Eight Step Positivity Process

FALLS COP WEBCAST RE

Welcome to the rerecording of the IOWA Healthcare Collaborative

Falls Community of Practice webinars. I want to start off. I am thanking everyone for joining us today. As reminder our

Community of Practice is an interactive resource sharing and skill building network. The next webinar will be focusing on falls assessment and as part of our CoP we are pleased to welcome Barb Marlin, Patient’s Safety and Risk Management

Director at Fort Madison Community Hospital. Barb is going to be joining us to share her experience at Fort Madison Community

Hospital and their processes for falls assessment both for inpatient and outpatient. So, thank you again for joining us and I will turn it over to Barb to tell us a little bit more about herself and to began explore the experiences that they had at Fort Madison.

Oh, thank you, I want to welcome everybody and appreciate your time. I have been a nurse for 30 years now and I have worked acute care pretty much every department except surgery as a supervisor and then I also have worked in a clinic and home health department which is really as a struggle with falls in IOWA Healthcare Collaborative Falls Community of Practice 2 the home and so I am here today to share what Fort Madison

Community Hospital has been doing to try to make our hospital a safer environment for our patients, our staff and our employees and my focus is to kind of talk about accessing for falls so we are going to talk about. We had a fall team and we meet on a monthly basis and initially when I began this position our fall team was just I felt in a red, just looking at inpatient falls and identifying a favor preventible, unpreventable or not applicable and I just thought our fall team could be more robust and be more active and doing more things, so began to branch out as we were working on developing and updating our policy for inpatient falls. We started to saying that we need to be working on this as an organization. We are in the organization that has a 50 bed acute care hospital. We also has several clinics that are attached to our campus that are employed by our own doctors and patients and so we started looking that as a campus in general, you know looking at the ER department, our outpatient departments as well as our inpatients in our clinics.

Some of the trends we were seen is with our inpatients, lot of our patients who fell had some cognitive issues and with our outpatients we were seen more falls in our radiology department and so we wanted to do something to try to make our campus safer. Our department leader also, an emergency department we saw a trend where she felt like she was having more falls in the IOWA Healthcare Collaborative Falls Community of Practice 3 emergency room but she really was not sure if she was a resident because we have never done statistics on it, so we are kind of share that with you later on this life, so you want to go at first one we are going to talk about our emergency department first.

As a fall team got together and we started looking at the emergency department and seen what they did currently do for falls. When we took on this endeavor last spring we found out that what they were doing was 30 minute rounding with their patients but it was not focused really on safety and fall prevention. It was 30 minutes rounding to let know how much longer it is going to be what are we waiting on your last three falls. You know, I mean it was to do everything with the patient that they did not really have a safety focus with it.

Also when we started doing some data we kind of released that it was not 100% across the board that they were get to patient a call light explaining the patients and the family that we did not let them to up to the bathroom by themselves though we wanted them to turn on their call light when they needed assistance. So we immediately you know have some issues. They were using no fall preventions tools, no communication tools, and they had no risk assessment for falls whatsoever. So we started researching what was out there, what had other hospitals IOWA Healthcare Collaborative Falls Community of Practice 4 done and we found that couple of hospitals and IOWA mostly was one of them. I think UnityPoint was the another one that had already started this process and had developed a fall risk assessment for their emergency department. So we listed a couple of their studies. One of the groups, I think it was

UnityPoint was that the Iowa falls last year for our National

Iowa Falls programs and she was a speaker so I got to spent some time with her and it was very interesting she shared all of her information of course with the talking. So we felt like we were starting from scratch. So one of the things we did do is that we developed our own fall risk assessment tool and also that in a couple of slides and go over kind of what we ask. We decided to do this at triage. Our nurses are triage at 0 to 15 minutes upon entry into the emergency department, so we decided we would try to get that fall risk done you know as soon as we see them as a patient. We also gathered three years of data to measure our falls per month. What we did when we took our fall data that we had in a database and we divided it by how many ER visits there were for that month and then multiplied it by 1000 so that we were you know comparing our numbers correctly so we could see you know how the numbers were looking and it did really show that we have arranged article kind of go over with your, that kind of show that what kind of up and down but we did have an identified risk factor in the ER with falls. We did IOWA Healthcare Collaborative Falls Community of Practice 5 decide after doing the fall risk assessment that we would want them to use a same fall identification communication tools that we use on the inpatient side. We had staff that flow from department to department. We really did not want to do something different than what we were already doing though we have a yellow fall pad outside the door that you can pull out when you have a fall risk patient in the ER which is just the same as what they have in the inpatient side. We will put a yellow band on the patient to identify them and that is the same as what we have in the inpatient side. Some of our patients who come to the ER do not have appropriate footwear to ambulate and if they don’t have nonskid shoes, we will put our yellow nonskid booties on them. Otherwise, they can leave their shoes on.

What we identify that there were no gait belt in the emergency room and we did have a department leader purchase gait belts for every room and so there is a gait belt in every room that we do kind of out of bed to make sure that they have not wander about.

We also gave some education with correct transportation that we make sure as we take them from the emergency room to another department for testing that we developed a ticket-to-ride 7:20

INAUDIBLE. One of the things we had noticed was this emergency room staff is very busy and a lots time in radiology would come over to get them further testing. There was really nobody around to give a verbal 7:36 INAUDIBLE and you know how there IOWA Healthcare Collaborative Falls Community of Practice 6 everybody got their own schedule and you got to get down and so then the radiology staff would be taking them over possibly by wheelchair when we feel that they are safer to go over by bed.

So we are going to talk about the ticket-to-ride in just a minute and how that we have just started that so I do not have a lot of data on how changing things yet. We also identified that patient and family needed to be educated on the call light and fall prevention to elicit that their part of team and they know we were using this. We are not trying to take away their independence; you know but we wanted them to be safe while they are here on our campus. We just recently remodeled the emergency room so it is really nice. Our new stretchers have alarms on them because of other things we just had one portable alarm down the emergency room that we would use if we had somebody if you know was getting up on their own without assistance. So now we have a bed alarm in the emergency room on the emergency side which is four of them and then our other five rooms have a portable alarm that we can move from room to room when we need to use that.

Next slide, this is our ticket-to-ride and this is something that we just developed. We had a trend already that we have some falls in the emergency department but some of those IOWA Healthcare Collaborative Falls Community of Practice 7 were like outpatient. These were like people in our ER that have gone over for portable chest x-rays, they would have to stand, hold their breath, keep their balance and we had two just recently that the doctor ordered PA and lateral of the chest and one of them was not considered the fall risk but did his lose his balance when he had to take a deep breath and hold it, it

9:32 INAUDIBLE center of gravity. The other one was dizzy and a weak and had a fall for when he went over. The nursing had told them that they needed to go by stretcher and they should not be standing but they had taken them over by wheelchair and stood them and ended up falling and actually getting lacerations to head that had to be repaired. So besides you know some staff education and letting them know that we know we need to be patient 9:58 INAUDIBLE and if that patient is not safe to stand then you know we need to talk to the doctor about ordering portable chest x-ray were the quality is really about the same any more and it will be safer for the patient that we need to be

10:10 INAUDIBLE. It is true that we have started developing a tool so that we have some good communication between departments to keep our patient safe. That we show that assessment that we have done with them so that they can you know keep them safe in their department. So they could try something new we just started so I don’t have a lot of feedback yet but if anybody else has then it would be great to share with each other. This IOWA Healthcare Collaborative Falls Community of Practice 8 pretty much we wanted other allergies because I get some medications over and radiology that could be affected. If there are fall risk yes or no and have the patient stand alone, yes or now and if it is no they should not be getting them up, they need to be asking for change in that order. The mode of transport and if that is by bed they need to not change it that’s how they have to go. Modality of something new we are trying to educate everybody. We are also working on a new policy with safe patient handling and part of that is using a same definition for their modality so along with its tool is a definition of all those so that we are trying to kind of train staff talking the same language so that we are all talking the same and on the same page with that. We also have on here if there is any special need, any medications that can alter their mentation that would put them at risk for falls. We also thought we would like to let them know their isolation yes or no so they could make sure they protect themselves and everybody else in the department. There is a place to put in their oxygen, their IV fluids if they have a chest tube resection. We thought it was important that they know when they have their pain medication and sedation last as that can affect their falls break and then the things we have to monitor. There is a place at the bottom for the primary nurse to sign and the transporter to sign as they bring them back and there is a place I think for IOWA Healthcare Collaborative Falls Community of Practice 9 them to put a comment. So again this something new, it’s a new tool we are trying to do to help with the assessment and hopefully keep our patient safer as they transport from department to departments and we are just trying an ER right now. Everybody else still requires to do the 12:29 INAUDIBLE and our Meditech system has a place where they can document their SR communication in the electronic health records.

Next slide. This is an example of our emergency room fall tool.

Again, it does not have as many questions as our inpatient one does but it was focused mainly on our emergency room patients and I know this does not show up most everything to one point except like the first one history of fall no is 0 point, if they have a single fall its 1 point, if its physiological fall or syncope they get 2 points and if they are prone to falls it is automatically a 3 which automatically fits them at fall risk.

Otherwise, would ask they were confused or disoriented, intoxicated or sedated and of course that is very specific to the emergency room because we do get a lot of patients to come in intoxicated or really sedated with too much medications. If they have impaired gait, if they need an assistive device, if they have altered elimination, polypharmacy, if they have three or more places they get their medications and each one of those is what the point if they are three or above we consider them as IOWA Healthcare Collaborative Falls Community of Practice 10 fall risk and all of our fall prevention communication tools were to use a gait belt with them either up for mobility that way I mean in case they do have a fall we can assist that fall and hopefully not injure out employees as well as keep the patient from having any major injuries with the fall and if they use the corrective assistive device to transport them by wheelchair. Currently, we do not have overhead lifts in our emergency department. All of our inpatient units have overhead

Hoyer lifts and so we are doing a capital and we are requesting that we have overhead lifts in the emergency room as well. They have the slide boards and they have wheelchairs but they don’t have the overhead lifts and I felt that we feel that they could really use. But anyway this is our fall risk assessment tool and we have started just this month doing an actual audit on a monthly basis over there. We are going to make sure that their fall risk assessment is being completed on a planned time and if they are fall risks, they are using all of their tools and they are keeping the patient safe and this has come about because if you want to go at the next slide we really started once we instituted here in July started really looking at their falls and instituting the risk assessment and the tool. You know, it was like a new thing and everybody was really thinking about it with plan on their mind. We were talking about as a lot. We really saw like six months in a row where we just you know no IOWA Healthcare Collaborative Falls Community of Practice 11 falls whatsoever and then we have had a couple and we kind of thing part of it you know we got a hard wire all those tools and get that culture safety in the emergency room. You know that they started really pretty good but yet then once we kind of backed off I think they got a little laxatives so we are just kind of start auditing it and making sure that they know what is important then we get that on culture and safety in there. I know this last month that I did I coached a couple of nurses and one of them like was completing the fall risk assessment in its entirety you know and another one was you know a little hit miss that was just kind of coaching about the importance of that and what they do with that information. They were all able to tell me what preventive tools they would use and what they do and it sounds like they are really great about doing it. When I am up there, I see it is done but it is just kind of making sure we keep building our culture of safety in that department. So, that’s kind of what we have done for the ER and again I am actually tracking and trending these numbers on a monthly basis and then the run chart gets printed as well with the inpatient one and gets posted in all the departments and they talked about this as there are department meetings on a monthly basis so they were trying to share that information back with the staff so they know what a great job they are doing and they can see how those numbers change overtime. Alright, next slide. So then on IOWA Healthcare Collaborative Falls Community of Practice 12 the inpatient side we were still working on our policy. They are like updating our policy and we have done some different things with the inpatient side. On the inpatient side or fall risk assessment, we looked at that as a group. It wasn’t really reference so we thought we were able to adjust it and change it.

So one other things we wanted to do is we saw that a lot of our cognitive patients were having a fall and so we wanted that to be if they had a cognitive issue to just automatically be a fall risk and so we changed these three numbers. If they were unsteady on their feet or they had syncopal episodes they were automatically a fall risk. We gave an 8. They got an 8 for that so they just were automatically a fall risk. If they have a recent history of falls within these last six months they were automatically a fall risk. If they were confused or disoriented they were automatically a fall risk and then we kind of looked at the tool to make sure it worked okay with them. We got somebody that was in their safety, and they just had recently knee replacement. They have an IV and they have some altered elimination. You know would they be a fall risk and I mean we kind of did it to make sure that our numbers all worked for our assessment. So, it looked like our fall risk assessment. We all like it as a group, but seem like it was working great and we put it into practice, it has really done a better job for our nursing staff. This policy initially had if they were fall risk IOWA Healthcare Collaborative Falls Community of Practice 13 of 5 to 7 they would use like the communication tool and certain tools but not all of them and then if they were fall risk at 8 or greater then they would use the alarms and all the tools and we have got, that was too confusing. You know what we feel everybody at the Camstar Organization is at risk for falls and we need to protect everybody but once you are a fall risk we really ask you just a fall risk. There isn’t like low, medium, high we just feel like you are and so we changed the policy to make it simpler that okay, man, once you are fall risk, you are fall risk. You use all the tools and put them in place. So, with our assessment it is required that they get a fall risk assessment on admission. Every shift has to reassess that fall risk. If we change their medication from a doctor’s order and if medication that can you know sedate them, or change their mentation they have to do another fall risk assessment and if they have had a fall they need to reassess that and document it.

On our fall prevention tool it is very similar to what most people use. We identify their fall risk outside the door and we have a yellow tab we can pull out. Our special care unit and our OB department have yellow stickers they put on the doors.

They have a yellow band that we put on them. They wear yellow booties as apposed to blue booties so that we know there are fall risks. We again identify that really teaching the use of gait belt all the time if there are fall risks that gait belt IOWA Healthcare Collaborative Falls Community of Practice 14 should be on every time we have them up. If not, the policy is written as if not a decision that they can or can’t. They have to have it on as a staff member. So any transfer, any mobility with fall risk patient they have to have their gait belt on. We have bed alarms on every bed and those are to be used. We did a

20:35 INAUDIBLE. We have gotten some new Stryker beds and I have somebody aids with me one day and we were like you know testing the new alarm, and I was in bed and I was showing all the different positions that we kind of identify that the active alarm that they know, we put it on, really doesn’t go off until

I could stand up and probably walk for about a good 4 to 5 feet and it would go off and so that really open their eyes and of course we did some education and sent out an e-mail and trained everybody that we really needed on that middle node. So now and

I have checked it. It is always and everybody is doing a great job and we have on that middle mode. We were finding out that was just too big but delay in that bed alarm that you really needed. Do you really needed to have such mode with somebody in that bed and see how long it takes for that to truly alarm and if there is that big of a delay on it you know you might want to change your mode and we did that. We changed our mode to the middle mode so that we don’t have that delay of getting into that room to help that patient. Our chair alarms are just one patient use sensor pads but we did find chair alarms that have IOWA Healthcare Collaborative Falls Community of Practice 15 an alarm in the room as well as an alarm we can put outside the door that responds by audio, you can hear it going off but it is also visual the lights on this the low it goes off and that helps if you have like three or four chair alarms in the same area. You could also look at the alarm and whichever one is lighting up, you know to go into that room. The thing with the chair alarms is they do not go into our Hill-Rom system, so you can only respond if you are in the area, so we again orient and train everybody that way. We also have a no PATs, so we train all new employees and every department that if they are up on the floor and there is an alarm that they respond to it. We do not expect to do clinical stuff or mobility assistance, but we expect them to do their INAUDIBLE22:36 go in the room. They know all the communication tools of how to get assistance.

There is a staff emergency button and they learn where

INAUDIBLE22:45 and how to get assistance to the room and we ask them to keep the patient as safe as they possibly can with their skills, talk to them, distract them by your staff sometime. So, we do that with the inpatient side.

So one part of the assessment in the policy that we changed is we did consider any patient in our organization be at risk for falls. So the policy does state that and I just kind of took this from our policy and so we expect everybody to have a call IOWA Healthcare Collaborative Falls Community of Practice 16 light within reach before we leave them, to have a bed or chair in the low and locked position at all times, to be sure we are orienting everybody to the environment because this is different than being at home and during orientation, we talked to everybody about you know it is a nighttime and I know you are trying to keep the lights dim and you are not trying to wake everybody. So, when you get them to the bathroom, you need lights on, you need to be well lit. You need to make sure that they know where they are at, they see where they are walking.

You do not want to be walking them in the dark. Is it appropriate footwear and we have the non-skid beauties that is what so funny as I had a fall in the past where the supervisor got a patient up at night and put on house slippers which were slipped and had her in our tiled bathroom and then when she got it from the toilet, that slid and she fell and so with just that educating everybody. You know even if you are not a fall risk, you have got to think about those things and you do not want slip footwear on. We keep their personal items within reach, we do not want them reaching or trying to get up without assistance two top rows up at the bed at all times. Educate our patient families about why we would need fall protection things, make sure that they understand that, they are not trying to take away their independence, we want to keep them safe, it is a different environment and they have sometimes IVs and tubes and stuffing IOWA Healthcare Collaborative Falls Community of Practice 17 and you are in bed more often, you are just, you know, do not have INAUDIBLE24:46 with the steady gait, you get lightheaded and dizzy, you are just weaker. So we did also institute a call, don’t fall policy. In all of our rooms, we added a bright yellow magnet that say call, don’t fall and so we encouraged everybody. So please turn on their call light when they need to get up. We would like to be their for standby assistance just to be sure if they need anything, we are there. Make sure with their pathways and we talked about lightening that we have their corrected system devices and if we do not know how to measure, we have physical therapy come over, make sure the walker that they have brought in is appropriate for them, and then of course we can also have therapy come over and do an assessment on them.

Alright, next slide.

So as we have been teaching our staff to do the correct fall assessment, another thing as we think is important with assessment is communication. So we do a monthly safety audit.

We started doing this over a year ago and we did it twice a month and now we are down to monthly. We are not 100% across the board but we are also, you know we will do like one patient, you know INAUDIBLE25:59 one or two. So, we actually go upon the floor and go to every patients room and notice it is going to print very well and I am sorry for that but we looked to make IOWA Healthcare Collaborative Falls Community of Practice 18 sure we are the first ones INAUDIBLE26:12 that is kind of some other, you know you are INAUDIBLE26:16 other issues, but we do make sure we look at our bands that all the communication or bands are on and appropriate for that patient. We have some VTE step on here to INAUDIBLE26:27 quality but we do a safety check and we make sure all the safety things that patient should have are in place and on, that the whiteboard is completed. That is our communication board, so we think it is important that we have the right communication. There is fall risk from the chart, Kardex to the whiteboard all match, all have the same number. We are checking the Kardex for communication as well as their chart. So we are doing a lot live up there. It is kind of started as I wanted to be checking on our safety tools with falls that we kind of added VTE staff and whiteboard communication and some other things. But it has been really great that I go up there and they see me and they are just like oh, oh, my God I wanted to make sure my whiteboards are updated.

You know as soon as they see me, it just makes them think about that. So, that has been going well. Next slide.

Another thing that we have been doing is all of our calls are recorded and INAUDIBLE27:27 which is our variance reporting software for us. So as we talk about a safety for those falls, it is really important that everybody knows that once we have a IOWA Healthcare Collaborative Falls Community of Practice 19 fall and I am talking inpatient fall, ER fall, outpatient fall, clinic fall, ground fall, all of our falls get recorded and we track and trend all of them. We want to see if we have more you know outpatient falls or we have not anything at certain departments, what can we do to keep it safer for everybody. So one thing is, as we do document it in our safety event in

INAUDIBLE28:00 there is a post-fall assessment in INAUDIBLE28:04 so they have to fill out that ask for lot of relief pertinent questions if they have been assessed for fall lately, has physical therapy worked with them or there are only medications that made them prone to fall and then we also felt that there was not all the questions we had so we also developed a post- fall huddle form.

So this our post-fall huddle form and what it is, is asking the questions our safety online system does not ask. So it is not only inclusive because the other questions that are already in are safety events reporting what we do a post-fall assessment and a post-fall huddle. So, we require a post-fall assessment by the staff nurse. Anybody on the department is involved with this patient’s care and our supervisor. If we have somebody fall once we have taken care of them and put them back in the safe place and they are doing okay, then we do a post-fall assessment and then we do a post-fall huddle and we want this IOWA Healthcare Collaborative Falls Community of Practice 20 people to get together and you know that we have a piece of equipment not working, that we not use our equipment correctly.

You know does this person need one-on-one sitter or do we have a cognitive issue. They need to get together and brainstorm and what do we need to do to keep the person safe going forward and they need to institute that but then they also have to complete this post-fall huddle form and then that comes down to me to track and trend, and I share that with department leaders well as it is in our safety band I put it in our computer system so that we can track it until besides making sure they have the correct fall tools on and the other questions. We kind of wanted to know the number of patients we had during that time and what our staffing was like and how many fall risk patients we had and how many people were actually on the unit at that time and how much time and INAUDIBLE30:06 we left since they last rounded on that patient. Last time, that the patient went to the bathroom and if they are continent or incontinent, have the catheter and was fall risk communicated to the staff and shift report. We want to know if they are still to be talking about the shift report and their huddle and the supervisor is supposed to get it during their report whether the patient is compliant with our fall prevention plan and was there a mental status change from baseline since the fall and were there are any psychological changes prior to the fall and then of course IOWA Healthcare Collaborative Falls Community of Practice 21 any comments we want him to write and anything they can think of it. They think it is a root cause or there are contributing factors in the falls. Again, you know everybody is trying to track and trend and see you know what we can do, what is out there, how do we keep our patient safer. Next slide please.

This is our inpatient fall run chart that starts from October

2014. Our institutional goal is to be less than 2.77. The national one I can find for Med Search Department was 3.92. So, that are the two lines and the green line are whole line and the other ones are the median lines and we are doing better about getting down below that and I would have to say with our trending most of our falls did have happen to have with people again with a cognitive issue. I can specifically remember one that was in with Alzheimer’s dementia. We had one-on-one with him. I mean he came to our meetings and everything, but he is up and never sits still for 2 seconds, up and down, moving around all over the place, but at this time he got agitated and was like batting at the employee to get away from him and lost balance and fell. So that was you know what caused his fall.

And again, you know we are always trying to get our numbers and to be great saver, never going to have a fall that we all know what is the acuity is on the inpatient side and the type of patients we get and that is probably never going to happen but IOWA Healthcare Collaborative Falls Community of Practice 22 we wanted to do the best we can to keep them safe and keep our employee safe.

I know I have kind of already talked about that we do no PATs on. This is the youtube video that we are going to share on orientation and then we have a quality handout we passed out, I think the next slide kind of show our hands out for like no PAT zones and so we orient all of our new staff that you know as they are here that we expect everybody to keep our patient safe, both inpatient and outpatient. Outpatient, we talked about that

10-5 rule and as we talk about the 10-5 rule, we are making sure we assist them to go anywhere they need to go. I remind them that we need to assist them to go their safely. So if somebody needs some assistance, INAUDIBLE33:07, clinics, radiology and they do not look very steady, or they are asking directions, then we walk them there. We may also need to get a wheelchair to take them there that we want to make sure we safely get them from place to place as we are escorting them. We definitely go up to the inpatient side and I showed them all the communication tools we have and it does not matter if they work in dietary department, in the business center, in accounting in the clinics, they all get the same orientation and they all know the communication tools on the inpatient side, how to respond to an IOWA Healthcare Collaborative Falls Community of Practice 23 alarm, what their expectations are because we do think it takes all of us to keep our patient safe.

So our fall team is a multidisciplinary team that meets monthly and so we have somebody from you know several different departments even somebody from dietary sits on the fall team.

We would like I said earlier we want to make our hospital white hall assessment. Something that we did is we definitely have the departments purchase gait belts and once we started looking,

I mean we have already talked about the emergency room not having gait belts. Ambulatory surgery just where they had a gait belt, they cannot one for anywhere or so we added a couple gait belts in ambulatory surgery, OB departments that does epidural and then gets them up for the first time walking when sometimes they do not have good feeling in their legs or you know they tested that showed that may be not very steady. They have got gait belts now, already allergy department whether department they really needed gait belts we had a lot of falls and of course we did gait belts with them, therapy came over and taught them how to use them and they thought that really helps a lot. I mean one time they had you know a lady walking down to get her CT scan which is quite a walk actually but it is all the way through the whole department and she had a cane and they were walking with her but she ended up falling hitting her head. IOWA Healthcare Collaborative Falls Community of Practice 24

She had to go to the ER and get assessed by the ER doctor, has had head CT, had called her primary doctor then eventually got her testing done once everything was clear and of course at that time she like up I have been falling a lot lately. This was before we started doing our outpatient fall risk assessment and so now we did do an outpatient fall risk assessment which we will talk about next. We already talked about no PAT training and do that as orientation. We have wheelchairs pretty much by all our entrances now so that they are all readily available for people and we assist our you know employees that will assist anybody to get from department to department and already talked about that we added a call don’t fall signs in all the rooms, so that people you know sometimes just have to give them permission that we want this on your call light work here to help you, you know lot of patients they do not want to bother us, they do not want to turn on your call light. They want to be independent.

They think they will be okay and you really need to you know given that permission this is what we wanted to do, we want you to turn on your call light, we want to come in here and be here why are getting up and around to make sure you are safe that is what we would like you to do and so you know that you just need to let them know that is the culture we have and that is okay.

We are also doing safe patient handling monthly checks through the HEN organization, so we have been going to all of our IOWA Healthcare Collaborative Falls Community of Practice 25 departments that do any patient mobility and do safe patient handling checklist and that honestly I am sure we are all doing that but that is an eye opener, you know we have identified some areas for improvement and I think that is a great assessment tool they have and then we have subcommittee meeting and we are working on our safe patient handling policy throughout the whole institution as well. So if anybody has anything on that I love to share be as a kind of starting working on that.

So next slide is our outpatient fall prevention assessment, so this is what we decided. We look for some tools that were out there and we decided we wanted to keep it brief and short. We felt like the outpatient registers ask the lot of information already. It is a lengthy process. We do not make it too long though we decided that we ask these three questions. Are you lightheaded or dizzy, have you had her recent fall, we specifically did not put a time factor on that on purpose and do you need help standing or walking. If they answer yes, pick any of those three, it flags them as a fall risk. When that order goes over, it shows that they answered yes to those and it put them as a fall risk and what that does is it allow that staff member who is coming to get them to know that there are fall risks. Because in the PAT, radiologist would just come out and like call your name expected to come walk to them but this way IOWA Healthcare Collaborative Falls Community of Practice 26 they know their fall risk and they know one. If I am taking them down with the CT or MRI room which is quite a walk and if there is a fall risk, I am to take wheelchair out with me and try to encourage them just to go in the wheelchair and it is not, you know what the people would like. I mean you might be at fall risk and you do not want to say you are but if I do not come out with the wheelchair and say well it is pretty long walk you think I need to get a wheelchair, so it is going to like no, not go, do that but you will be have it there, they are more at to, you know agree with you and use that, but then we also have a gait belt that they can use and then they also note that they can make sure that they are assisting them and not you know walking with them and to keep them safe, so this really helps.

I think the department feels like we have more of our culture safety that were really focusing on people and trying to keep them safe. If we have somebody that falls on the ground and of course we know about it, we immediately go assist them any first aid encourages them to be seen in the ER or by either doctor but we get a wheelchair we assist them, we actually call doctor rapids on people that fall out on the ground and we need assistance, so that we get a quick response and we take care of them and then I follow up and call them in 24 hours to make sure they are still doing okay and they do not have any injury but anyway I think that is the majority of our assessment and where IOWA Healthcare Collaborative Falls Community of Practice 27 we are. Again, this is an ongoing process, there was always new things that we are learning from each other and working on and I hope this added something you guys can think about. Any questions, but there is nobody there.

Thanks so much far. There is not anyone but this is recording but I know that this information had just a lot of thought among our community practice members especially related to some of your outpatient assessment, so for those are listening to this recording, Barb has been kind enough to share some of these resources that she is overviewed with the community of practice including a copy of their kicking to rise assessment, the post fall huddle form and a safety audit form, so those resources were shared through e-mail to all of their registrants and will also be posted to the website and through the HEN-HUB. The course you may also reach out to Jennifer Creekmur or Jennifer

Brockman for additional access to those resources and I am sure that Barb would be happy for any connection as well as anybody would like to follow up.

Oh yes, I probably should have slide with my name and contact number. I did not think about it, not a problem we can share that with some other resources, so the one thing I would like to highlight in addition to the tools that we overviewed IHC a part IOWA Healthcare Collaborative Falls Community of Practice 28 of our HEN INAUDIBLE41:08 the patient there is an active tool kit that we have available, so you are able to see that by going to the IHC website so I am kind of pull that over right now.

The really cool thing about this is a not only can you print out but you can also have a PDS form so you can see a quite a full tool kit this year but you can always look for fine, type in fall and it is going to connect you with exactly where you can find falls and mobility resources that align with our focus areas throughout the hospital engagement network. As I mentioned earlier, we will also be posting some of these resources through the HEN-HUB. For those of you that are already part of the HEN-HUB, that is excellent, we are glad to have you on there. For those of you that having yet, the HEN-

HUB is a resource sharing platform for it where you are able to connect directly to your IHC staff as well as to other hospitals, you can post questions, you can follow topic line, it follows a social media type of platform and it is really easy to use so if you go to health viewer website, I am just going to kind of give quick over view for what the HEN-HUB looks like, but you will use your e-mail address, you can type in your password and then you can see it is really easy if you have right password here. It is not letting me in your for that when you get in there the one whole thing that has is that we do two- week topic cycle for all of our topic areas and through the HEN IOWA Healthcare Collaborative Falls Community of Practice 29 including falls and it is also great that if you have questions that you would like to ask to Barb or to the greater HEN network. It allows us to all see that and fits you in for that, so if you are not part of that please reach out to Jennifer

Creekmur or Jennifer Brockman and they will get you the link for that, so just a couple of reminder for some great tools that we have access to is the part of our HEN participation. Last notes that I would like to add that we do have a couple of upcoming education events, so save the date we know that the HEN regional meetings are ongoing right now, so tomorrow it is Storm Lake,

Waterloo on the 24th and INAUDIBLE43:18 on the 25th and then back into one on the 26th so that is just week I know many of our community of practice members were intending to be there, so if you were not able to participate, be there on sight reach out we are happy to share some of those materials with you again focusing on quality improvement and run chart and how we can use our data to better improve the success and as you can see Barb in Fort Madison have really use access to their data to number one target where the problems may actually lie such as in the emergency room and then moving that forward and seeing how the interventions that they have been putting in place have impacted their INAUDIBLE43:49. In addition to our regional meeting, the next HEN learning community on June 14th, this will be in-person events here in Altoona and that is at the Meadows Events and IOWA Healthcare Collaborative Falls Community of Practice 30

Conference Center where we typically hold it. One really great thing is that we are able to offer a $175 travel stipend for all of our critical access hospital, so please reach out earlier so we can make sure to get you in there for that. There will also be a care coordination conference the next day on June 15th, so if you are making the trip down you can kind of tie those two things in together and get two days’ worth for your bank for your buck as a HEN learning community is a free registration on there. There is also a fall coalition symposium that will be held on July 8th. There is a $35 registration fee and that there is some really great speakers and content that will be featured as part of that event and on our last event, we just want to make sure everybody has on their radars is IHC annual conference which will be held on August 16th. That event would be very robust. We will have some national keynote

INAUDIBLE44:57 speakers and then we will have four breakout tracks. We will be offering looking kind of leadership track overviewing some of the great initiative that we have going on throughout the state not only the hospital engagement network but the transforming clinical practice initiative and the state innovation model that a lot of our hospitals are wanting more information and I know where they fit in at and that how we can use those resources to further advance the care you providing in

Iowa, though we track population health and patient engagement IOWA Healthcare Collaborative Falls Community of Practice 31 as well as a track specifically for care transition and then also one focusing on performance improvement and really driving in INAUDIBLE45:32, they will find to prudent you guys at the HEN hospitals for that, so it would be a great event I am sure you do not want to miss it.

The only other reminder that I have is all of these community of practice webinars are recorded, so you are able to access those through the update link then on the IHC web page you will see here, just simply go to new and events and you will be able to see the different all INAUDIBLE45:54 issues and the posting that will be happening in through these arena. You are also able to reach out to Jennifer Creekmur and Jennifer Brockman if you would like to receive any additional information or if you are not able to find on the website, we are here to help so we are very happy to do so. So that is all that we have for you today.

Again, I would like to thank Barb for joining us and sharing

Fort Madison story along with all of the great resources that she has, again that is really simplify what we are trying to do as a community of practice coming together, building up experiences that we have had to help you know improve the care for Iowans and to make sure that we avoided many falls if possible, so thank you very much Barb and thank you to everyone for joining this community of practice today. IOWA Healthcare Collaborative Falls Community of Practice 32

Thanks Katie.