This in-class presentation demonstrated how a fictional hospital could use a team-based approach to solve a serious and costly problem.

1. Falling Isn’t Child’s Play:A Community Hospital’s Process Improvement Plan for Fall Prevention By: Michelle Parker HIT 225 – Fall 2009

2. Table of Contents West Side Community Hospital (WSCH) Problem: Medicare non-reimbursement for HACs Falls Data 2004 – 2005 – 2006 The Process Improvement Team Brainstorming and Affinity Grouping Brainstorming Follow-up The Solution: Early Identification and Morse Rating Scale Staff, Family and Caregiver Training Monitoring Conclusion Thank you Bibliography About Jack, Jill and Marie Antionette

3. West Side Community Hospital In 2007, West Side Community Hospital (WSCH) wasa 400-bed community hospital located in a large Midwestern city. The hospital has a growing population of patients 65-years-old and older. The patients live independently in the community, reside in assisted living or long-term facilities.

4. Problem: Medicare Non-Reimbursement for Inpatient Falls As of October 1, 2008, Medicare will no longer reimburse hospitals for a Hospital Acquired Condition (HAC). Medicare created a list of eight occurrences deemed to be HACs, and falls/trauma is one of the items. The new regulation also states that expenses related to an HAC cannot be passed on to the patient.

5. Data on Fall Occurrences

6. The Process Improvement Team Facilitator Director, Risk Management Head of Nursing Services Safety Committee representative Occasional members: Physicians and geriatric specialist A Member of the Board of Directors Billing staff representative

7. Brain Storming and Affinity Grouping Who was falling? The team identified geriatric patients and patients using rehabilitation services. Where were the falls occurring? The fall reports were coming from general floors 8, 9 and 10. But, it was also noted that the rehabilitation floor was starting to report more falls. When did the falls occur? Team questioned if the time of day or season mattered. What is the physical environment like? What physical safety measures are in place (i.e. hand rails, lights, wrist bands, etc.) The solution will begin here with a new safety measure.

8. Brainstorming Follow-up The team decided to look at other hospitals and see if there were any ideas that could be implemented at WSCH. A more detailed look at all the costs of patient falls should be calculated. It was suggested that an outside consultant be brought in to create a fall management program if the team couldn’t create a plan on its own. Bring more internal staff into the process. Set a realistic goal for the number of reduced falls.

9. Follow-up 1: A Management Company Fall Prevention HFRM II Most hospitals have always had some type of patient fall prevention program, yet few have had effective, patient-centric programs that encompass injury free outcomes on a consistent basis. It has been six years since the Institute of Medicine published Crossing the Quality Chasm in which the six aims for health system transformation were described. Creating safe, effective, patient-centric, timely, efficient and equitable care has become the framework for the evolution of a national patient safety movement built upon clinically excellent care. Derived from 20 years of research, theHendrich II Fall Risk Model®, is an evidenced based tool for identification of patients at risk for falls. The AHI Fall Prevention Program will help your organization meet JACHO goals and Magnet standards. The Centers for Medicare and Medicaid ( CMS) may soon add falls to the list of events that should not occur in hospitals –“Never Events” AHI Fall Prevention Program Comprehensive Computer-Based Education The AHI fall prevention program contains three unique components: 1. Licensure of the Hendrich II Fall Risk Model® for use in your patient health record 2. The CE approved comprehensive computer-based education in three media formats; Cd- Rom, Client-server, and internet applications. 3. A comprehensive Resource Guide, to help you develop a successful fall prevention program for your healthcare organization Improve your patient’s safety while promoting sensible resource management through a time-saving and engaging educational program: A Vital Sign For Safety©2007. Clinicians will gain competency with the identification of evidenced based risk factors and their root causes that enable staff to develop effective preventative fall interventions…with precision in real time.

10. Follow-up 2: St. Luke’s Hospital St. Luke’s Hospital (Duluth, Minnesota) had a detailed falls prevention program that would be the benchmark for WSCH. Along with the environmental safeguards, St. Luke’s used the Morse Fall Scale. This scale “is a rapid and simple method of assessing a patient’s likelihood of falling. 54% (of nurses) estimated that it took less than 3 minutes to rate a patient.” 1.

11. The Solution Decision On admission, the Admission Department or Emergency Department will begin the process of identifying a fall risk, and enter that information into the chart. Family members and caregivers will be asked for information to determine the risk of falling. When the patient arrives on the floor, nursing staff will use the Morse Rating Scale. There will be more communication among hospital staff (nurses on 8, 9 and 10, doctors, rehab staff)

12. Training Working the hospital’s geriatric specialist, a list of screening questions will be created for the Admission and Emergency Department staff. If the patient can not answer the questions, the family or facility will be called. The patient safety department and nursing/CNA staff will work together to observe patients at risk for falls, and make adjustments for each patient. The Morse Fall Risk Scale will become part of a complete chart.

13. Monitoring Weekly, monthly and quarterly figures will be collated and presented at the monthly team meeting (without the occasional members). The focus will be on LOS and bills that are being reimbursed. At the six-month point, there will be an all team meeting. This meeting will include the occasional members, and will review the collated figure, discuss how the process is going, and what changes to the process or team should be made. Have the number of falls significantly dropped? What changes in the process or team need to be made. Set a date for a final review before October 1.

14. Conclusion West Side Community Hospital wisely decided to tackle its fall prevention program before the October 1, 2008 date. This decision benefitted not only the hospital financially, but provided better patient care as well. This program will be ongoing, but the team is open to meeting changes in direction as necessary.

15. Questions?

16. Bibliography http://www.cms.hhs.gov/HospitalAcqCond/Downloads?HACFactsheet.pdf. http://nejmhighwire.org/cgi/content/full.360/23/23990 http://www.ahincorp.com/falls/research/php http://www.mnhospitals.org/inc/data/pdf/fallsprevention/St.Lukes_Policy_&_Tool.pdf 1. http://www.sacramento.networkofcare.org/library/Morse%20Fall%20Scale.pdf.

17. About Jack and Jill and Marie Antoinette