Team:

Head Nurses Charge Nurses Staff Nurses NTs & PAs Nurse Educator Rehab Physicians Occupational Therapists Physiotherapists Speech Therapists Pharmacist QM Reviewers  

Results:

Conclusions: 1. After the implementation of action plans (test of change), from 2012 to 2013, the fall incidence reduced to 50%, and for 2014, “there was about 75% reduction in the fall incidence rate wherein only 3 patient had falls as per OVA were reported”, more than the 50% target/goal for this year, it was a remarkable success of the project.

2. Utilization of Hendrich II as a standardized tool in fall risk assessment is very significant in identifying high risk patients targeted for bundle approach on fall prevention.

3. Patients & families active involvement or participation in the fall preventive measures after receiving education added to project’s success.

Next Step:

1. It is good that the bundle approach really made an impact in fall reduction but there should be no complacency: on a 25 – bedded unit, even a success rate of 75% leaves 3 patients unprotected. So the next target for year 2015 is to reach the international quality benchmark: Zero or No Patient Fall.

2. Ongoing education of staffs, patients & families for strict adherence to bundle approach on fall prevention.

3. Continue next PDSA cycle for Fall Prevention as the NeuroTrauma Rehabilitation Unit’s Nursing Quality Performance Measure with frequent random evaluation of the process.

Patients - Staffs Communication & Patient Safety Whiteboard

“BUNDLE APPROACH ON REDUCING PATIENT FALLS AND FALL – RELATED INJURIES IN NEUROTRAUMA REHABILITATION UNIT OF RUMAILAH HOSPITAL”

Jasmin Cherian, DON; Habib Ben Gaied, HN; Abicel Lowen Filio, CN; Shamini Biju, CN; Maria Huab, CN; NTR Staff Nurses

Description: According to Center for Disease Control and Prevention (CDC), 22,900 older adults died from unintentional fall injuries and one out of three older adults falls each year. Up to 50% of hospitalized patients are at risk for falls, and almost half of those who fall suffer an injury. For the past years, Rumailah Hospital – Rehabilitation Unit particularly NeuroTrauma Section had a high incidence of fall & fall – related injuries due to high risk patient population such as TBI, SCI, Musculoskeletal & other neurologic conditions & the care specialty itself, on “promoting independence & maximizing the patient’s abilities & potentials”, hence, Fall Prevention is the primary Quality Performance Measure of the unit in compliance to the Joint Commission International – IPSG standards # 6: “Reduce the risk of patient harm resulting from fall” & the Nursing Database on Quality Nursing Indicators (NDNQI) as a Nursing – Sensitive measure. Aim: To reduce to 50% the incidence of patient fall & fall – related injuries by staffs’ adherence to CL 6027 – HMC Fall Prevention Policy with the Hendrich II as the selected standardized tool in fall risk assessment for rehabilitation patients and by adopting the bundle approach from 2013 to 2014 & every succeeding year. Actions Taken: • Review & revision of the ongoing FOCUS – PDSA for Fall Prevention as the NeuroTrauma Rehabilitation Unit

Quality Improvement Methodology. • Adhere to the revised HMC Fall Prevention Policy (CL 6027) utilizing the standardized fall risk assessment tool

selected for Rehabilitation Unit patients, which is the Hendrich II. • Encourage active involvement of all the Interdisciplinary Rehab Team members & conduct regular meetings to

update fall prevention strategies. • Monitor staffs’ compliance to fall prevention policy/protocol & perform competency validation & education. • Continue adopting the six elements NeuroTrauma Rehabilitation Unit’s BUNDLE APPROACH in fall prevention:

1. Primary Nursing Care Delivery System (assigned primary nurses in specialty care rooms) 2. 1:1 Direct Observation or Buddy System with Patient Attender & Nurse Technician 3. Highlighting of High Risk patients in the Nursing Assignment Sheet (Every Shift) 4. Bladder & Bowel Training Program (as per Physician’s Order = Every 3, 4 & 6 hourly) 5. Use of Low Height Bed (can be lowered up to 6 inches off the floor) 6. Use of Patient-Staff Communication & Patient Safety Whiteboards

• Design effective & safe process map in moving patients to other Rehab Departments for their therapy sessions. • Intensify the Patient & Family Education to encourage their active participation in the fall prevention measures. • Interdisciplinary Team Case Conference focusing on fall prevention.