Benchmarking Helps Drive Improvement in the Falls Rate at PresCare Alexandra Gardens

Alexandra Gardens is a 94 bed high care facility located in Rockhampton, Queensland. It is owned and operated by the PresCare Group based in Queensland. Twelve months ago Care Manager, Sandra Thomson decided that the quality strategy for Alexandra Gardens would benefit from benchmarking performance outcomes with other facilities and a decision was taken to join the QPS Benchmarking program.

The very first results rang some alarm bells in relation to the falls rate. PresCare Alexandra Gardens maintains a strong role in the area of dementia care and it appeared that the type of residents in the facility were prone to falls and other similar accidents.

The first step taken on the road to improvement was the establishment of a Falls Prevention Committee. The aim of the Committee is to review residents who experience multiple falls so that recommendations can be made in respect of falls prevention strategies using a holistic approach. The net is cast wide for input into the Committee and its review processes, and input is commonly received from the resident, relatives, medical practitioners, pharmacist, physiotherapist, therapy assistants and the podiatrist. One early strategy that resulted from the Committee was the introduction of a system to identify residents who were at the high end of risk for falls. High risk fallers are now identified with a photo of a possum. Currently there are 38 residents identified as "high risk" fallers.

Rather than tagging Residents with a label that says Frequent Faller the facility simply puts up the Possum Photo to alert staff.

Staffing support for the 19 bed specific dementia care area was reviewed and it was found that not all shifts were covered by staff who fully understood the requirements for managing behavioural issues. Rosters were revised to provide improved supervision and a more appropriate skill mix across all shifts. With the support of Dementia Care Australia, staff members were provided additional training to enhance their understanding of behaviour management. The behaviour management capabilities of staff were reviewed and they are now using resources provided by Dementia Care Australia to look beyond the behaviours and understand the needs of residents.

Detailed incident review enabled an improved focus on medication management and by highlighting multiple fall residents to the Falls Prevention Committee, the medical practitioner and the pharmacist have been provided information that prompts closer scrutiny of medication regimes. Several residents have now had their medications reviewed with the result being fewer falls resulting from dizziness and disorientation. For example, one high falls risk resident on psychotropic drugs had very poor sleep patterns spending most of the time pacing during the day and night resulting in numerous falls. The resident had fallen 15 times in the three months leading up to the medication changes. After being reviewed by the Falls Prevention Committee, the Pharmacist and Medical Practitioner the resident was weaned off the drugs. The outcome was a return to normal sleep patterns and no falls for the past three months.

The team have also focused on their Lifestyle Programs and have introduced activities that have assisted with regular supervision and targeted deficits that contribute to falls. The Lifestyle Team Leader now spends more time providing one-to-one interaction with residents prone to boredom and who have a very short concentration span. These one-to-one sessions are often held outside in the gardens and some new activities (e.g. making jewellery out of beads and having a regular furniture restoration activity "oiling furniture" for some of the male residents) have provided more enjoyment for residents. These residents now appear more confident and settled.

Whilst the organisation have noted general improvement since commencing benchmarking, some of the biggest improvements have occurred at the end of the last quarter and if these trends continue then the organisation can expect to see sustained improvement to their falls rate of between fifty to eighty percent across both the general and specific dementia areas. Benchmarking does not provide the solutions to problems but it has certainly helped to focus the minds of everyone on the issues which need to be addressed and will highlight future performance compared to others in the industry.

The Falls Prevention Committee has deservedly started to celebrate the success being achieved. Congratulating the staff and continuing to support the strategies that have worked will help maintain the success achieved over the past twelve months.

Monitoring and Improving Falls at PresCare Alexandra Gardens