According to Health Canada, falls are by far the most common cause of major injury for seniors in Ontario, accounting for 90 per cent of hip fractures and 20 per cent of subsequent deaths within a year for those 65 and older. The team at Providence Healthcare has developed a strategy that is making a significant dent in this important aspect of seniors care.
Since the Toronto healthcare organization rolled out a Falls Risk Prevention Toolkit across its seven in-patient rehabilitation units in late 2011, falls among its patients have decreased by 24 per cent.
The toolkit consists of falls risk information and identifiers for patients/caregivers. But the really innovative aspect is a process whereby a patient’s risk assessment and treatment plan is passed between healthcare providers for the first 24 hours.
“We were doing assessments before, but we saw silos occurring. People weren’t talking to each other, so the assessments weren’t going any further,” says Leo Audette, Professional Practice Leader, Nursing. “This [process] ensures all team members are aware of falls risks and that a treatment plan is carried out.”
The process starts with a falls risk assessment of the patient within three hours of admission from acute care that is completed by the occupational therapist (OT) or physiotherapist (PT). Those deemed high risk for falls get a yellow bracelet to wear, as well as a magnet at their beside so they’re easily identified by staff. The other key element is a 4×6 card detailing a patient’s potential fall risks and possible interventions, which is passed between healthcare providers so that a face-to-face conversation about the patient is part of the process. This chain of communication continues between teams so changes in the patient and treatment plan can be noted and discussed throughout the day and night.
Eventually the card comes full circle when it’s handed back to the OT or PT the next day to determine if the intervention worked and if the treatment plan needs to be adjusted. “Having a card to hand off forces face-to-face communication,” says Shawn Brady, Director, Interprofessional Practice.
It also promotes accountability, says Audette. “Having to physically hand off the card gives a sense of this being important and something they have to follow through on,” he says. “We know it’s had a remarkable effect on staff.”
The proof is in the numbers—and in the response from Providence staff. Within the first three months of rolling out the program, compliance among employees was at 80 per cent. A presentation about the falls prevention program also earned the Providence team a 2013 People’s Choice Award at the GTA Rehab Network’s annual Best Practices conference.
But both Brady and Audette admit that changes in processes like these take some getting used to. The two, along with Professional Practice Leader of Physiotherapy Anna Marie Sneath, worked with OT, PT and nursing practice consultants who have been key to the program’s success.
“We identified one champion per unit to provide input on the tools and processes and to assist us in rolling out the education,” says Brady. “They were also our eyes and ears on the ground if something wasn’t working or staff weren’t using the tools properly.”
In addition, the toolkit is put into all orientation packages for new staff and Brady says it’s imperative to have a “refresh” around the process with new employees to ensure it is sustained.
With the program up and running successfully, the team is now working on several other initiatives to reduce the number of patients’ falls even further. An interprofessional approach to dealing with incontinence is one focus as is a better structure for assessing falls risk over the long-term. “Some patients come in low risk and fairly immobile, but as they progress with therapy they start to move more and may become high risk,” says Brady.
Overall, the Falls Risk program is just one of the ways Providence Healthcare is meeting its quality and safety promise to its patients, residents and clients.