HBH Senior Living - A New Approach to Falls Prevention

HBH Senior Living (previously called Howick Baptist Healthcare) is a not for profit organisation who have been caring for residents within the community of Howick, Auckland since 1977. HBH provides a full continuum of high-level care and living options for older people from independent apartments, low cost-rental units, rest home and hospital care to respite and day programmes. In early 2018 the quality team at Howick decided to take a new approach to falls prevention. Jejson Jose, Quality Manager has shared their story and the strategies which have been effective in minimising falls and harm to residents.

Our Falls Reduction Strategy

Our aim at Howick Baptist Healthcare is to prevent falls and reduce harm from falls. We had a fall prevention strategy in place. Since early 2018, our quality team started looking at those differently. We started doing it differently.

1. Improved Documentation of Incidents

To improve the clarity of documentation relating to the incident, we looked at our incident form. We had a generic incident form to record all resident incidents like falls, skin tears, challenging behaviours and other incidents.

In June 2018, we trialled and implemented a new falls report form which captured;

• Detailed information relating to the incident. How, what and when did it happen, subjective and objective data.
• A post fall assessment checklist followed by a column to document preventative measures. So, the post fall interventions are developed based on the checklist.
• The best thing about this change was that it did not increase any paperwork whereas it captured accurate and relevant details on a new 2 page form.

2. Staff Education

The next step was to educate the RN’s and care staff on how to fill out the new form. We also educated the RN’s on how to use the post fall checklist to develop plans to prevent further falls. As a follow up, the Quality Manager reviewed the falls reports to ensure they were completed as per instructions.

3. Analysis of Incident Data & Trends

Our 129-bed facility consists of 5 similar sized communities (or units). We developed a system which compares incident data amongst those communities. It was communicated to the staff during various meetings and a pictorial representation is displayed on the staff notice boards and each nurses’ station.

The quality team’s role was to identify and communicate to the nursing team. It enabled the nursing team to set a different focus on each community’s falls prevention strategy based on the trends identified. It also developed healthy competition among each community.

4. Introduction of the ‘Falls Clock’

We introduced a large ‘falls clock’ on each nurses’ station in which our care staff mark the date, time and place of each fall. A different coloured dot is used for each resident and each month the clocks are analysed. While talking to the staff, we have identified that most staff did not know how to interpret the data/trends on it. We have re-educated the staff to identify the trends using the falls clock.

5. Environmental Changes

We reviewed the environment and replaced the dull lights with brighter light bulbs (LED) in our corridors.

6. Increased Staff Awareness of Impact of Falls

In our education sessions and meetings, we have emphasised on the impact of falls on residents as well as staff workload. A few minutes check on residents can prevent a fall. When a resident fall occurs the staff will have to spend their time in assisting the resident off the floor, filling in an incident form, progress note, ringing the family, manage and document about the injury related to the fall which is more time consuming and stressful than a few minutes check on the resident. We have an hourly rounding process in place which requires caregivers to check on every resident on an hourly basis. The caregiver checks the resident is comfortable, reviews toileting needs, pain levels and ensures the call bell is within easy reach.

7. Resident Centred Care Approach

HBH is an Eden Alternative registered facility and most of our staff have undertaken Eden alternative training which emphasises on eliminating loneliness, helplessness and boredom through resident centred approach.

We have implemented a number of initiatives to assist in enhancing resident’s quality of life including;

• “Playlist for life”, which enables older people, especially those living with dementia or cognitive decline, to enjoy the benefits of music that’s individually tailored to them. The programme stimulates memory, emotion and communication and brings great joy to older people.
• “Cognitive stimulation therapy”, for residents with mild to moderate dementia. The sessions actively engage people with dementia and aims at enhancing cognitive and social functioning.
• Modelled on the “Spark of Life” programme, we developed a socialisation club program to meet the needs of people with dementia.
• Engaging volunteers and visitors of all ages including students from local schools.
• A pet policy was established to allow pets and enable residents to have their own cats and dogs.
• Raised gardens and other resident gardening.
• Play spaces and toys for young visitors.
• Residents help with daily tasks, such as giving out morning tea, folding washing, just as they would in their own homes.
• Spontaneous activities, such as discos in the dining rooms after a meal.

8. Programmes to Improve Resident Mobility

All of our residents receive ongoing Physiotherapy and Occupational Therapist support as per the plan. The saying ‘use it or lose it’ very much applies. If an older person has a fall and is in bed for a month, he or she will very quickly lose their mobility. Services like OT and physio ensure our residents don’t ‘lose it’. And our cognitive programmes and Spark of Life work in the same way - keeping people intellectually stimulated and engaged, as do volunteers from the community who bring the outside in.

Improved Resident Outcomes

We have noticed a continual improvement in our falls rate since the implementation of these strategies. Resident falls have declined over 4 consecutive quarters, and our result is now performing below and better than the QPS industry benchmark.

Supporting & Engaging Staff in Quality Improvement

This story is an example of using data to develop effective strategies in improving resident’s health outcomes. The quality improvement/change is sustainable when the team embraces it. It happens when leaders point out the areas of improvement to the influencers in the team and support them to lead the change process within their team by providing them with adequate resources, tools, and guidance. As you can see from our story, we haven’t done anything new or increased the workload to achieve positive outcomes. Quality improvement does not always happen as an outcome of an expensive/new projects. However, I believe that in the majority of cases, it can also be achieved by changing the way we used to do things and effectively communicating the benefits of those changes to all staff.