falls, accidents, qapi - mmic group · pdf file1 ©pathway health 2013 falls, accidents,...

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©Pathway Health 2013

Falls, Accidents, QAPI

Risk assessment, proactive planning, root cause analysis

Presented by Chris Osterberg RN, BSN Pathway Health Services


1.Review the regulatory interpretive guidelines for

accidents and injury investigation.

2. Discover the key components of completing an

accident root cause analysis.

3. Apply the quality improvement components to

the investigative process.

Objectives

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“Fall” refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (e.g., resident pushes another resident).

An episode where a resident lost his/her balance and would have fallen, if not for staff intervention, is considered a fall. A fall without injury is still a fall.

F323 Definition of a Fall

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• Identifying hazard(s) and risk(s);

• Evaluating and analyzing hazard(s) and

risk(s);

• Implementing interventions to reduce

hazard(s) and risk(s); and

• Monitoring for effectiveness and modifying

interventions when necessary.

Key F323 Components - QAPI

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Interventions that the facility might

incorporate in care planning include:

• Providing restorative care to enhance abilities to stand, transfer, and walk

safely;

• Providing a device such as a trapeze to

increase a resident’s mobility in bed;

• Placing the bed lower to the floor and

surrounding the bed with a soft mat;

SOM Interventions (1/3)

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Providing frequent monitoring by staff with

periodic assisted toileting for residents who attempt to arise to use the bathroom;

• Furnishing visual and verbal reminders to use the call bell for residents who are able

to comprehend this information and are able to use the call bell device; and/or


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Providing exercise and therapeutic

interventions, based on individual assessment and care planning, that may

assist the resident in:

• achieving proper body position

• balance and alignment

• without the potential negative effects associated with restraint use.


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Key features of RCA:

• Blameless problem-solving

• Involvement of those most affected by the issue

• Willingness & means to coach & mentor after

training

• Person-centered care

Discovering Root Causes

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• How effective is your restorative program?

• Do residents lose function through

reduced mobility?

• Could you review ambulation status to find

out?

Review Your Programs

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1. Run a report of Current Mobility Status

for this quarter and last quarter – walk in

room, walk in corridor

2.Compare it to report from last quarter

3.Have there been changes, declines?

Use Your Data – MDS

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Quality Assessment & Performance

Improvement is a data driven & pro-active approach to quality improvement.

QAPI Definition

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Look for trends in conjunction with – wing,

diagnosis, falls, behaviors – the more granular, the more effective your root cause

analysis will be.

• Location - room, hallway, bathroom

• Devices in use, call lights, alarms, etc.

What to Look For - Trending

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Reasons for the mobility decline-Root Cause

Analysis

Interview direct care-giving staff, family, resident for their perspectives regarding

why the decline happened

Document interview results & analyze

Questions

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QAPI aims to help nursing home residents

realize their own goals for care and how they live their lives, including these areas:

• health and safety

• quality of life

• exercise of choice

• effective transitions

http://cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapitools.html

Realizing Goals

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Establish commitment to Falls and Injury

Prevention:

• Market your commitment

• Pre-admission considerations

• Admission assessment in-put

ALWAYS include them in assessment findings &

Education if responsible, or

with resident permission.

Resident/Family Alliances

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Risk assessment tools by themselves do not

prevent patient falls - they predict them…*

*National Patient Safety Foundation Professional Learning Series

Risk Assessment Tools

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• On admission

• Upon transfer from one unit to another

• With any status change

• Following a fall

• At regular intervals

When to Assess

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www.cdc.gov/injury/STEADI

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History & Root Causes Documentation

Current Status

• Footwear

• Seating

• Standing

• Transfers

• Toileting status

Resident & family response to commitment, immediate care plan measures

Assessment Recommendations

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• Ideal sitting posture is unnatural

• People slide into a position of comfort and

support. However . . . everyone fatigues out of the ideal sitting posture

• Body type and disability often prevent ideal sitting posture

Seating Challenges

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Untreated, pain leads to:

• Restlessness

• Irritability

• Depression

• Reduced mobility

• Atrophy

Pain

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• Remain in place, wait for direction

• Get up to see what’s wrong

• See what you can do to help

What’s Your Response to Alarms

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“The body registers noise pollution as assaultive. The automatic tightening of muscles to armor (protect) and defend themselves produces sensations that range from mild discomfort to extreme pain. Gentle, appropriate touch can help the body to relax without more intrusive intervention.

Caring touch can restore equilibrium and balance.”

Integrating Touch Into Our Daily Interactions

Posted on June 20, 2013 by Glenn Blacklock

Why Alarms Don’t Work

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Environmental review at the time of the event by on-shift staff

• Make immediate modifications

• Add to care plan immediately

• Communicate interventions

& rationales immediately

Critical Investigation Elements

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http://blog.actionpact.com/2013/06/20/integrating-touch-into-our-daily-interactions/

http://blog.actionpact.com/author/nursinghomewellness/

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INDEPENDENT WALKING

Fall Commonalities

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Can You Predict the Next Fall

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• Watch them in action to assess correct use

• Therapies evaluation to identify modifications

• Do not let the device be

a potential cause for falls

Use of Devices

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Making Rounds / Supervision

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Who Should Observe and Correct

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Assess As You Go

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Safety Rounds

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Do not wait until a fall happens to check for:

• Effects

• Side effects

• Interactions

Plan for Falls Prevention!

Anticipate Medication Risks

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Excessive decrease in ability to form blood

clots can cause bleeding, leading to anemia, weakness & dizziness.

Watch for bruising easily, unusual bleeding around gums, blood in urine, or rectal

bleeding.

See pamphlet:

Blood Thinners: Risk Factors Associated with

Falling and What to Do When You Fall

Anticoagulants

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Practice to reinforce

Stand up slowly after sitting or lying down.

If lying down, sit up first, remain seated for

a few minutes, then stand slowly

Mandatory Return Demonstration

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Muscle weakness –

Exercise, therapy

Gait problems - Exercise,

devices, modifications,

therapy

Balance problems-

Exercise, therapy, devices

Arthritis, Degenerative Joint Disease – Exercise, therapy

Impaired ADLs – Exercise, therapy, devices, modifications

A MERICAN Geriatric Society

Match Interventions to Risks

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To get the most information out of critical

times around an event

Staff on the scene must be coached in:

skills of observation

critical thinking

Investigate Immediately

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Delaying the investigation until morning or

Monday, or whenever the DON or Risk

Manager gets around to it will not improve

your outcomes or statistics.

Don’t Wait

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QAPI

More eyes & ears = more thorough perspectives + problem-solving

Assemble Key Players

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• Placement of the person’s body at the time

of the fall

• What was the person trying to do?

• Was it unusual or typical – has it happened before?

Observations + Questions

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‘Person needed to use bathroom’ Urgently?

– Why? Does this follow their usual pattern?

Do they usually call for help?

– If they do, but didn’t, what happened this time?

– If they did, why didn’t they wait?

What Exactly Happened

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If they don’t, or didn’t wait

what makes them unsafe to do it

independently -

weakness, stiffness,

dizziness…?

And Then What

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If they are known not to call for help, what

are you doing

to make it safer for them?

Strengthen, loosen up,

address causes of dizziness

Compensation VS Restriction

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Handouts

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Pathwayhealth.com

[email protected]

Thank You

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NCOA – Excellent Resources- Falls Prevention Day – September

22, 2013

http://www.ncoa.org/improve-health/center-for-healthy-

aging/falls-prevention/falls-prevention-awareness.html

National initiative web site - videos and educational materials.

Celebrate Fall Prevention Awareness Week - September 22 – 28,

2013.

http://www.stopfalls.org/service_providers/sp_bm.shtml

Michigan Falls in the Elderly rates 2011

http://www.michigan.gov/documents/mdch/falls_factsheet_final_390532_7.pdf

Resources

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mailto:[email protected]




http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/falls-prevention-awareness.html















http://www.stopfalls.org/service_providers/sp_bm.shtml



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Falls Prevention brochure for distribution

http://www.michigan.gov/documents/Fast_Facts_About_Older_

Adult_Falls_in_Michigan_167793_7.pdf

Veteran’s Administration projects

http://www.visn8.va.gov/patientsafetycenter/fallsTeam/

VA Falls Prevention Tools and Programs

http://www.patientsafety.va.gov/SafetyTopics/fallstoolkit/index.html

Institute for Person Centered Care

http://ubipcc.com/

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Resources


http://www.patientsafety.va.gov/SafetyTopics/fallstoolkit/

media/morse_falls_pocket_card.pdf

Vibrant Living Concepts

http://blog.actionpact.com/2013/07/29/vibrant-living-prevents-falls-and-eliminates-need-for-alarms/

http://actionpact.com/index.php/product/eliminating-alarms-and-reducing-falls-by-engaging-with-life

Sue Ann Guildermann, RN, BA, MA. Effective Fall Prevention Strategies Without Physical Restraints or Personal Alarms Empira, 4/24/2012 Webinar for Stratis Health

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Resources


Willy BA; Wheelchair Seating for Elders; On line pamphlet

prepared under contract for Mountain Pacific Quality Health– Wyoming 2010. http//:www.mpqhf.com/WCSbooklet508.pdf

Illustrations by Chris Willy; Web publication by Mountain

Pacific Quality – Wyoming’s 9th Scope of Work CMS; Wheelchair Seating for Elders by BA Willy.

http://www.carf.org/Programs/ProgramDescriptions/AS-

Person-Centered-Long-Term-Care-Community/

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Resources

http://www.michigan.gov/documents/Fast_Facts_About_Older_Adult_Falls_in_Michigan_167793_7.pdf



http://www.visn8.va.gov/patientsafetycenter/fallsTeam/



http://ubipcc.com/

http://www.patientsafety.va.gov/SafetyTopics/fallstoolkit/media/morse_falls_pocket_card.pdf







































http://www.stratishealth.org/documents/F-MNFALLPREVENTION042412.wmv

http://www.stratishealth.org/documents/F-MNFALLPREVENTION042412.wmv

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Newsletter & CEUs – Initiatives in Safe Patient Care

http://initiatives-patientsafety.org/Initiatives2%20.pdf

www.cdc.gov/injury/STEADI

http://www.npsf.org/wp-content/uploads/2013/03/PLS_1302_FallPrevention_LAG_MF.pd

f

https://www.dhs.wisconsin.gov/publications/p0/p00548.pdf

Resources

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Initiatives in Safe Patient Care – Newsletter with CEUs regarding

alarms:

http://initiatives-patientsafety.org/Initiatives2%20.pdf

[email protected]

One More Resource

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http://initiatives-patientsafety.org/Initiatives2 .pdf









http://www.npsf.org/wp-content/uploads/2013/03/PLS_1302_FallPrevention_LAG_MF.pdf










falls, accidents, qapi - mmic group · pdf file1 ©pathway health 2013 falls, accidents,...

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