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“Preventing Falls Utilizing the Targeted Solutions Tool ” www.centerfortransforminghealthcare.org © Copyright, The Joint Commission ® © Copyright, The Joint Commission Objective To help attendees gain a deeper understanding of the work of the Joint Commission Center for Transforming Healthcare, high reliability in health care and robust process improvement. To present how one organization implemented a successful falls prevention project using the Preventing Falls Targeted Solutions Tool® (TST®) and achieved significant improvement in all falls and falls with injuries. © Copyright, The Joint Commission To present the Preventing Falls Targeted Solutions Tool® (TST®) methodology and analytical capabilities. Interactive Innovative Click on the hyperlinks to access additional information Ask questions through the chat box during our Q&A session THE WEBINAR REPLAY AND SLIDE PRESENTATION WILL BE AVALIABLE ON THE JOINT COMMISSION WEBSITE IN 5-7 BUSINESS DAYS. THE REPLAY WILL ALSO BE SENT TO ALL REGISTERED EMAILS. Accreditation Council for Continuing Medical Education (ACCME) Accreditation Council for Pharmacy Education (ACPE) American Nurses Credentialing Center (ANCC) American College of Healthcare Executives (ACHE) California Board of Registered Nursing Certified Joint Commission Professionals (CJCP) International Association for Continuing Education and Training (IACET) © Copyright, The Joint Commission This webinar is approved for 1.0 Continuing Education Credit from: Continuing Education Credit CE/CME/CEU are available for the live audio only. Credits will not be available for webinar replays. Individually registered for the webinar through The Joint Commission website. Listened to the webinar in its entirety. Only those listening live on the day of the call will be eligible to receive credit. This is an educational program being offered to our accredited organizations only. Completed a post program evaluation/attestation. A link to the post program evaluation/attestation will be sent to your registered email 24-48 hours after the webinar. After completion of the survey you will receive a certificate available to download. You are responsible for printing and filling out your own CE certificate. © Copyright, The Joint Commission In order to claim credits you must have: Disclosure Statement The following staff and speakers have disclosed that neither they nor their spouses/partners have any financial arrangements or affiliations with corporate organizations that either provide educational grants to this program or may be referenced in this activity: Dawn Glossa, MPA, Director Corporate Communications, The Joint Commission Anne Kilpatrick, RN, BSN, CSSBB, Black Belt, Falls Project Lead, Joint Commission Center for Transforming Healthcare Beth Neidlinger, RN, CENP, Coordinator, Workforce Development and Professional Outcomes, Trinity Mother Francis Hospital © Copyright, The Joint Commission Erin S. DuPree, M.D., FACOG, Chief Medical Officer and Vice President, The Joint Commission Center for Transforming Healthcare © Copyright, The Joint Commission Erin S. DuPree, M.D., FACOG, Chief Medical Officer and Vice President, The Joint Commission Center for Transforming Healthcare © Copyright, The Joint Commission Preventing Falls Utilizing the Targeted Solutions Tool® Preventing Falls: Background Hundreds of thousands of patients fall in hospitals each year Each of these injuries, on average, add 6.3 days to the hospital stay. Cost for a fall with injury is about $14,056. 10 © Copyright, The Joint Commission Between 30 to 35 percent of patients who fall sustain an injury. One Vision 11 © Copyright, The Joint Commission All people always experience the safest, highest quality, best-value health care across all settings Leadership 12 © Copyright, The Joint Commission MISSION To transform health care into a highreliability industry by developing highly effective, durable solutions to health care’s most critical safety and quality problems in collaboration with health care organizations, by disseminating the solutions widely, and by facilitating their adoption. We have learned from: Major corporations (for example, GE, Lilly, BD, Cardinal) Extensive experience with 27 hospitals and systems that use RPI (Joint Commission Center for Transforming Healthcare) Joint Commission: internal experience 13 © Copyright, The Joint Commission Performance Improvement Leadership Safety Culture Robust Process Improvement® Chassin MR, Loeb JM. High-Reliability Health Care: Getting There from Here. Milb Q 2013;91(3):459-90 14 © Copyright, The Joint Commission FROM LOW TO HIGH RELIABILITY 15 © Copyright, The Joint Commission Excellence in patient care for every patient, every time © Copyright, The Joint Commission ZERO ROBUST PROCESS IMPROVEMENT® Facilitating Change FOCUS IS ON THE PATIENT 17 © Copyright, The Joint Commission Lean Six Sigma ROBUST PROCESS IMPROVEMENT® Results(%) Hand hygiene Hand-off communication failures Wrong site surgery risks – Scheduling – Pre-op – Operating Room Colorectal SSIs Falls with injury rate Falls rate Milbank Q 2013;91:459-90; J Nurs Care Qual 2014;29:99-102 71 56 46 63 51 32 62 35 18 © Copyright, The Joint Commission Center Projects A Systematic Approach for Complex Problem Solving DEFINE & MEASURE Discover specific causes ANALYZE Solutions are targeted to each specific cause IMPROVE & CONTROL © Copyright, The Joint Commission Define & measure the impact of the problem 19 12 © Copyright, The Joint Commission Top Contributing Factors 13 © Copyright, The Joint Commission Targeted Solutions Guided Robust Process Improvement Measure current state Analyze causes Select targeted solutions Sustain and spread improvements Confidential Separate from Accreditation Complimentary 14 © Copyright, The Joint Commission Preventing Falls TST® Development: Using RPI Preventing Falls Initial 5 Center hospitals: – 30 different causes, varied by hospital – Reduced falls with injury rate by 62% Pilot: 7 hospitals – Tested and validated methodology 15 © Copyright, The Joint Commission – Reduced falls rate by 35% Preventing Falls with Injury Implications of a Robust Approach Expect 358 falls/yr Annual impact – 117 injuries – 72 fewer injuries – $1.7M in costs – $1M in costs avoided 16 © Copyright, The Joint Commission 200 Bed Hospital © Copyright, The Joint Commission Anne Kilpatrick, RN, BSN, CSSBB, Black Belt, Falls Project Lead, Joint Commission Center for Transforming Healthcare Request Access If you do not have a user name and password click here: 26 © Copyright, The Joint Commission If you already have a user name and password, click here: 27 © Copyright, The Joint Commission TST Navigation 28 © Copyright, The Joint Commission Training Data Collectors Both Electronic and Paper Form Include “Skip Logic” 20 © Copyright, The Joint Commission Data Collection Form 30 © Copyright, The Joint Commission Identifying Top Contributing Factors 31 © Copyright, The Joint Commission Measuring Outcomes 32 © Copyright, The Joint Commission Solutions 33 © Copyright, The Joint Commission Solution Guide 34 © Copyright, The Joint Commission Action Plan 35 © Copyright, The Joint Commission Control Plan Focused, Systematic Approach Data Collection Form Asks “Right” Questions Helps Us Understand Our Root Causes Drills Down to Detail We Need to Implement Efficient Solutions Emphasis is on Process, Not Blaming People The Training is Excellent TST® and the Paper Form Are Easy to Use 27 © Copyright, The Joint Commission TST® Feedback www.centerfortransforminghealthcare.org or e-mail: tst_support@tst.org. 37 © Copyright, The Joint Commission Take a Stand Against Patient Falls Beth Neidlinger, MSN, RN, CENP TST Fall Prevention Project Update Beth Neidlinger, MSN, RN, CENP March 18, 2016 About Trinity Mother Frances Hospitals & Clinics • Located in Tyler, TX • Smith County’s largest employer • One of the highest rated integrated health systems in the United States • Employs over 4,000 and includes six hospitals and 36 clinics with over 350 physicians and mid-level providers located throughout the region Project Background • • • • Unit Selection Preparation Task Force Role & Responsibilities Goals: – Falls with injury (FWI) – Total Falls • Methodology • Project status Organization Falls Structure • Oversight Committee • TST Falls Task Force • Falls Committee – Quality & Safety Committee • Unit Based Councils Organizational Data Trinity Mother Frances Preventing Falls 4 Dawson Baseline Falls w/Injury Improve Falls w/Injury 0.939 0.000 Relative Change Baseline Falls Improve Falls 3.443 1.241 Baseline Falls Improve Falls 7.626 3.965 Baseline Falls Improve Falls 2.975 2.630 100.000 Relative Change 63.956 4 Ornelas Baseline Falls w/Injury Improve Falls w/Injury 2.283 0.000 Relative Change 100.000 Relative Change 48.007 5 Ornelas Baseline Falls w/Injury Improve Falls w/Injury 0.744 0.263 Relative Change 64.651 Source: Center for Transforming Healthcare, 3/3/2016 Relative Change 11.597 Contributing Factors: All Falls 4Orn Contributing Factors: Falls w/Injury 4 Orn • NO FALLS WITH INJURY SINCE IMPROVE PHASE! Location: All Falls 4Orn Injury Level: All Falls 4Orn Improvement Plan • Robust Process Improvement approach – Use of TST Toolkit- linked contributing factors to improvement activities – Enhanced by EBP – Data supported! • Rapid Cycle Change – UBC driven • Pilot, persuade, promote! Improvement Activities • Assistance/call bell action steps – Purposeful rounding – 5 P’s – Hardwiring evidence • Rounding audits • Staff accountability – Staff contract/agreement – Patient contract • Toileting – – – – Design program Scripting Bedside commodes “Keep foot in the door to keep your patient off the floor” – Arm’s reach – White board use – Documentation & tracking Improvement Activities • Communication – – – – Data Staff meetings Huddles Falls Hall of Fame/Shame- Bright Ideas Program – Employee recognitionBright Ideas Program – TMF “Motherboard” with action plans • Education/awareness • Signage– RYG (Education UBC project 2/16) – Caution/ceiling “Call, Don’t Fall”- launched 11/15 • Hourly rounding focus & audits- launched 11/15 • Foot in the Door- launched 2/3 (4 Orn UBC) • Toileting protocol- launch 2/18 (4 D UBC) Improvement Activity A FOOT IN THE DOOR KEEPS PATIENTS OFF OF THE FLOOR Preventing falls one patient experience at a time! Foot in Door • • • • • Signage – Promotes awareness and aids in education – Holds everyone accountable by allowing everyone to see what we are doing to prevent falls. – Will be placed in sign holders on the door of every room Foot is kept in door of all patients who need to be helped to bathroom – Privacy is maintained, but not at expense of safety – Applies to BSC as well, • No more an arms-reach away from patients – Requires education to ensure that patients know we have their best interests in mind When called to assist other patients – “My foot is in the door” is an acceptable indicator for the secretary to contact another staff member – Secretary should call next staff member (RN or UT) and inform them that the other team member has their “foot in the door” and another patient needs assistance. Goal – Prevent falls during toileting – Promote teamwork and communication amongst the staff – Provide awareness to patients and families Falls are a real issue and one of our biggest issues is that patients overestimate their abilities Product review • Footwear (PT pilot) • Gait Belts- all patient rooms to have one • Bed-side commodes- all patient rooms to have one • Walkers- all patient rooms to have one • Chair alarms- in process • Fall Mats- in process • Other Next Steps • Spread the change!!! • Keep pilot units on TST tool – sustain the change! • Add additional units who are still challenged • Ongoing reporting • Ongoing improvements • Celebration! Now & future……….. QUESTIONS??? Beth.Neidlinger@tmfhc.org 55
