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Falls that occur in hospital can result in longer hospital stays and can negatively impact patients’ physical and mental health and well-being. Sometimes these falls could have been prevented, or the impact of the fall reduced with timely intervention.

Although many hospitals have a fall prevention strategy in place, it may not always be implemented as effectively as it could be. Markham Stouffville Hospital (MSH) completed a current state assessment of their fall prevention strategy and made changes that has led to positive results. Health Quality Ontario had a chance to catch up with Kanwal Ali (Patient and Family Centred Care Consultant), Michelle Samm (Director, Quality, Patient Relations & Experience, Patient Safety and IPAC), and Stacey Thorpe (Quality & Safety Specialist) to find out more.

Can you tell us about your current fall prevention strategies?

Our fall prevention strategies, as outlined in our fall prevention policy, is based on leading practices and includes a falls risk assessment, various interventions tailored to patients’ needs, and timely communication with patients and families.

Although the policy has been in place for many years, there were certain in-patient areas that had a high number of falls causing harm. In the 2017/18 fiscal year, there was an average of 37 falls per month, 37.5% of which resulted in harm.(1)

We decided to complete a current state assessment of all inpatient units at the Markham site, Uxbridge site and Reactivation Care Centre, and compared our corporate falls prevention policy with the implementation in these units. This helped us to define gaps in our current strategy and identify opportunities for improvement.

Our goal was to reduce the rate of falls resulting in harm by 30% (from 37.5% to 26.0%) in the 2018/19 fiscal year.

What did your current state assessment reveal?

We discovered inconsistencies across every area of the hospital, including:

• <50% completion of required fall risk assessments
• <30% available interventions were being implemented
• There were communication gaps between staff and patients/families about falls
• There was no consistent root cause analysis after serious falls occurred

How did you go about revitalizing your fall prevention efforts?

We have implemented several strategies to tackle the gaps that were revealed in our current state assessment.

Redesigning the falls working group:

Previously, an existing falls monitoring group met monthly to review falls data and to discuss new ideas and interventions. However, there was low engagement from frontline staff and slow movement in new projects. This group was converted to an inter-disciplinary falls working group with new frontline champions recruited from across the organization.

Above: Falls Working Group participants.

Over 45 highly engaged frontline staff (including Registered Nurses, Registered Practical Nurses, Personal Support Workers, Physiotherapists, Occupational Therapists, Porters and Patient Experience Participants) meet bi-weekly to monitor falls data, generate ideas and implement PDSA cycles in their units.

Recruitment of frontline healthcare champions with a passion for keeping the patient safe was a key success factor. By listening and engaging these champions in the design of interventions, the adoption of interventions in patient care areas was easier and more meaningful.

Ideas generated from this group have led to several early successes including enhanced signage and tools for patients.

Improving data sharing:

High-level falls data was shared monthly with management across the organization; however frontline staff were unaware of monthly rates of harm and trends over time.

We conducted a deep dive on falls data for each unit across the organization, including monthly analysis, trends over time, and key root causes for falls causing harm. This data is now shared openly with frontline staff as well as management on a monthly basis.

We also established a process for daily auditing of falls risk assessment completion, and we’re currently testing an auto-generated ‘falls-risk’ report to easily identify gaps in risk assessment completion and falls prevention protocol.

Increasing engagement and awareness across the organization:

There was a low level of engagement from frontline staff on falls prevention and instead of preventative measures, discussion was reactive after a fall had occurred.

Falls are now viewed as everyone’s business as opposed to a single team or department. In addition, falls is now a strategic priority and is the 2019-20 wildly important goal (WIG) for the organization.

As such, every department is expected to monitor and discuss at their quality huddle, and senior leaders will review and monitor falls weekly.

Increasing awareness among patients and families:

There was little communication with high risk patients and families about their role in falls prevention, and the existing falls prevention pamphlet was unused. Patients did not understand the meaning of falls signage, yellow wristbands, and were unaware of additional measures they could take to prevent falls.

Through the falls working group, we developed a list of “ Top 10 Tips” and a resource called "Falls Prevention Tips for Family and Friends" to guide conversation with at-risk patients and their families. Initially tested on two units, the guide has now spread hospital-wide and has served as a strong communication tool and a method to partner with patients and families.

Improving community engagement:

An appetite for education on preventing falls at home was noted from several community members during engagement in MSH Patient Safety Week.

We developed a falls prevention roadshow to deliver 90-minute talks to local senior groups in Markham. The team includes a Quality Improvement Facilitator, Registered Nurse, Physiotherapist, Occupational Therapist, Pharmacist, and a representative from Lifeline Medical Alert.

Each member gives a short talk about fall prevention strategies and equipment use at home and during a hospital stay, and there is an open forum for questions and answers. Our roadshow has received excellent feedback with strong community participation and requests for repeat sessions.

The Falls Prevention Roadshow team with community participants.

What results have you seen to date?

Our falls rate with harm has decreased from 37.5% in 2017/18 to 28.4% in 2018/19, which is just shy of our goal of 26.0%.

What advice would you give to hospitals wanting to improve their fall prevention efforts?

• Ensure that all levels of the organization, including senior leadership makes falls a priority. Falls are everyone’s business and requires ongoing focus.
• Engage and involve patients and families through clear communication at point-of-care, ensuring high-risk patients are aware of their role in fall prevention.
• Provide transparency through data sharing across all levels, detailed root cause analyses and daily discussion at team huddles. Data brings fall prevention efforts alive and engages staff in the process.
• Ensure frontline staff who are involved as champions have a passion for patient safety and allow them to generate and implement ideas in their units. This will increase buy-in and make the work easier.
• Finally, think about reaching out to the community. Patient safety should go beyond our hospital walls. Engage with community partners and work collaboratively to educate the public about fall prevention.

Read more posts in the fall prevention series on Quorum.

How do you prevent falls in acute care? Share your advice and lessons learned by clicking on “ADD A COMMENT” below.

(1) Definition of harm: An unintended outcome of care that may be prevented with evidence-informed practices. At MSH this includes level 2 (mild harm) to Level 5 (death or permanent disability).