Friendly Manor Nursing Home has adopted a comprehensive falls prevention program that has significantly reduced the incidence of resident falls in their home by 44%, as indicated in their most recent Quality Improvement Plan (QIP).
Health Quality Ontario had a chance to catch up with Rebecca VanSteenbergen RPN, Assistant Director of Care, Sylvia Jackson RPN, RAI Coordinator, Stacey Maracle RN, Resident Program Coordinator, and Debbie Long RN, Home Administrator/Director of Nursing at Friendly Manor to learn how they achieved their success.
Can you describe your falls prevention program?
Friendly Manor is a home to 60 residents with complex medical needs. We have many residents who are diagnosed with Parkinson’s disease, Multiple Sclerosis and supranuclear palsy. These conditions predispose our residents to falls.
Our facility ensures that a falls risk assessment is completed for all new residents upon admission and when there is a change in a resident’s condition. Ongoing quarterly assessments are also completed.
Based on the information gathered in the assessments, modifications are made to a resident’s environment based on their unique needs to minimize hazards and risk factors.
Interventions may include the use of slip resistant socks, hip protectors, a high/low bed with bed adjacent fall mats, a chair/bed alarm, a transfer pole, and underbed lighting.
If a resident experiences two or more falls within a calendar month, they are placed on the “Falling Star” program. A yellow star is placed outside the resident’s room, on their wheelchair/walker if applicable, and on their medical chart. This acts as a simple reminder to all staff about residents who have the highest immediate risk of falls.
Residents in the Falling Star program receive an individualized care plan to help prevent future falls. This is based on factors such the time and place the resident fell in the past, and what factors contributed to the fall, like an environmental factor or a change in routine.
For residents in the Falling Star program, we consult with our pharmacist to determine if any medications may be a contributing factor. A nursing staff member will also complete a review of the resident’s sitting and standing blood pressure to rule out orthostatic hypotension. Our physiotherapist also assists us by offering interventions such as strengthening and balance exercises, ambulation programs, and the use of restorative aids to assist with ambulation when warranted. Individual assessments are also completed by the physiotherapist which outlines appropriate programs for each resident.
From left to right, Stacey
Maracle RN, Debbie Long RN, Sylvia Jackson RPN, Shirley Newnham, Life
Enrichment Coordinator, Rebecca VanSteenbergen RPN, Ana Ferreira, Food
Services/Environmental Services Supervisor.
What benefits have you seen with the Falling Star program?
In addition to helping us reduce our incidents of falls, we’ve been able to reduce the use of restraints. Since we have very individualized and comprehensive care plans in place, we find that we are less reliant on restraint devices.
We’ve also reduced the use of bedrails and chair/bed alarms. When we began this program, every bed in the facility had bedrails and currently, we have only one bed with bedrails. We now use alarms just for Falling Star residents. Alarms are no longer constantly going off because of the overuse of alarms.
How do you communicate with staff about the Falling Star program?
Communication with staff is a key component to this program:
- We keep an updated list of Falling Star residents available in a communication binder that all staff access when they come to work.
- A board is placed above residents’ beds which contains all the interventions that are in place. This board is easily seen by staff and is updated as needed.
- Our electronic medical record has detailed information available on the message board.
- We have quarterly staff-wide meetings to review fall prevention plans for residents.
- We have weekly Falling Star meetings which include department supervisors, the physiotherapist, the activation department, nursing, and other staff members to review residents’ fall prevention plans.
- We have initiated “hourly rounding” (or “intentional rounding”). Residents are checked every 1-2 hours based on when residents are at highest risk for falls. This rounding may include housekeeping, personal support workers, nurses and so on. We use the full potential of all our staff to help keep residents safe.
- We have an open-door policy so that any staff member can connect with our senior management should they have questions or concerns about a resident.
Who did you work with to develop the Falling Star program?
This strategy was developed in collaboration with front-line staff, some residents, our activation department, the physiotherapist and our advisory physician. It is a continuation of the work done by the previous Assistant Director of Care.
We have also worked with Lee Mantini, Long Term Care Best Practice Coordinator from the Registered Nurses Association of Ontario (RNAO) to complete several gap analyses, which included our falls prevention program. Through this work, we were able to identify that improving communication among staff could significantly impact our falls prevention work.
How do you track falls?
We use CIHI statistics and our physiotherapist tracks falls and analyses trends. The data is compiled into a quarterly report which is reviewed by our Professional Advisory Committee which consists of Dr. Reynolds, our advisory physician, Randy Goodman, our pharmacist from Geriatrx pharmacy, Stacey Maracle, Rebecca VanSteenbergen and Debbie Long. Data is also shared with our resident council and at the various meetings we hold with staff.
By analysing the data, we noticed that falls were occurring on Wednesday evenings, which is when our physician makes his rounds. This causes a change in our residents’ routine and many residents get excited/anxious to see the doctor. We therefore adjusted our staffing numbers and work schedules to prevent falls during this time.
What advice would you give to other homes who want to work on reducing falls?
We’ve had many “lessons learned” which we’re happy to share!
- Focus on residents at highest risk of falls: Prior to the Falling Star program, every resident was seen as high-risk. Instead, the Falling Star criteria (i.e. residents who experience two or more falls within a calendar month) allowed us to really focus our efforts on residents who are falling now. We still maintain our falls prevention program for all residents, but have made a significant impact by focusing on our Falling Star residents.
- Work with the RNAO: Working with Lee was very useful. She visited our home and worked with us on a gap analysis and helped us implement best practices. She follows up with us and supports our progress. She is never critical and accepts the limitations we face.
- Focus on communication: A key to our success was improving our communications. Think about who, what, where, when, how, and how often you want to communicate to staff.
- Change takes time, don’t give up: It has taken about 2 years to achieve our improvements. We used several different tools and communication strategies and we’re still learning what works best. There is a lot of trial and error and it’s been a process.
- Use data to track progress: Falls prevention work can slip through the cracks if you don’t constantly evaluate your progress and measure and analyze your data. This needs to be embedded into everyone’s work.
- Celebrate success: Falls prevention is very important to our staff and they work hard to keep residents safe. We share the data with them to maintain buy-in and provide evidence of our joint success.
Do you work on falls prevention strategies in your organization? Share your experiences by clicking on “Add a Comment” below or reach out to Debbie Long, on Quorum.