Essential Hospitals Engagement Network November 19 2013 Our new Name Weve rebranded The National Association of Public Hospitals and Health Systems is now Americas Essential Hospitals ID: 356665
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Fall Prevention in Inpatient and Outpatient Units
Essential Hospitals Engagement Network
November 19, 2013Slide2
Our new Name
We’ve rebranded! The National Association of Public Hospitals and Health Systems is now America’s Essential Hospitals.
Although we’ve changed our name, our mission is the same: to champion hospitals and health systems that provide the highest quality of service to all by achieving the best health outcomes for every patient, especially those in greatest need. The new name underscores our members’ continuing public commitment and the essential nature of our work to care for the most vulnerable and provide vital community services, such as trauma care and disaster response.
This is an exciting time for us and our members, as we lean forward into new care models, opportunities and challenges of reform, and quality and safety innovations that often take root in our member systems.
Our
new website address: www.EssentialHospitals.orgSlide3
Chat feature
The chat tool is available to ask questions
or comments at anytime during this event. Slide4
Raise Your Hand
To raise your hand – you must be in the “Participants” pane.
Your line will be un-muted to ask your question. Once your question has been answered, plus un-raise your hand. Slide5
Speaker information
Carol
Boylan
, MSS, LCSW
Director, Psychiatric Medical Care Unit
Hahnemann University Hospital
Philadelphia, Pennsylvania
Stefania Kaplanes, MSW
Injury Prevention Specialist
Alameda Health System
Highland Hospital
Oakland, California
John
Young
, RN, MBA
Improvement Coach EHEN
Vickie Sears,
RN,
MSImprovement Coach EHENSlide6
Agenda
Falls work in EHEN and
Partnership for Patients
Feature falls prevention strategies in inpatient behavioral health and ambulatory elder populations
Q
& A
Wrap-up
and
announcementsSlide7
Partnership for patientsSlide8
EHEN falls Results (as of June, 2013)
Measure
Baseline events
Performance period events
% Change
Falls & Trauma (UHC-Modified CMS HAC)
11
6
-45.46%
Falls with Injury (JC NSC-5)
19
18
-5.26%
All Falls (JC NSC-4)
155154-0.32%Slide9
Risk Factors for Falls in Psychiatric Inpatient Units
and Tools to Prevent Falls
Carol Boylan, MSS, LCSW
Director of the Psychiatric Medical Care Unit
Hahnemann University Hospital
Broad & Vine Sts. MS 302
Philadelphia, PA 19102
tel
: 215-762-4684
fax: 215-762-3104
pager: 215-762-7243 pin: 41693
carol.boylan@tenethealth.comSlide10
Hahnemann University Hospital
A 496-bed academic medical center in Philadelphia, Pa.
In 2009, Hahnemann earned Magnet® designation. The Leapfrog Group awarded Hahnemann with an “A” Hospital Safety Score in the spring of 2012 and 2013.
U.S. News & World Report ranked 5 medical specialties at Hahnemann among the top 50 in the nation and 11 medical specialties as high-performing in the Philadelphia metro area.Slide11
Psychiatric Medical Care Unit
In 1983 the Psychiatric Medical Care Unit (PMCU) opened a 20 bed acute locked unit to address the special needs of co- occurring psychiatric conditions and medically compromised patients along with care to individuals with co-occurring drug addictions.
We specialized in adult patient programing that bridges healthcare systems to address the holistic needs of the acute mentally ill people in recoverySlide12
Reasons for Psychiatric
Medical Care Units
Multiple studies document a higher prevalence of chronic illnesses such as diabetes, respiratory disease, hepatitis B and C, and HIV.
5
Depression increases risk of cardiovascular diseases and diabetes.
6
Schizophrenia may predispose persons to metabolic syndrome, hypertension, and obesity.
7
Fifty percent of patients affected by mental illness are diagnosed with a known medical disorder.
Thirty-five percent of these patients have undiagnosed medical conditions and one in five has a medical problem that exacerbates their psychiatric condition(s).
8
Slide13
Risk factors for
falls
Although previous studies have aimed to identify risk factors for falls, few have focused on falls in psychiatric hospitals where many patients are taking psychotropic medications.
Risk
factors
for falls frequently
associated are sedative medications, urinary urgency, history of
falls, diagnoses, mental status and ambulatory aid/gait. Reducing the risk of patient harm from falls is one of the stated goals of the Joint Commission on Accreditation of Healthcare
Organizations.
Falls prevention protocol activated at Hahnemann and a Shared Governance Committee reviews cases weekly for areas to improve and new techniques to roll out.Slide14
Risk Factors on Psychiatric Units
People admitted to inpatient psychiatric care are at a higher risk for falls due to the nature of care which promotes mobility, independence with self-care activities, community style dining and interaction of patients in
a group setting.
Psychopharmacology also impacts the risk for falls due to the sedating side effect of certain medications such as Ativan and Clonazepam
.
Co-occurring medical and psychiatric disorders such as management of heart
disease and diabetes with depression
may impact the person’s awareness of
their environment
.
People with co-occurring substance and
mental
health
illnesses have an increased risk for falls due to withdraw symptoms.Impulsivity and active psychosis may also increase risk for falls due to increase in behavioral actions. Slide15
Preventing falls
Upon admission patients are screened for falls by using the Morse Fall Scale risk screen.
Nurses
complete risk assessments during each 12 hour shift and document any changes.
Information
is shared at change of shift reports
.
Patients at risk are educated on fall prevention, given clothes that prevent tripping and fall socks
to
prevent slipping
.
Daily
interdisciplinary treatment meetings occur twice a day to review at risk patients
.
Review of medications, behaviors, symptoms, mental status, sleep, nutrition and ambulation are discussed to continuation of safety plan. Slide16
Preventing falls…
Treatment plans are
developed
for patients at risk for falls and consideration is given to medication use, dosages and management of behaviors
.
Uses of traditional bed alarms are considered only as a last resort due to the increase risk of use to harm self or others
.
1-1 unit companion use is recommended to help reeducate the patient and support the patient with their psychiatric treatment. Slide17
What has been the best intervention?
Safety Huddles
Review of high risk patients multiple times during the day and night gives the treatment team the opportunity to be proactive rather than reactive.
Staff sharing observations and changes in
patient
behaviors allow for treatment interventions to be quickly altered to meet the
patient’s
needs.Slide18
2012 PMCU Fall Rates
7 Falls
No injuriesSlide19
The
Fall Prevention Center
Stefania Kaplanes, MSW
Injury Prevention Specialist
Trauma Services
Alameda Health System: Highland Hospital
Oakland, CA
skaplanes@alamedahealthsystem.org
HIGHLAND
HOSPITALSlide20
Projected Senior Population Growth 2005 – 2030
RAND Roybal Center for Health Policy SimulationSlide21
Incidence
30% of community-dwelling people over the age of 65 fall each year
Increases to ~50% for those 80 years and older
Half are repeat fallers
If you’ve fallen once….Slide22
Falls Cause Morbidity and Mortality
2.2% of injurious falls
death
Cost of fall-related injuries for 65+
$20.2 billion in 1994 -> 32.4 billion by 2020 (in 1994 dollars)
Injuries are common:
40% of falls result in minor injuries
10% result in major injuries
Fracture, soft tissue injury, TBISlide23
The Launch
Fall Prevention Center (
FPC
)
Initial Discussions and Research
Senior Injury Prevention Program (SIPP)
& Community Partners
Trauma Director
Trauma Team Residents
ED Physicians
Out-Patient Clinics
Out-Patient Physical
TherapySlide24
fall prevention
Continuity of Care
The Issues:
Early identification of those at risk
Who’s responsible Slide25
Solutions
The fall prevention center
Emergency Department Staff
Out-Patient Clinic Staff
Discharge PlannersSlide26
fall prevention
Continuity of Care
The Issues:
How are those at risk identified
What is done with those at risk
Time lapse in setting follow-up appointmentsSlide27
Referral Guidelines
*
Abnormal get Up and Go (>13.5 sec)
*60 years old or older (no age turned away)
*Previous Fall/s
*Balance or Gait Problems
*Dizziness
*Vision Problems
*Polypharmacy or High Risk Medications
Psychotropic:
Neuroleptic/Antidepressant
Benzodiazepine, Sedative, or Hypnotic
*History of Stroke or Parkinson’s
*Recent Acute Illness or Injury
*Recent Weight Loss
*
Fear of FallingSlide28
The Fall prevention center
What happens next
Referral made to the FPC
Reminder call made to patient
Importance reinforced
Reminded to bring all medications
Herbs, Vitamins, OTCsSlide29
The fall prevention center
AT THE FPC
Medication Review by:
Clinical Pharmacist
Screenings by:
Physical Therapy
Occupational Therapy
Fall Prevention Education by:
EMS Educator & Patients*
Geriatrician Consult
as needed
It’s a family affair! Slide30
Materials
Fall Prevention Center
For Staff
Data
Fall Risk Pocket Cards for MDs
For Patients
Follow-up Letter
Medication Mgmt Form
Fitness Checklist
Fall Prevention Manual
Local Resource Information
Dynaband
Pedometer
Cook Book
Pill Box
Local Walking Groups
Home Safety ResourcesSlide31
Highland’s diverse world
American Sign Language (by appointment)
Amharic
Arabic
Bosnian
Burmese
Cantonese
Cambodian
Croatian
Dari
Farsi
Hindi
Korean
Karen
LaotianMandarinMienNepaliPashtuPunjabiRussianSerbianSpanishThaiTigrignaUrduVietnameseSlide32
Mrs. B & las
tres hermanas
Mrs. B
88yoF; resides alone
Brought all meds
Pharmacists asked which ones she takes at night?
“Well dear….the ones on my dresser by my bed”
Las
Tres
Hermanas
98yoF
95yoF
89yoF
Sisters living independently with each other. THANKS FPC!Slide33
Out-patient Physical Therapy
Special block set aside for quick aptClinicsPrimary Care MD for Follow-Up
With notes from FPC staff
Community Programs
Physical Activity
Home Modification
Social
Referrals
Fall Prevention CenterSlide34
The fall prevention center
Is a Work In Progress and will hopefully in the future include:
Podiatry
Vision
Visit Fall-Risk In-Patients at bedside before discharge
Research and Include additional Resources
Inform/Educate All Staff re: resources
Wii
Fit and Balance
Tai Chi
Annual FPAW
Neuro
Psych ConsultsSlide35
THE RESULTS………
100% of our FPC participants have not returned to Highland Hospital Trauma Center due to a fall.Slide36
Fall Prevention Center Mission
The Fall Prevention Center’s mission is to identify older adults who are at risk for a fall and provide them with assessments, screenings, education, resources, and interventions that will decrease their fall risk and thereby reduce the number of preventable falls suffered by older adults in Alameda County.Slide37
Goals
The fall prevention center
To help ensure that continuity of care for older adults at risk for a fall is provided by:
Early Identification
Quick Appointment at the FPC
Needed
I
nterventions Received in a Timely
M
anner
Follow up by their primary care physicianSlide38
Recognition
Alameda County Board of Supervisor’s Commendation (2010)
United States Congressional Recognition (
2010)Slide39
THANKS
EHEN FOR ALLOWING ME TO SHARE
ALAMEDA HEALTH SYSTEM
:
HIGHLAND
HOSPITAL
FALL PREVENTION CENTER!Slide40
Q & ASlide41
Thank you for attending!
Patient and Family Engagement
Webinar
–
December 3 @
2pm
ET
The Patient Advisor’s Voice in Patient and Family EngagementSpeakers: Sharon Cross,
LISW, Patient/Family
Experience Advisor Program
Manager,
OSU
Wexner
Medical Center Patient Experience DepartmentCortney Forward,
Patient Family Experience Advisor, The Ohio State University Wexner Medical CenterEvaluation: When you close out of WebEx following the webinar a blue evaluation will open in your browser. We greatly appreciate your feedback!Essential Hospitals Engagement Network website: http://tc.nphhi.org/Collaborate