St Joseph's Village - A Proactive Approach to Managing Falls

Background
Falls are a major challenge for the Aged Care Industry, with one in three people over the age of 65 experiencing a fall each year. The ramifications of this are far reaching and can impact with loss of confidence leading to less activity, independence and a lesser quality of life for the residents affected. Financially, falls remove funding from other areas of care and it was estimated that in NSW (2006-2007), the cost of falls in people 65 and over was approx. $558.5 million dollars (Incidence Cost of Falls - Table 4 - NSW Government Publication).

Government policies focussing on the support of older people in their homes have resulted in people entering residential aged care facilities at an older age with a higher level of care needs. The introduction of older, frailer people, often suffering from Alzheimer's or other forms of dementia, to a new environment is just one of the risk factors facing aged care providers.

A belief that falls are preventable, not just an acceptable part of ageing and a proactive approach to falls management is required. Falls prevention is not just an added extra in the care plan; it is an integral part of the plan.
Falls in St Joseph's Village
St Joseph's Village is collocated with St Joseph's Hospital on the Auburn Campus. Since the foundation of St Joseph's Hospital by the Sisters of Charity in 1886, St Joseph's Hospital has provided services to the sick and aged residents in the local and wider community of Auburn and Western Sydney.

St Joseph's Village opened in November 1991. The facility comprises 88 hostel apartments (which include an 18-bed secure dementia unit and 10 designated beds for Residents with complex health needs), 27 self-care apartments, and 35 community aged care packages. The facility works collaboratively with St Joseph's Hospital and is part of the residential aged care services provided by St Vincent's Health Australia.

With ageing in place, residents are becoming frailer, with falls the highest reported incident type in St Joseph's Village. The QPS trend report also flagging the increasing number of falls over time.


In conjunction with the Patient Safety and Quality Coordinator, Staff of St Joseph's Village recognised the need for this proactive approach to falls management. A number of strategies were introduced with the aim of reducing falls and improving the quality of safety and security for residents.

• The following problems were identified when meeting with the main stakeholders:

• Incomplete information noted in the incident reports
• Incident reports were not sent to the Nursing Unit Manager in a timely fashion and this delayed the investigation.

• The Falls prevention program was introduced in 2011

Interventions

• To review the existing system and identify all stakeholders.
• An Electronic Incident Management Program including an escalating system was introduced to St Joseph's Village in July 2011. Once the incident is entered into the system, managers receive an email notification. Follow Up actions can be conducted in a timely manner. An incident/hazard report form is also made available for the staff that cannot access the system. Incidents are monitored and trended.

A committee, which includes the Patient Safety and Quality Coordinator, the Nursing Unit Manager, Care Staff and the Physiotherapist, review all reported falls fortnightly to look for opportunities for improvement. Major activities are listed in the following table:

Outcomes
The proactive approach to managing falls in St Joseph's Village has resulted in positive outcomes for:

Residents:

• The Residents and carers participate in own care
• The number of falls with injury has declined. Results were compared with other QPS Benchmarking facilities

Staff:

• Staff are involved in developing falls prevention strategies, which has resulted in a change of their attitude towards the reporting of incidents.
• Better staff morale as reflected by the QPS report in Quarter 3 - 2011-12. The Employee satisfaction survey result was 83.3%, with the industry benchmark 81.2%.

Management:

• A Proactive falls prevention program in St Joseph's Village.
• Incidents are more timely managed. Investigations are conducted within 24 hours and included in the Electronic Incident Management system.
• A Change in focus of the organisational culture to a learning organisation.