presentation at Canada's Virtual Forum.