Hospital decreases patient falls through education, culture change
Despite already being below the national average on patient falls, Lallie Kemp Regional Medical Center's staff and leadership still felt falls were happening too often. The small but busy 25-bed critical access hospital pulled together to implement many tried-and-true methods, and in the process earned a national patient safety award and proved that a combination of methods, along with a new culture, works best for success.
In May, the National Patient Safety Foundation (NPSF) recognized Independence, La.-based Lallie Kemp for its exemplary efforts in improving patient safety with the 2012 Stand Up for Patient Safety Management Award. The organization developed and implemented a program that dramatically reduced falls among its inpatient population.
To qualify for the award, an initiative was required to demonstrate evidence of patient safety improvement with involvement of staff at all levels of the organization and be led or created by the mid-level management of a hospital. The award is given for initiatives within a member organization of the NPSF Stand Up for Patient Safety program. Shawn Hariel, risk manager, accepted the award May 24 at the Stand Up member breakfast, held during the 14th annual NPSF Patient Safety Congress, May 23-25, in Washington, D.C.
"This effort, designed by a multidisciplinary team, resulted in measurable, positive change at their facility that took them beyond the 'acceptable' range and closer to 'zero' for this particular form of patient harm," Diane C. Pinakiewicz, MBA, CPPS, president of NPSF, said in a press statement.
Lallie Kemp's efforts resulted in an overall 95% reduction in falls, with zero serious injuries from falls and no repeat falls for the year after implementation compared to the prior year. Looking at Joint Commission and NPSF statistics, Lallie Kemp figured that the national average for falls was around 3.5 falls per 1,000 patient days.
The initiative began in September 2010. The key driver, says Hariel, was staff involvement and attitude toward preventing falls. Accountability, involvement, and education fostered a culture focused on preventing falls.
"We had a couple of repeat falls and we got concerned about it," says Hariel, despite being a bit below the national fall rate. "So we got started on this new patient safety initiative. We wanted to increase staff awareness and involvement."
Hariel and others at Lallie Kemp involved in the initiative began by taking a look at data for the prior year and identifying everyone who was on the unit, including supervisors, when falls occurred. The tactic elicited an immediate response as staff realized they would be held accountable for falls under their supervision.
"They really got involved with it," says Hariel.
Small steps and greater accountability
The patient experience began to change as soon as patients arrived.
"We revamped our evaluation of fall risk," says Hariel. They also ensured that physicians' order sheets included a place to indicate risk and that the patients would need assistance out of bed. Patients and families were also educated about the risk of falls.
"Every time they come in, first thing is you have to talk to them about fall prevention and how to call for assistance for getting out of the bed," says Hariel. "We encouraged family members to stay with the patients, and identified high-risk patients and placed them closer to the nurses' station."
The initiative to reduce falls took shape gradually and was a learning process, especially as many of the methods implemented to prevent falls came from staff input during reviews of previous falls-Hariel and his team conducted training with the entire unit every time a fall occurred.
"We learned a lot of things that way, by getting their feedback," says Hariel. Call lights became high priority, and conducting hourly rounds for high-risk patients became routine.
"We also found out that we had some rolling chairs for the nurses that sometimes found their way into patient rooms, and obviously removed those," he says.
The organization installed new bed alarms and provided education about those alarms, particularly for nursing assistants who weren't entirely sure how to turn the alarms back on or adjust them when patients got back into bed. That education was made a part of the annual competency training.
Despite initial staff resistance, they became the well of knowledge and ideas for positive change.
Hariel emphasizes the importance of staff feedback, as many of the initiatives implemented came directly from the staff. "They take care of the patients, they're with them all the time, so they had a lot of great ideas," he says.
"I think staff is always somewhat resistant to change at first," says Hariel. "But once we put out a chart that was updated every month, after a couple months when it was clear the rate was really going down, and they were really improving and it could really be done, things changed."
Many times with a falls initiative, some staff are convinced that some falls aren't preventable, or that some patients simply will not heed advice to ask for assistance before getting out of bed, and that there's nothing that's going to change that. This sentiment makes showing staff evidence of positive progress so important.
"The chart helped staff take more initiative in preventing falls," says Hariel.
Teaming up with patients
Improved communication with patients and families-really urging them to call for help and explaining to them that they are in a new environment with new risks-was also critical, says Hariel, who adds that it is a team effort between the patient and staff to prevent falls.
Hariel speculates this communication also helped Lallie Kemp improve its HCAHPS scores, as patients felt that staff truly cared for them and were appreciative of the time they took to talk with them about falls. Staff warned patients that falling could result in an injury that is slow to heal, appealing to their desire to be discharged sooner than later. Importantly, staff made it abundantly clear that they were glad to help, which Hariel says made patients feel more comfortable asking for assistance. Many patients needed to be told specifically that they were not causing a burden.
With staff accountability and education, and better patient communication, a hospital can greatly decrease falls, says Hariel. "You have to make it a priority," he says. "You have to listen to employees and get their feedback."
The keys to keeping falls low are educating staff upon hire and annually, as well as thorough review and education with each fall, says Hariel, who warns that if you don't train new staff immediately, you're putting patients at risk.