Colleen Dougan, MSN, RN

• Group convened in 2008 to address fall prevention and pressure ulcer prevention for inpatients
– Nurses, Nurse Assistants, Clinical Nurse Specialists, Nurse
Managers, Nurse Administrators, Physical Therapist,
Wound Care Specialist, Physician and Quality Specialist

• Wendy Quinn-Scott, RN, Nurse
Administrator
• Sue Craft, RN, NM MICU
• Colleen Dougan, RN, CNS,
Hematology/ Oncology
• Catherine Draus, RN, CNS, Cardiology
• Lynne Freimuts, RN, Quality Specialist
• Dana Greggs, RN, CNS, Internal
Medicine
• Joanne Guanio, RN, NE,
Neurosciences
• Catherine Jackman, RN, CNS, MICU
• Mary Kravutske, PhD, Nursing
Development
• Cathleen McCloskey, RN, NM,
Neurosciences and Neuro ICU
• Geri Muller, RN, CNS, DEM
• Adele Myszenski, Physical Therapist
• Kathy Raniszeski, Respiratory
Therapist
• Stephanie Schuldt, RN, CNS, MICU
• Christine Seigert, RN, Wound Care
Specialist
• Christine Sotto, RN, NE, Cardiology
• Cheryl Stone, RN, Nurse
Administrator, Ambulatory
• Rebecca White, RN, NM, Internal
Medicine
• Sheila Daley, RN, Neurosciences
• Rebecca Gregory, RN
• Katherine Herrmann, RN, Quality
Specialist
• Shereen Patten, RN, NE, ICU
• Sonalee Shah, MD
• Nicole Sims, NA
• Carolyn Taylor, RN, ANM

• Decided that we needed to bundle together the two issues—fall prevention and pressure ulcer prevention
• Reviewed literature that detailed other ‘P’ programs
• Added to ‘P’ list from HFH incident reviews

• Pain
• Personal Needs
• Pulmonary Hygiene
• Position
• Possessions
• Place

• Dry erase board for every patient
• Fall Risk Sun signage
• Switch to yellow arm bands/socks
• Patient education brochure
• Partners in Patient Care ‘Agreements’
– Fall Prevention
– Pressure Ulcer Prevention
• Medications increasing fall risk identified on MAR

• Post-fall debriefing protocol and audit
• Employee Education
– RNs and NAs attended mandatory classes including videos with scripting
– Competency validation at the bedside
• Monitoring of Incidence,
Compliance and Patient
Satisfaction

HFH Falls/1,000 Patient Days
HFH Total Falls/1,000 Patient Days
6Ps implementation house-wide
4.50
4.00
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
Ja n-
0
9
A pr
-0
9
Ju l-0
9
O ct
-0
9
Ja n-
1
0
A pr
-1
0
Ju l-1
0
O ct
-1
0
Ja n-
1
1
A pr
-1
1
Ju l-1
1
Falls / 1,000 Pt Days
Monthly Average/1,000 Pt
Days

HFH Falls with Injury/1,000 Patient Days
HFH Falls with Injury/1,000 Patient Days
1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
6Ps implementation house-wide
Ja n-
0
9
A pr
-0
9
Ju l-0
9
O ct
-0
9
Ja n-
1
0
A pr
-1
0
Ju l-1
0
O ct
-1
0
Ja n-
1
1
A pr
-1
1
Ju l-1
1
Falls with Injury per 1,000 days
Monthly Average/1,000 Pt
Days

Hospital Acquired Pressure Ulcers > Stage 1
Percentage of Patients with Hospital Acquired Pressure Ulcers >
Stage 1
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
6Ps implementation house-wide
Ja n-
0
9
A pr
-0
9
Ju l-0
9
O ct
-0
9
Ja n-
1
0
A pr
-1
0
Ju l-1
0
O ct
-1
0
Ja n-
1
1
A pr
-1
1
Ju l-1
1
Percentage of Patients
Monthly Average

Patient Satisfaction:
Noise Level In and Around Room
HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Noise Level In and
Around Room
77.0
76.0
75.0
74.0
73.0
72.0
71.0
70.0
69.0
68.0
67.0
66.0
6Ps implementation housewide, higher score = higher satisfaction
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008 2009 2010 2011
Noise Level In and Around Room
Quarterly Average

Patient Satisfaction:
Promptness Response to Call
HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Promptness Response to
Call
85.5
85.0
84.5
84.0
83.5
83.0
82.5
82.0
81.5
6Ps implementation housewide, higher score = higher satisfaction
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008 2009 2010 2011
Promptness Response to Call
Quarterly Average

Patient Satisfaction:
Staff Sensitivity to Inconvenience
HFH Press Ganey Quarterly Scores 2008 - 2011 YTD: Staff Sensitivity to
Inconvenience
84.0
83.5
83.0
82.5
82.0
81.5
81.0
80.5
6Ps implementation house-wide, higher score
= higher satisfaction
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008 2009 2010 2011
Staff Sensitivity to Inconvenience
Quarterly Average

• Do you think hourly rounding has:
– Decreased patient falls
• Strongly Agree 19.5%
• Agree 37.9%
• Neutral 25.0%
– Decreased falls with injury
• Strongly Agree 19.7%
• Agree 37.0%
• Neutral 26.1%
– Decreased pressure ulcers
• Strongly Agree 15.4%
• Agree 37.8%
• Neutral 29.3%
• I can incorporate the 6 P’s concepts into my daily practice
– Always 50.7%
– Sometimes 27.8%
– Neutral 15.7%
• Feedback given for dry erase boards

Staff and Customer Feedback
• RN staff were surveyed 1 year after go-live
• Family member reported that she was so relieved to really know that her mother was checked on over night
• Patient reported that she felt safer knowing that someone was checking on her regularly even if she was asleep
• Some patients are bothered by the frequent checking

6 P’s Lessons Learned and Refreshed
• Pilot program in all practice areas
• Adjust for different patient populations
– ICU
– OB/NICU
• White boards are not a part of the Medical Record
• Test your materials—dry erase board
• Engage as many frontline staff as possible
– Review results frequently
– Listen to feedback carefully
• Maintain momentum
• Share the knowledge
• Some of 6 P’s reworked
• Dry Erase Board modified
• Partners in Patient Care
‘Agreement’ modified
– On every admission
– Includes basic information about fall and pressure ulcer prevention and now with infection prevention measures
• Re-education of the Staff
– Healthstream for RNs and NAs
• Results, 6Ps review, reinforce content of conversation, less focus on actual scripting