CPG Fall Risk Implementation Example 296919 7 by mPg36k5q

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									Implementation Example
Fall/Fall Risk
Clinical Process Guideline
        Joint Provider/Surveyor Training
              September 15, 2009
  Karen M. Kinyon, M.S., R.N., C.P.H.Q., N.H.A.

                                                  1
    FOCUS-PDCA

• Find a process improvement opportunity
• Organize a team who understands the process
• Clarify the current knowledge of the process
• Understand process variation and
  capability
• Start the Plan-Do-Check-Act cycle


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Find a process improvement opportunity

• High risk
• Problem prone
• Previous citations
• Rank order all clinical process guidelines
  based on previous quality findings
• Implementation plan for all guidelines


                                               3
Organize an effort to work on improvement
Team/Group Make-up
 •   Geriatric Resource Nurse
 •   Director of Nursing/Assistant DON
 •   Unit Managers
 •   Maintenance/Safety Champion
 •   Pharmacy
 •   Medical Director
 •   Staff Educator
 •   Social Work
                                              4
 •   Admission Coordinator/MDS Coordinators
 •   Restorative Staff
Clarify the current knowledge
of the process
• Clinical Process Guideline interpretation
  – Debra Ayres presentation
  – Clinical Process Guideline Team members
  – Review CPG
      • Care Step Process/Expectations/Rationale
      • Documentation Checklist: Audit tool
      • Tables 1, 2, & 3

                                               5
Understand process variation and
capability
•   Current practice compared to best practice
•   Data collection
•   Data analysis/display
•   Identifying opportunities for improvement




                                                 6
Opportunities for Improvement
• Fall assessment
• History of previous falls
• Medication-recent change, interactions
• Appliances or devices-side rails
• Environmental factors-floor mats, transfer bars
• Physician participation in identification for
  medical cause of falls or medication related
• Physician identifies reasons for falls after
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  interventions
Select a strategy for continued
improvement
•   Plan the improvement process
•   Do the improvement
•   Check the results and lessons learned
•   Act by adopting, abandoning or accepting
    the change




                                               8
Plan the improvement process
 • Culture of safety
 • Resident & staff understanding of a safe
   environment
 • Positioning and bed safety
 • Documentation
    • Physician
    • Pharmacist
    • Nursing
                                              9
Do the improvement
•   Policy & procedure review/revisions
•   Education of staff
•   Education of residents/families
•   Assessment & evaluation of current side rail use
•   Assessment & evaluation of equipment
•   Purchase of new equipment
•   Revision of forms
•   Development of new tools
                                                   10
Policy & Procedure Changes
• Resident Safety Report
• Investigation and Intervention Report
• Physical Safety: Sleeping Environment
• Physical Safety: Restraints
• Physical Safety Assessment & Admission
   Procedure
• Learning Tree

                                           11
Forms/Brochure
•   Resident Safety Report
•   Investigation and Intervention Report
•   Physical Safety Assessment
•   Learning Tree
•   Resident/family brochure: Restraint Use in the
     Long-Term Care Setting


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Education
• Resident Council/Family
• Resident/Family Brochure
• Staff
  – RNs/LPNs/CNAs
  – Maintenance
  – Housekeeping
  – Activities
  – Therapy
• Education/Resource Manual   13

• Orientation Manual
Check the results/lessons learned
• Follow-up data collection
• Cost of change
   – Brochures
   – Positioning devices
   – Floor mats
   – Hand controls
   – Time
• Change is difficult
                                    14
Act by adopting, abandoning or
accepting the change
• On going training/education
  – Staff
  – Residents/families
• Future state = no side rails
• Reinforcement of change
• Can’t go back
• Celebrate success
• On going monitoring and data collection
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     Resources
• Process Guideline for Evaluation of Falls/Fall Risk
     http://www.michigan.gov/documents/mdch/bhs_CPG_Falls_Process_206279_7.pdf

• AMDA Clinical Process Guidelines, 2003.
• Centers for Medicare & Medicaid Services, State Operations Manual,
  Guidance to Surveyors for Long Term Care Facilities (2006)
      http://cms.hhs.gov/manuals/Downloads/som107ap_pp_guidelines_ltcf.pdf.

• TMF Health Quality Institute, the Medicare Quality
  Improvement Organization of Texas-LTC Ombudsman
  Initiative: Restraint reduction Toolkit, 2007
   http://nursinghomes.tmf.org/Restraints/RestraintToolkit/tabid/548/Default.aspx.

• MDCIS Guidelines for Use of Bed Rails in Long Term Care
   Facilities (March 1, 2001) http://www.michigan.gov/documents/cis_bhs_fhs_guidelines_bedrails_35726_7.pdf.
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Questions?



  kkinyon@lakelandregional.org
      1-269-473-3003




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