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Improving compliance of applying fall risk precautions

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Mohamed Nassif, MD, MSc, CPHQ, CPPS, LSSGB.
Mohamed Nassif, MD, MSc, CPHQ, CPPS, LSSGB.

This document describes a quality improvement project to increase compliance with fall risk precautions for patients at medium to high risk of falling in inpatient units. An audit found that only 33% of patients had all precautions in place. The team identified the most common reasons for non-compliance and addressed them, such as providing more durable signage and repairing broken beds. Re-auditing showed compliance increased to 84%.

Healthcare
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Improving compliance of applying fall risk precautions for medium/high risk patients for fall in in patient units Improvement Project utilizing FOCUS PDCA Methodology.
Find The Problem • Based on the data provided by the clinical audit department it was noted that only 33% of the observed sample had completely all the fall risk precautions applied. • Which meant about 67% of the patient stated to be at high risk for fall were at risk of fall because incompliance to the proper fall prevention precautions.
Percentage of Compliance For Fall Risk EL-Iman Hospital; Dhulhaj 1434. 33% 67% 80% 70% 60% 50% 40% 30% 20% 10% 0% Precautions. Complete Incomplete Percentage Compliance N= 115
Find The Problem • Further data collection was made to determine which of the fall risk precautions were more frequent to be not applied.
Percentage of Incompliance of Different Fall 30% Prevention Precautions. El-Iman Hospital; November 2013. N= 115 24% 21% 16% 5% 3% 0% 35% 30% 25% 20% 15% 10% 5% 0% F sign on Door/Bed Low bed Position ID Band Side Rails Avoid clutter Dim Light Leave Door Open Percentage Precautions N(Incompliance)=77
Find The Problem • The most common fall precautions (vital few) that showed incompliance (80%) were: • F Sign on door. • Low bed position. • ID band.
Organize The Team • Team leader: Mrs. Hanan (Nursing deputy manager) • Facilitator: Dr. Reem (Quality Manager) • Members: • Dr. M. Raslan (Deputy Medical Director). • Mr. Abdullah (Biomedical dep.). • Mrs. Janet (Nurse Supervisor). • Mrs. Entesar (Nurse Educator).
FLOW CHART
Incompliance with fall risk Precautions application Equipment Materials People Nurse Busy Policy Nurse Negligence Unawareness of the policy Escort Interference F sign not available Bed Broken Patient Incompliance Unawareness of Required Precautions Nurse Can’t Use Morse Scale Broken Side Rails ID bands Not Available
Understand The Variation • A data collection sheet was made to verify the frequency of the causes generated by the brainstorming the team performed. • And a sample size of 115 cases was determined to detect the frequencies.
Percentage of Causes of Fall Risk 25% Precautions Incompliance Al-Iman Hospital; Muharam 1435. 20% 20% 11% 11% 5% 5% 5% 30% 25% 20% 15% 10% 5% 0% Percentage Causes N=52
Vital Few Involved 1. Nurse is busy (Gives other care requirements higher priority). 2. Escort Interference. 3. F Sign not Available. 4. Broken Bed. 5. Nurse unawareness of the policy.
Percentage of Beds Condition in Inpatient Units 59% 41% Al-Iman Hospital; 1434 N= 207 Broken Beds Functioning Beds
Percentage of Broken Beds In Inpatient Units 100% 42% Al-Iman Hospital; 2013 88% 60% 27% 50% 65% 44% 46% 7% 120% 100% 80% 60% 40% 20% 0% Percentage Area N= 207
Problem Action Responsible Person Due Date Escort Interference. Nurse Education About Importance of Patient & Family Education About Fall Risk and Precautions Applied. (Every Monday Nursing Lecture). Ma’am Comfort (Nurse Director). Every Monday Till All Nurses Are Covered. Nurse unawareness of the policy. Nurses Training & Education. Ma’am Comfort (Nurse Director). Every Monday Till All Nurses Are Covered. F Sign not Available. Replace The paper made Signs with laminated F Signs in all units. Nursing Department. 2/1435 Broken Bed. All beds which need spare parts are to be provided and fixed. Biomedical Dep. Nursing Dep. 3/1435
Percentage of Beds Condition in Inpatient Units 18% 82% Al-Iman Hospital; 1435 N= 207 Broken Beds Functioning Beds
100% 46% 42% 88% 60% 27% 50% 65% 44% 16% 14% 33% 0% 0% 0% 65% 0% 50% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Paediatric Ward Obstetric Ward L&D Gyn. Ward Female Medical Ward Female Surgical Ward Male Specialist Ward Male Medical Ward Male Surgical Ward Percentage Area Percentage of Broken Beds In Inpatient Units Al-Iman Hospital; 2013 After Before
Percentage of Compliance For Fall Risk EL-Iman Hospital; 12/1434 : 3/1435. 33% Precautions. 84% Invalid Data 23% 77% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 12/1434 1/1435 2/1435 3/1435 Percentage Month Before Bed Repair

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Improving compliance of applying fall risk precautions

  • 1. Improving compliance of applying fall risk precautions for medium/high risk patients for fall in in patient units Improvement Project utilizing FOCUS PDCA Methodology.
  • 2. Find The Problem • Based on the data provided by the clinical audit department it was noted that only 33% of the observed sample had completely all the fall risk precautions applied. • Which meant about 67% of the patient stated to be at high risk for fall were at risk of fall because incompliance to the proper fall prevention precautions.
  • 3. Percentage of Compliance For Fall Risk EL-Iman Hospital; Dhulhaj 1434. 33% 67% 80% 70% 60% 50% 40% 30% 20% 10% 0% Precautions. Complete Incomplete Percentage Compliance N= 115
  • 4. Find The Problem • Further data collection was made to determine which of the fall risk precautions were more frequent to be not applied.
  • 5. Percentage of Incompliance of Different Fall 30% Prevention Precautions. El-Iman Hospital; November 2013. N= 115 24% 21% 16% 5% 3% 0% 35% 30% 25% 20% 15% 10% 5% 0% F sign on Door/Bed Low bed Position ID Band Side Rails Avoid clutter Dim Light Leave Door Open Percentage Precautions N(Incompliance)=77
  • 6.
  • 7. Find The Problem • The most common fall precautions (vital few) that showed incompliance (80%) were: • F Sign on door. • Low bed position. • ID band.
  • 8. Organize The Team • Team leader: Mrs. Hanan (Nursing deputy manager) • Facilitator: Dr. Reem (Quality Manager) • Members: • Dr. M. Raslan (Deputy Medical Director). • Mr. Abdullah (Biomedical dep.). • Mrs. Janet (Nurse Supervisor). • Mrs. Entesar (Nurse Educator).
  • 10. Incompliance with fall risk Precautions application Equipment Materials People Nurse Busy Policy Nurse Negligence Unawareness of the policy Escort Interference F sign not available Bed Broken Patient Incompliance Unawareness of Required Precautions Nurse Can’t Use Morse Scale Broken Side Rails ID bands Not Available
  • 11. Understand The Variation • A data collection sheet was made to verify the frequency of the causes generated by the brainstorming the team performed. • And a sample size of 115 cases was determined to detect the frequencies.
  • 12.
  • 13. Percentage of Causes of Fall Risk 25% Precautions Incompliance Al-Iman Hospital; Muharam 1435. 20% 20% 11% 11% 5% 5% 5% 30% 25% 20% 15% 10% 5% 0% Percentage Causes N=52
  • 14.
  • 15. Vital Few Involved 1. Nurse is busy (Gives other care requirements higher priority). 2. Escort Interference. 3. F Sign not Available. 4. Broken Bed. 5. Nurse unawareness of the policy.
  • 16. Percentage of Beds Condition in Inpatient Units 59% 41% Al-Iman Hospital; 1434 N= 207 Broken Beds Functioning Beds
  • 17. Percentage of Broken Beds In Inpatient Units 100% 42% Al-Iman Hospital; 2013 88% 60% 27% 50% 65% 44% 46% 7% 120% 100% 80% 60% 40% 20% 0% Percentage Area N= 207
  • 18. Problem Action Responsible Person Due Date Escort Interference. Nurse Education About Importance of Patient & Family Education About Fall Risk and Precautions Applied. (Every Monday Nursing Lecture). Ma’am Comfort (Nurse Director). Every Monday Till All Nurses Are Covered. Nurse unawareness of the policy. Nurses Training & Education. Ma’am Comfort (Nurse Director). Every Monday Till All Nurses Are Covered. F Sign not Available. Replace The paper made Signs with laminated F Signs in all units. Nursing Department. 2/1435 Broken Bed. All beds which need spare parts are to be provided and fixed. Biomedical Dep. Nursing Dep. 3/1435
  • 19. Percentage of Beds Condition in Inpatient Units 18% 82% Al-Iman Hospital; 1435 N= 207 Broken Beds Functioning Beds
  • 20. 100% 46% 42% 88% 60% 27% 50% 65% 44% 16% 14% 33% 0% 0% 0% 65% 0% 50% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Paediatric Ward Obstetric Ward L&D Gyn. Ward Female Medical Ward Female Surgical Ward Male Specialist Ward Male Medical Ward Male Surgical Ward Percentage Area Percentage of Broken Beds In Inpatient Units Al-Iman Hospital; 2013 After Before
  • 21. Percentage of Compliance For Fall Risk EL-Iman Hospital; 12/1434 : 3/1435. 33% Precautions. 84% Invalid Data 23% 77% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 12/1434 1/1435 2/1435 3/1435 Percentage Month Before Bed Repair