No Harm from Falls – Aroha Care Centre

Aroha Care Centre a charitable trust have been providing services to the Hutt Valley and Wellington communities for over 40 years offering a range of care options including Hospital and Rest Home level care, day centre social programmes and independent living villas. In 2013 Aroha Care Centre began a No Harm From Falls initiative with the aim to prevent and minimise falls and skin tears. The initiative has continued to be a Quality Improvement Focus for the home over the past three years. Michelle Montgomery, Clinical Nurse Manager has shared their journey and the strategies implemented which have been successful in minimising falls and resultant injuries.

The Beginning of our Journey:

Yellow Tags were attached to walking frames to alert staff of residents with high falls risk who require assistance when mobilising

Skin care,In 2013 our analysis of skin tears identified the incidents were primarily sustained by frail dependent residents and occurred during moving and handling of the residents. As a result, we determined our current moving and handling training sessions needed to be supported by 6 monthly workshops which were more extensive and involved a greater number of staff. Our aim was to implement a more comprehensive training programme which facilitated a team approach in regards to;

• Handling and positioning of residents,
• Ensuring suitable transferring aids were being used (as assessed by the physiotherapist),
• Promoting teamwork (buddy system) and
• Staff allocation i.e. junior caregiver partnered with a senior caregiver.

We decided that a half day workshop on moving and handling involving Registered Nurses and the physiotherapist as trainers and care staff as students would be a good forum to learn, bond and have fun. The programme was designed by our physiotherapist which included practical scenarios requiring care staff to demonstrate how they would safely move and handle residents. The workshop was a great success in terms of learning and creating the awareness that working in buddies was a safer option for both residents and staff. Following the workshop we noted a slight improvement in skin tears and we decided the workshop would be repeated every six months.

‘No Harm from Falls’ Committee:

Halfway through the year we heard about the District Health Board’s (DHB) collaborative, ‘No Harm from Falls’ programme and saw this as a great opportunity to help us in our endeavours to prevent adverse events for our residents including falls and skin tears.

We attended the workshop and became highly motivated to develop initiatives to prevent harm from falls at Aroha. The four staff who attended the workshop included the Principle Nurse Manager, Clinical Nurse Manager, Quality Coordinator and physiotherapist and from then on we decided to call ourselves the No Harm from Falls Committee.

The purpose and responsibilities of the committee include;

• To meet each month,
• To develop initiatives and to continue to evaluate them,
• To review our falls reports/data and implement any changes to the residents care that may reduce their likelihood of continuing to fall,
• To network with other facilities and hold or attend support group meetings,
• To involve staff in the programme by reporting back to meetings and to display statistics on notice boards and
• To raise staff awareness of the No Harm from Falls programme.

Our No Harm from Falls Committee has attended 2 workshops to date which we found to be motivating and informative and has provided positive reinforcement for the work we are undertaking.

Early “No Harm from Falls” Project Initiatives:

The initiatives implemented which we also presented to the February 2014 Age Related Residential Care (ARRC) facilities workshop include;

• Attaching ‘Yellow Tags’ to the walking frames of residents who are assessed as having a high risk of falling and the effectiveness was assessed each month.
• Calendars were put up in staff rooms and red spots placed on each day a resident fall is recorded. The calendars generated much discussion and heightened the awareness of care staff.
• Nurse Call Audit was undertaken.
• Vitamin D was introduced for all mobile residents and any new admissions.
• Nurse Practitioner to facilitate the Health Quality & Safety Commission 10 topics in reducing harm from falls.
• The use of the Plan-Do-Study-Act (PDSA) cycle for each of our initiatives and
• The use of Severity Assessment Code (SAC) guide of Severe, Minimal, Moderate and Minor in analysis of our incident/accident falls reports.

Project Aims for 2015:

One care staff member operates the hoist and the buddy helps guide and support the resident

Our aim for 2015 was to continue to provide Moving and Handling training for all staff by:

• Completing one to one, moving and handling training sessions provided by our registered nurses and physiotherapist for all new staff members.
• Simplifying our moving and handling competency assessment check list which all staff will be expected to complete annually.
• Spot competencies which will be completed throughout the year, correct moving and handling techniques will be demonstrated by all staff in their working environment. Spot competencies will be observed by a registered nurse who will then complete a competencies assessment checklist.
• Physiotherapist to complete monthly training sessions for all new staff and annually for all other staff members.

Strategies Implemented & System Changes to Date:

We have made a number of changes to systems over the past year as a result of our ongoing Quality Improvement Initiative relating to No Harm from Falls which are highlighted below:

1. Questionnaire: Fall Management Questionnaire; A questionnaire was created which relates to Fall Policies Management and Prevention. Staff are to complete the questionnaire during their orientation which will then be placed in their file. This is to ensure that all staff have read and understood Fall Policies Management and Prevention prior to Moving and Handling Residents.

2. Orientation Booklet; All staff during their orientation period will be given a copy of our Moving and Handling Booklet which includes policies relating to Moving and Handling Residents and documentation that they will become familiar with and use.

3. Yellow Tags; Introduction of Yellow Tags for residents who require supervision during mobilisation. All care staff are aware that if they see a resident mobilising independently and they have a yellow tag attached to their walker, they must attend to that particular resident immediately. This has also been added to our policy.

4. Incident Forms; Introduction of SAC Classification to our Incident Forms when documenting a resident fall, Registered Nurses have been educated on correct use of classification.

5. Tracing Audit; We have created an audit tool which traces incident forms ensuring that all recommendations/interventions made have been carried out by the Registered Nurses. Our Quality Officer completes a tracing audit monthly to ensure correct policies and procedures have been followed, thus ensuring that incidents do not reoccur in the future and risk is isolated, eliminated or minimised.

6. Walking Record; The Walking Record was designed for individual residents who have been assessed by our Physiotherapist and require daily exercise. Walk records provide instructions on how to mobilise whether the resident requires one or two person assist, equipment required i.e. walking frame etc. It also includes the distance that the resident is able to mobilise and all care staff have been educated on its correct use. The walking record was created so that it adapted information required when the Registered Nurse completes a resident assessment.

We also have 'alert cards' which are continuously updated as mobility changes/or on admission, the cards are a quick visual cue for staff to identify a residents current mobility status. The alert cards are kept in the residents bedrooms above their bed visible for all care staff.

Improved Resident Outcomes:

The positive outcomes resulting from of our No Harm from Falls Initiative are reflected in our QPS Benchmarking Trend Report which demonstrates a continual downward trend in falls at Aroha over the past 2 years from 2014 to 2016. We have also noted a decline in injuries resulting from falls over the past 9 month period.

Michelle Montgomery, Clinical Nurse Manager, Aroha Care Centre