Falls reduction & falls management quality improvement initiative in the Kerry Community Hospitals/ Nursing Units. Presentation from 31st August 2017 at Forever Autumn COP Meeting

1. Susan Daly A/Clinical Development Co-ordinator, Cork/Kerry Community Healthcare Organisation

2.  The World Health Organisation Report: Prevention of Falls in
Older Age (April 2007) described falls injuries as an epidemic.
 Falls account for approximately 75% of all accidental injuries
in older people.
 20% of people aged > 65 years sustain injury from a fall.
 Approximately 250 people > 65 years die due to a falls
related incident in Ireland annually
 <50% of all hip fracture patients aged >65 years regain their
pre-fracture health status
 Falls precipitate 40% of admissions to continuing care
WHY FOCUS ON FALLS

3. People over 65 years represent
11.7% of the national population
figures, corresponding figure for
Cork & Kerry is 12.6%.

4. Background to the
Quality Improvement
Initiative
In August 2016, Ina
McGrath Risk Manager
HSE Kerry Area, suggested
the introduction of a post
fall review checklist similar
to the one used in St Marys
Hospital falls prevention
management programme.
“I was looking for a one page
tool that team members
could use post fall, that
would help identify causes of
a fall, and help the nursing
team in identifying
contributory factors for a
fall” Ina McGrath
(Ina.McGrath@hse.ie)
From A Risk Management Perspective:
 It is attached to an incident report to provide a holistic
comprehensive timely overview of what occurred at the time of a
fall
It helps the nursing team to identify the contributory or key casual
factor(s) for a fall
It includes the person in the risk assessment process
In the event of a serious incident, it can be used to show what was
done in the past to prevent reoccurrence (e.g.The person who
refuses to wear slippers and repeatedly falls when wearing socks)
It provides recommendations to staff on how to prevent
reoccurrence of a fall and increases staff awareness of risk factors
for each person
It can be used to support an investigation to show a holistic
approach to risk management and quality improvement in each
persons care

5. Adaptation of
St. Marys in the Park
Post Fall Review
Following on from the Risk
Managers recommendation,
the Clinical Development Co-
ordinator sought permission
from Daragh RodgersANP St.
Marys Hospital to adapt the
post fall review and implement
throughout the 6 Kerry
Community Hospitals.
Once permission was kindly
granted, Clinical Development
engaged with local
stakeholders (General
Manager, Risk Manager,
Directors of Nursing,Clinical
Nurse Managers, Nurses,
ConsultantGeriatrician and
Physiotherapy Department)
From A Clinical Development Perspective:
 It provided an opportunity to prompt the nursing team to ensure
the person was assessed for any apparent injuries using
AVPU Rapid Assessment
Checking and recording vital signs
Conducting a Secondary Survey
Neurological observations (if fall is unwitnessed by a licensed
practitioner and/ or suspicion of head injury
PINCH ME Assessment
Blood glucose check (if deemed clinically necessary)
Urinalysis (if deemed clinically necessary)
ISBAR the doctor if deemed clinically necessary
In addition it provided an opportunity to prompt the nursing team
to ensure
The FRASE Falls Risk Assessment to repeated
The persons care plan was reviewed and updated (if
necessary)

7. FRONT PAGE BACK PAGE

8. ...continued
The introduction of theA6
ISBAR adhesive label promoted
good communication and the
gathering of information prior
to contacting the Medical
Officer, the completed label
can be attached to the persons
narrative notes once the
Medical Officer has been
contacted.
The ISBAR communication tool
has promoted accurate
assessment, ensured
recommendations are sought
and received and reduced
duplication in nursing
documentation.

9. 0%
20%
40%
60%
80%
100%
120%
Do you think the post
fall review promotes
rge inclusion of the
person in the risk
assessment process
Do you think the post
fall review pcan be
used to show a
pattern of behaviour
Do you think the post
fall review can be
used to show what
was done in the past
to prevent
reoccurance
Do you think the post
fall review provides
recommendations to
staff on how to
prevent reoccurance
of a fall
Kenmare Community
Nursing Unit
Caherciveen Community
Hospital
Killarney Community
Hospital
Tralee Community Hospital
West Kerry Community
Hospital
Listowel Community
Hospital
YES

10. 0%
20%
40%
60%
80%
100%
120%
Do you think the post fall
review has increased staff
awareness of the risk
factors for each person in
their care
Do you think the new
documents are user
friendly
Do you think the new
documents intehgrated
easily into your hospital./
nursing unit
Has the post fall review,
ISBAR and observation
booklet improved the
management and
reduction of falls with you
hospital/ nursing unit
Kenmare Community Nursing Unit Caherciveen Community Hospital
Killarney Community Hospital Tralee Community Nursing Unit
West Kerry Community Hospital Listowel Community Hospital
YES

11. Kenmare
Community
Nursing
Unit
Cahercivee
n
Community
Hospital
Killarney
Community
Hospital
Tralee
Community
Nursing
Unit
West Kerry
Community
Hospital
Listowel
Community
Hospital
2016 27 26 145 27 42 20
2017 11 12 50 12 26 9
0
20
40
60
80
100
120
140
160
Numberoffallsincidents

19. Ongoing questioning
The success of the quality
improvement initiative has led to
increased awareness and enthusiasm
among team members regarding all
aspects of falls reduction and
management.Through reviewing the
FRASE risk assessment tool we
identified discrepancies in relation to
correct completion of same. Policy
and practice stipulated that an
assessment must be completed on all
persons irrespective of mobility
status.This resulted in significant
variations in FRASE scores
(depending on the assessor) and
confusion regarding “bedbound” in
the mobility section of the FRASE
assessment tool. Clarification was
sought on the issue and practice and
policy will change to only completing
a FRASE assessment on persons who
are mobile – avoiding the completion
of unnecessary risk assessments.

20. References
Thank you for listening
Any questions: susand.daly@hse.ie
Wang. S. (2007) Reducing the risk of falls in care
homes. Nursing and Residential Care 9(11), 524 –
526.
Wang .S. (2007) Protecting hips and preventing
trips in care homes. Nursing and Residential Care
8(5), 208-211.
Journal of the American Geriatric society (2011)
American Geriatrics Society/British Geriatrics
Society (AGS/BGS) clinical practice guidelines on
prevention of falls in older persons. Jan: 59(1):148
Clinical Development would like to acknowledge and thank
Daragh Rodgers,Advanced Nurse Practitioner,Care of the OlderAdultCommunity, St. Marys Hospital, Phoenix Park.
daragh.rodger@hse.ie
Ina McGrath, Senior Community OccupationalTherapist Ina.McGrath@hse.ie
MaryT. Ring, NurseTutor/Specialist Co-ordinator,Centre of Nursing and Midwifery Education University Hospital Kerry
MaryT.Ring@hse.ie
Breda Delves, Projects FacilitatorOffice of Ber Power,General Manager Residential Services OP Cork/ Kerry Breda.Delves@hse.ie
Tracy Fitzgerald Project ManagerViClarity tracy.fitzgerald@viclarity.com
Catherine Lyne, Senior Community Physiotherapist Catherine.lyne@hse.ie
Sincere thanks to the management and staff in the 6 Kerry Community Hospitals/ NursingUnits for engaging in
the quality improvement initiative
Kenmare Community Nursing Unit,Caherciveen Community Hospital, Killarney Community Hospital,
Tralee Community Nursing Unit,West Kerry Community Hospital and Listowel Community Hospital