Newport Long Term Care
FALLS – PROCESS IMPROVEMENT
NHHS Board Meeting – 11/21/13
Collette Meyers
Allison Hare
Mary Medina
Heidi Hedlund
Process Improvement & Quality Teams
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Process improvement projects are set in motion 2 ways:
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A high priority goal or project drives the need for improvement, and/or
A work team decides to tackle a situation they feel strongly about
Small teams work together to:
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Identify a problem they would like to fix, set a goal
Use data to create a picture of the situation/problem
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This creates a baseline, and
Often points a finger at what is causing the problem
Brainstorm potential counter-measures that seem highly likely to improve the problem
Implement the chosen change
Measure whether the change resulted in improvement
Evaluate whether the improvement satisfies the goal, and begin again
Practice “kaizen”, striving for continual improvement
This process uses the principles of PDCA, or Closed Loop Corrective Action. It
is based on measuring the output of an often-repeated process to ensure that
any change really has improved the problem.
Why Are We Talking About Falls?
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“Despite heightened national attention to
…(falls in healthcare settings)…threats to
reimbursement, and the best possible
intentions, patient fall rates across the U.S.
continue to escalate. Up to 50% of
hospitalized patients are at risk for falls, and
almost half of those who fall suffer an injury.”
- “ Special Supplement to American Nurse Today – Best Practices for Falls
Reduction: A Practical Guide” March 2011 Vol. 6 No. 2. Multiple Authors.
More “Why”
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“…(Falls)….directly affect healthcare
organizations’ cost per case and length of
stay. The average hospital stay for patients
who fall is 12.3 days longer, and injuries from
falls lead to a 61% increase in patient care
costs.
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- “ Special Supplement to American Nurse Today – Best Practices for Falls
Reduction: A Practical Guide” March 2011 Vol. 6 No. 2. Multiple Authors.
The Final “Why”
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Falls are likely our greatest threat to patient
safety. Reducing falls increases patient
quality of life significantly. Safety is our
highest priority.
Picture The Problem
3 Year Trend: Falls By Type
20
18
NON-INJURY
Average falls/month 2011 = 10
INJURY
16
FRACTURE
Average falls/month 2012 = 8
REPEAT FALLERS
Average falls/month 2013 = 6
12
TOTAL FALLS
10
Average Daily Census:
2011 - 39.3
2012 - 42.4
2013 - 39.1
8
6
4
2
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/13
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Number
14
Time Period
Too many falls (green)
Too many injuries (blue)
Too many repeat fallers (yellow)
High variability, indicating lack of process
What We’ve Done: 3 Phases
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PHASE 1: Joined the district-wide Skin &
Falls Team and began sharing best practices
cross-district. (2012)
What We’ve Done: 3 Phases (cont.)
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PHASE 2: Implemented a Falls risk
stratification process that helps identify at-risk
patients and effective counter-measures (2nd
Half 2012). Look at what happens on the
graph!!!
Picture The Problem
3 Year Trend: Falls By Type
20
18
NON-INJURY
Average falls/month 2011 = 10
INJURY
16
FRACTURE
Average falls/month 2012 = 8
REPEAT FALLERS
Average falls/month 2013 = 6
12
TOTAL FALLS
10
Average Daily Census:
2011 - 39.3
2012 - 42.4
2013 - 39.1
8
6
4
2
Ju
l
Au
g
Se
p
Oc
t
No
v
De
c
1/1
3
2/1
3
3/1
3
4/1
3
5/1
3
6/1
3
7/1
3
8/1
3
9/1
3
10
/13
11
/13
12
/13
Ju
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Number
14
Time Period
20% less falls per month (green)
Injuries down (blue)
Repeat fallers down (yellow)
Less variability, indicating improved process
What We’ve Done: 3 Phases (cont.)
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PHASE 3: POP UP Falls Prevention
Program launched 8/13 with phenomenal
results.
Purpose of Pop-Up Program
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Prevent injury
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Improve quality of life
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Maintain dignity
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Provide a restraint free environment
Essentials of Pop-Up Program
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Greater awareness via all-staff education
Mindset of injury prevention
At-risk patients identified w/ Pop-Up logo
Posters to keep awareness high
Emphasizes staff responsibility in fall/injury
prevention
Risk stratification still used
Post-fall medication reconciliation
Acronym Definition
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Planning
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Observation
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By ALL staff
Rounding at high risk times
Prevention
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Fall risk evaluation
Environmental Hazards
Visual identification (as determined by evaluation)
Take the time it takes
“Put your best foot forward”
Wheelchair safety
“U” Are The Solution
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Use of scripts
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“Is there anything else I can do for you? It’s no bother.”
“Please call for assistance, we’re here to help you.”
“I’ll be outside the bathroom door, please don’t get up without me.”
“The call bell is within your reach.”
Knowledge of individual residents
Post-Fall Assessment
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Medication review
RCA on Major Injury falls
Goal: Create A Culture Of Safety
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This Skilled Nursing Facility’s goal is to
promote personal freedom and safety for
patients with impaired mobility.
All staff will be knowledgeable and respond
appropriately to patients identified with the
POP-UP logo.
Mindset of proactive injury prevention
Going forward: In-house target of l.t.e. 5
falls/month
Wrap Up
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2013 YTD average of 6 falls per month
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40% reduction in falls since 2011
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In October we reported 3 falls, no major injury and no repeat fallers. The process we have in place is
more predictable, and is performing at a better level.
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MDS reporting still shows Falls above state and national averages, due to a 275 day look-back period,
making MDS a very important lagging indicator
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We are on track to meet our 2013 LEM goal
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We also track our “Days Without Falls” and have reached a record of 29 d.w.f. this month. A RECORD.
A Multi-Year Effort: 40% Falls Reduction
3 Year Trend: Falls By Type
20
18
NON-INJURY
Average falls/month 2011 = 10
INJURY
16
FRACTURE
Average falls/month 2012 = 8
REPEAT FALLERS
Average falls/month 2013 = 6
12
TOTAL FALLS
10
Average Daily Census:
2011 - 39.3
2012 - 42.4
2013 - 39.1
8
6
4
2
0
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
Ju
l
Au
g
Se
p
Oc
t
No
v
De
c
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
Ju
l
Au
g
Se
p
Oc
t
No
v
De
c
1/1
3
2/1
3
3/1
3
4/1
3
5/1
3
6/1
3
7/1
3
8/1
3
9/1
3
10
/13
11
/13
12
/13
Number
14
Time Period
MDS (Lagging Indicator)
2012/2013 Falls W/ Major Injury Benchmark
12.00%
Percent of Patients
10.00%
8.00%
Falls w/ Major Injury
6.00%
National Avg.
4.00%
State Avg.
2.00%
0.00%
Q1'12
Q2'12
Q3'12
Q4'12
Q1'13
Q2'13
Q3'13
Q4'13
Time Period
MDS reporting includes falls occuring within 275 days of current assessment
For example, Q3’13 results include falls occuring as far back as Q4’12
2013 LEM Status
2013 FALLS VS LEM GOAL
90
80
70
Number
60
50
2013 CUM. FALLS
40
2013 LEM GOAL
30
20
10
0
1/13
2/13
3/13
4/13
5/13
6/13
7/13
Time Period
8/13
9/13
10/13
11/13
12/13
Measuring The Value To Patients As
Approximated By The Savings To The
Healthcare System They Are Accessing
L.T.C.
Patient
Medicare/Medicaid/Reimburser
Estimated System Savings:
Using the quoted increase in length of hospital stay
LTCU Falls
Year
Falls
Per
Month
Falls
Per
Year
2011
2012
2013
10.33
7.58
6.10
123.96
90.96
73.2
LTC Inpatient Fully
Additional
Allocated Cost Per Length of Stay
Day
Per Article
250
250
250
12.3
12.3
12.3
Estimated
Total Cost
381,177
279,702
225,090
Year over
year system
savings
(101,475)
(54,612)
(156,087)