They say that “many heads are better than one” and when it comes to working cooperatively through the Quality and Safety Service Level Alliance (Q&SSLA) this approach has demonstrated success lately in assisting South Island DHBs to leverage and share their learnings and support each other to improve patient safety says Q&SSLA chair Mary Gordon.
“By working as an alliance we are putting our heads together, sharing our experiences, gathering insight and learning from each others efforts in ways that can make a big difference in terms of supporting the long term goals of South Island DHBs to improve patient safety.”
The Quality and Safety Service Level Alliance is part of the South Island Alliance, a collaboration of five DHBs working together to develop more innovative and efficient health services than could be achieved independently. The group, whose members span the five South Island DHBs, primary care sector and consumers have been meeting since March 2013 to improve the quality, safety and experience of care delivered by the South Island DHBs and provide better value for public health system resources.
Working alongside the Health, Quality & Safety Commission as part of the national Open for better care campaign, the group has seen several members achieve good success recently with their regional campaigns to reduce falls within hospital settings.
Canterbury’s “Roving Grannies” Campaign a Hit with Patients and Staff
A fun and unique falls campaign delivered by two Canterbury DHB staff has been raising interest from across the health sector because of its innovative approach to promoting falls prevention and reducing hazards around hospital environments.
“Roving grannies” Betty Tripp and Mavis Brown, otherwise know as Canterbury District Health Board staff members Lisa Bee and Helen Mathieson, undertook a tour of Canterbury’s hospitals and aged residential care homes during April, to help identify risks and promote actions to keep older people safe from falls.
The “grannies” created a great deal of interest with Betty decked out in a hospital gown, non-slip socks, hair curlers and a walking frame, and this made it easy to initiate conversations with staff and patients about potential falls and reducing falls hazards, such as keeping hospital trays and call bells within reach and staying active to maintain fitness.
The approach was well received by staff and viewed as a fun, entertaining way to talk about patient safety issues and engage staff on this topic. As Betty Trip – one of the Roving Grannies explained “‘I think people find it easier to ask me questions about how they can prevent a fall when I’m dressed up as Betty, rather than as how I am normally dressed as a nurse educator. Being in character definitely helps to engage more interest” she says.
“Bundle of Care” Sees Dramatic Reduction in Serious Falls
Staff at Timaru Hospital’s Assessment, Treatment and Rehabilitation (AT&R) ward have been achieving impressive results for patients and staff following their comprehensive approach to reducing patient falls. The approach was triggered by a series of six serious falls in the ward during 2012/2013, and while a target was set to reduce the incidence of harm falls by 20%, staff on the ward wanted to bring the total falls number right down. They undertook additional efforts to build on the safety measures already being taken by developing a new “falls bundle of care” that has taken patient safety to a whole other level.
Their thorough approach utilised the Institute of Healthcare Improvement’s “Model for Improvement” using the plan-do-study-act cycle to test and implement changes. In addition resources were borrowed from Northland DHB and the Health Quality & Safety Commission to create a “bundle of care” that was dedicated to reducing falls and improving patient safety outcomes.
|Falls strategies already introduced||New initiatives introduced in "falls bundle"|
|Falls action assessment||Morse Falls Risk Assessment Tool|
|Falls action plans||Capturing the likelihood of serious or major injury to individual patients from falls|
|Chair and bed sensors||Documenting individualised Falls Action Plan directly into the patients care plan|
|Grip socks||Use of safety posters (A3)|
|Low beds||Multi-disciplinary team review of patients following a fall|
|Identification of high risk patients||Revamp of patient information folders/includes information regarding falls prevention in hospital and community|
|Mobility flip charts||Promotion of staff education/posters|
|Falls champions||Consideration of prescribing Vitamin D for patients|
|Care calling||Mobility tag for walking frames|
|Staff cover early mornings to reduce falls risk when walking|
The AT&R ward staff began implementing additional interventions from July 2013, testing new initiatives and implementing them when the team had a high degree of confidence that they would make a positive difference. The resulting ‘bundle of care’ provides a method for ensuring that all patients within the ward received universal precautions, that corrective interventions were applied for risk factors that were identified and that high risk patients received additional interventions.
From July 2013 to April 2014, the number of ‘falls with harm’ reduced by 65.6 percent, well ahead of the 20 percent target (a total of 10 harm falls from July 2013 to April 2014). In addition there have been no serious harm falls in AT&R since June 2013, which is a dramatic improvement on the previous period, when six serious falls had occurred.
“Staff are very proud of what we have achieved in the AT&R ward” said Tracy Worthington, Clinical Nurse Manager AT&R “the efforts we have undertaken to protect our patients from falls have seen a major reduction in general falls and a complete eradication of serious falls to date.
Staff are continuing to build on this good work into the future with plans underway at Timaru Hospital to roll the bundle out across the whole hospital, and mapping exercises underway which identify where and when falls occur within hospital wards. Results are collated and sent to the ward each month which provides a visual map of the ward. “This provides information which is easy for staff to interpret,” explains Kaye Cameron, Improvement Advisor: “Helping us to better understand where and why falls happen and minimize the risk of falls.”
In addition staff are being asked to place a real emphasis moving ahead on getting patients and their families more involved in developing their own falls care plans: “We see this as an important step as its bringing patients closer to the centre of the decision making,” says Jayne Bradley, AT&R Clinical Nurse Specialist .
The collaboration of Health professionals through the South Island Alliance is creating opportunities for DHBs to easily learn from each other, so that successful interventions can be build upon and rolled out through other DHB and primary care facilities. “It’s been excellent to see how our members are bringing their unique, individual ideas to the table and offering those up for others to build on – this can only mean better outcomes for quality and patients safety for all South Island residents over time,” said Q&SSLA Chair Mary Gordon.