Benchmarking and Participation in Research Improves Awareness and Outcomes for Falls Management at Storm Retirement Village

The Storm Retirement Village is a 117 bed residential aged care facility located in Taree on the Mid North Coast of NSW. It provides mid range care with a mixture of high, low and specific dementia unit beds. It commenced benchmarking with QPS Benchmarking in 2008.

After three to four quarters of data collection it became evident that falls and harm resulting from falls might be an emerging issue at the Storm Retirement Village and this led to a more in depth review of the incidents and outcomes of the falls by Quality Manager, Margaret Mills. Through the review of falls data collected over a 15 month period, it was found that 5 people had sustained fractures as a result of a fall and the management and staff considered that the need for improvement was indicated.

The first step was to complete a more in depth analysis of the data and so the following graphs were produced: falls with no injury; falls resulting in injury; and, falls with skin tears.

The next step was to analyse the time of day (shift) when the falls were occurring:

It was evident from the analysis of the "time of fall' data that the highest number of falls occurred in the time slots 2-4 pm (afternoon shift changeover) and 4-6 pm (meal time). It was also noted that the majority of falls in the 4-6 pm time slot occurred in the dining room.

As a result of this better understanding, decisions were taken to adjust staffing allocations to provide an additional staff member during the 2-4 pm changeover and the activities officer was asked to arrange for the activities program to include activities around the dining room to provide an extra set of eyes to monitor residents. Results over the past six months shows improvement in both time slots and an overall reduction in falls in the facility.

A review undertaken by the Quality Manager also indicated that not all residents were being risk assessed for falls during admission. The Quality Manager commenced the improvement process by undertaking some of the risk assessments herself and then encouraged registered nursing staff to complete falls risk assessments on all residents during the admission process. The need for re-assessment has also been enhanced by ensuring that all residents that have multiple falls are immediately flagged for re-assessment. Actions and improvements in this area have prompted the question of `how well are the assessments being done' and this issue will be addressed in the future.

During this period Storm Retirement Village participated in a regional study on falls conducted by Dr John Ward (Geriatrician and Clinical Leader in Aged Care), Mandy Harden (Clinical Consultant in Aged Care Education), Richard Gibson (Research Assistant - Biostatistics) and Julie Byles (Director, Research Centre for Gender, Health and Ageing Faculty of Health, The University of Newcastle). Participation in this project enabled the Quality Manager and other staff from Storm Retirement Village to access information, educational support, and falls management resource material from the Hunter New England Area Health Service.

Materials provided by Hunter New England Health (sample shown) are provided in Publisher format so that the facilities can re-badge them for their own facility.

In their article titled "A cluster randomised controlled trial to prevent injury due to falls in a residential aged care population" MJA - Volume 192 Number 6 - 15 March 2010, the HNE Research team (Ward et.al) noted that "30% of all hip fractures in the community occur in residential aged care, representing substantial cost to the health care system. Evidence from overseas on calcium and vitamin D supplementation and hip protectors suggests these strategies could reduce hip fractures in aged facilities by up to 50%." The Storm Retirement Village has picked up on these two issues and the facility's visiting pharmacist and attending medical staff have promoted the use of vitamin D supplements, and the use of hip protectors is now wide spread. It is noted that there have been no fractures resulting from falls where the resident has been wearing hip protectors.

The combined processes of benchmarking and participating in the Hunter New England Area Health Service research programme have promoted awareness and a better understanding of the risk of falls. Through data analysis, considered action and better education, Storm Retirement Village has managed to both reduce falls and to reduce the harm arising from falls over the past six months.