Inpatient & ED Fall Reduction DMAIC Project Kickoff

Inpatient & ED Fall Reduction DMAIC Project Kickoff.

[Audio] Our OI team consists of Dana Gill and Augusta Tanner from our team, Sam Hoffmann from Clinical Informatics, and Nikki Livermore from Clinical Nurse Specialist. This slide shows our team leading a project focusing on reducing falls in inpatient and ED at Nebraska Medicine. So, what does Operational Improvement do? We are process experts, analyzing and improving processes so that they are both safe and effective. Achieving this is done by combining process improvement methodology, project facilitation, and data gathering/analysis. We also use LEAN, Six Sigma, and other process improvement tools to push initiatives focused on eliminating inefficiencies and waste, thereby improving the quality of care for patients and increasing productivity for the health system..

[Audio] We are kicking off a project to reduce falls in inpatient and ED at Nebraska Medicine, with a team of experienced professionals in operational improvement, clinical informatics, and clinical nursing. Agenda items include project background, quick wins, scoping summary, data analysis, and process evaluation. We will also take a look at upcoming DMAIC projects and next steps, as well as fall mats, high-low beds, and post-fall documentation. We aim to make an impact on the lives of patients in our care..

[Audio] Nebraska Medicine has taken an initiative to reduce the number of falls, particularly serious ones leading to sentinel events. Over the course of 2021 to 2023, Nebraska Medicine has recorded 1880 falls, with 40 of them classified as Serious Safety or Sentinel Events, of which 8% resulted in death. These falls mostly occurred while leaving the bed, ambulating, or toileting. To address this, the Operational Improvement, Clinical Informatics, and Clinical Nurse Specialist teams conducted an investigation to identify areas of improvement. Two quick wins were suggested to be implemented, whilst two larger projects were proposed to empower fall prevention. With this intervention, Nebraska Medicine is aiming to reduce the rate of falls and associated injuries..

[Audio] We are proud to have worked with an exceptionally talented and passionate group of people throughout the scoping and quick win process of our project to reduce falls in inpatient and ED at Nebraska Medicine. We would like to express our gratitude to the sponsors and owners who provided valuable feedback, guidance and considerable support. Our appreciation also goes to the project team for their remarkable expertise, insight and hard work. A special thank you to Sue Nuss, Micah Beachy, Dawn Straub, Angie Boesch, Dr. Scott Diesing, Lauren Hood, Tamera Fandrich, Tammy Winterboer, Augusta Tanner, Michelle Freeman, Dana Gill, Keri Leach, Natalie McCready, Nikki Livermore, Sam Hoffmann, Amy Mead, Sarah Clark, Arien Gallegos, Emily Morrissey, Dani Schulz, Erin Harold, Brooke Brown, Jamie Peterson, Tiffany Whitney, Kate Buehler, Kellie Clapper, Josh Cunningham, Emily Morrissey, Brian Lake, Marla Melgoza, Ashley Liess, Sarah Swistak and Cassie Smith. Your dedication and commitment to making this project a success are greatly appreciated..

[Audio] Nebraska Medicine has developed assessments tools such as the Modified Schmid and Kinder 1 Scale to address the problem of falls. The Modified Schmid is used in all adult inpatient units and should be undertaken on admission and every 12 hours after any changes in patient status. The Kinder 1 Scale is used during triage in the Emergency Department. With these assessments, Nebraska Medicine is able to reduce falls in their inpatient and ED units..

[Audio] Drawing on the data gathered from the SOS Database from January 2021 to March 2023, our analysis of all falls and serious falls or sentinel events has identified several important factors. Age is not a significant factor with 80% of patients 60 and older experiencing falls with injury. We found that 81% of all falls and 71% of falls with serious injury had two or more risk factors, such as impaired elimination, impaired mentation, or impaired mobility. When considering the circumstances that resulted in falls, 77% of all falls and 84% of falls with serious events were caused by patients getting out of bed or a chair, being ambulatory, or toileting. In addition, a spike in falls was seen at changeover and break times. We identified several contributing factors, such as acuity on the unit, short staffing, poor communication during handover, lack of interventions, patients refusing care, and lack of resources. It is clear from our data analysis that reducing falls in inpatient and ED at Nebraska Medicine is a complex issue with multiple causes that must be addressed..

[Audio] Our team of Dana Gill and Augusta Tanner from Operational Improvement, Sam Hoffmann from Clinical Informatics, and Nikki Livermore from Clinical Nurse Specialist have kicked off a project with an aim to reduce the rate of falls in inpatient and ED at Nebraska Medicine. An evaluation of the current processes related to fall risk assessment, interventions, and post fall revealed several gaps in the process. The scope of tools used is limited and fails to identify patients at higher risk for injury. The documentation system lacks automation and does not accurately capture repeat falls, making it prone to screening inaccuracy due to heavy reliance on the nurse’s memory to recall risk factors. Additionally, identification and maintenance of the interventions are challenging due to limited resources. Documentation of the interventions lacks visibility across the chart and not every intervention is captured. Post-fall huddle is also inconsistent and there is lack of guidance on interventions for repeat falls. Further, discrete incident details are not available in Epic making it difficult to track data..

[Audio] Our research has identified that from January 1, 2021 to March 31, 2023, there was a total of 1880 falls recorded, including 40 classified as Serious Safety/Sentinel Events. Of these 40 events, 8% resulted in death. Patients aged 60 and over were disproportionately affected, and 23% of these incidents were repeat falls. The most frequent causes of falling were from the bed, then while ambulating, toileting, and from a chair. In response, a project has been initiated to reduce the number of falls across inpatient and ED at Nebraska Medicine..

[Audio] Our team focused on developing criteria for when to use high low beds and mats, as well as a workflow for storage, obtaining, and using them. This was done to ensure these materials would be available to reduce the risk of injury from falls from bed. Additionally, updates were made to the policies and documentation. In addition, Informatics and the Clinical Nurse Specialist developed a new post fall flowsheet template to discretely capture fall detail, eliminate double documentation, and increase visibility among clinicians. The goal of these two quick wins was to help us trend data better while we work to improve our fall risk assessment and intervention processes. Augusta will now be taking us through the DMAIC projects. Any questions?.

[Audio] Four representatives from Nebraska Medicine have come together for a project that seeks to reduce falls in inpatient and ED settings. To achieve this, the DMAIC (define, measure, analyze, improve, and control) methodology will be employed. Scoping has been done, allowing for faster progression through the define, measure, and analyze phases. Solutions will be brainstormed and implemented, followed by a plan to sustain them. It's time to begin this important project..

[Audio] Nebraska Medicine has launched a project to reduce falls in inpatient and ED. A team has been assembled to carry out the initiative, comprising Dana Gill and Augusta Tanner from Operational Improvement, Sam Hoffmann from Clinical Informatics, and Nikki Livermore from Clinical Nurse Specialist. Two DMAIC projects have been recommended with the first one focusing on optimizing the current fall risk assessment tools and developing a process that ensures accuracy. Through scoping, critical issues and gaps that the project will address have been identified, these include the need for the tool to accurately identify fall-risk patients, easy to understand and interpret fall assessment, and for the patient's fall risk to be made visible to the care team. The first part of this project will determine if the current tools should be enhanced or replaced in order to adequately address these issues. Therefore, the timeline for this project is staggered with Operational Improvement and Clinical Informatics leading the project..

[Audio] Our team has launched a project to reduce falls in inpatient and emergency department settings at Nebraska Medicine. We are now discussing the second DMAIC project that focuses on improving and standardizing interventions, including Sitter Getter. The main objectives of this project are to simplify instructions, make sure staff knows what to do, and increase the consistency of interventions so that patient's care team can collaborate better. In response to feedback from staff members, this project will also provide evidence-based patient and family education. Additionally, this project will ensure interventions are targeted according to our data. Even though the project isn't due to start until November, we are undertaking some preparation in order to get off to a good start when the appropriate tool is identified..

[Audio] Have you implemented any quick wins that are designed to have an immediate impact on reducing falls? In addition to these initiatives, what DMAIC projects are included in the timeline? What specifically are they focusing on? Could you provide more detail on the parallel and future initiatives included in the timeline?.

[Audio] This project team is an excellent opportunity to collaborate and work towards reducing falls at Nebraska Medicine. The team consists of Dana Gill and Augusta Tanner from Operational Improvement, Sam Hoffmann from Clinical Informatics and Nikki Livermore from Clinical Nurse Specialists. We have identified key stakeholders and made room for others who may join the project midway. Furthermore, there is a Steering Committee, which consists of sponsors, owners and a provider champion, to provide decision making and remove any potential challenges. The workgroup will involve the project team and will meet bi-weekly; however, there are certain expectations of the team, such as attending meetings consistently, actively participating and reviewing project materials as required. We have been given a great chance to be part of a project that is striving to make Nebraska Medicine a better place..

[Audio] Our goal is to come up with a set of guiding principles that will keep the team focused and aligned to our desired outcomes. We should focus on six main points: patient and family-centered care, a culture of safety, injury prevention, simplicity and intuitiveness, user-friendliness, and staying mindful of timelines. Let's take time to discuss ideas for how to progress with these guiding principles. Let's create a foundation for success by ensuring our objectives are clearly communicated and our actions lead to the desired outcomes..

[Audio] We need to progress with this important project. In the upcoming weeks, we will be carrying out resource and project planning, which includes forming the project teams. After forming all the teams, we plan the meetings and start the project. We will use the DMAIC process and organize work sessions for each step of the process. Let's get going and ensure we are taking the necessary steps to reduce falls in our inpatient and ED units..

[Audio] Four departments at Nebraska Medicine are launching a project to curb the number of falls in inpatient and ED settings. Utilizing AHRQ, a tool for spotting patients with heightened risk due to illness, clinicians will be able to make informed decisions, target interventions, and coordinate care and communication. The two most commonplace tools, Morse and Stratify, require medication review and gauging of sensitivity, specificity, positive and negative predictive values for research purposes. In the end, it is necessary to determine the preferable features of a fall tool..

[Audio] We put together the first DMAIC project aimed at optimizing current fall risk assessment tools. The project is set to address issues and gaps in the current assessment tool by ensuring its accuracy, developing a process to guarantee its accuracy, making it easier to identify fall-risk patients, improving its visibility and understanding, and improving multi-disciplinary collaboration. The project has set deliverables and outcome metrics to ensure the project is successful. It will also deliver an improved workflow to ensure and maintain standard interventions based on fall risk factors as well as real-time alerts for timely response. Dana Gill will lead the Operational Improvement in June 2021, with Augusta Tanner and Nikki Livermore leading Clinical Informatics and Clinical Nurse Specialist initiatives in August 2021, and Sam Hoffmann leading Clinical Informatics initiatives in October 2021..