Preventing falls in hospital and at home

Falls are one of the top reasons that the elderly are admitted to hospital. Studies show that one in three people 65 and older will fall at least once a year. Falls cause more than 90% of all hip fractures in seniors. Possibly the most distressing statistic is that one in five seniors who fractures a hip will die within a year of the break…

Patient Shirley Andrews, pictured here with Personal Support Worker Laurie Kizlyk, is slowly getting her strength and breath back after a bout with pneumonia. She is looking forward to going home, where a number of changes have been made to create a safer environment and prevent a fall.

Quick facts on falls

• Falls are the leading cause of injury in the elderly
• About 4,500 Niagara seniors come to an ER each year due to a fall
• Falls are the No. 1 cause of hospitalization
• $962 million is the estimated annual cost of seniors’ falls in Ontario
• 50% of our 65+ population have two or more chronic conditions
• Use of multiple medications is a risk factor for falls
• 29.9% of Niagara seniors live alone
• Learn more at fallsprevention.ca

Quality Improvement Plan

Through our Quality Improvement Plan for 2011-12, our community will be able to very clearly see our targeted areas for improvement and will be able to chart our progress.

To create this year’s goals, the NHS Board Quality Committee worked closely with administration, physicians and other healthcare professionals to determine areas where we are doing well and areas where we have room for improvement. The following aims and objectives have been set to be achieved by March 31, 2012.

Safety

Our aim is to improve the overall safety of care we deliver to our patients. Our success in achieving this aim will result in:

• A reduction in the number of patient falls from 12.14% to 10.94%.

Effectiveness

Our aim is to provide patient care reflective of current evidence-based practice and the appropriate use of available resources. Our success in achieving this aim will result in:

• A reduction in our Hospital Standardized Mortality Ratio from
• 100 to 95.
• Continued financial improvement which will see our Total Margin being maintained at -0.80%.

Access

Our aim is to ensure patients in the communities we serve have timely access to the appropriate care and services required to maintain their optimal health status. Our success in achieving this aim will result in:

• A reduction in the amount of time patients who are admitted to hospital wait in the Emergency Department before moving to their inpatient bed from 45.3 hours to less than 39.9 hours.

Patient-Centred

Our aim is to provide care and services to all patients and families that reflect our respect for individual choices and patients as partners in their care. Our success in achieving this aim will result in:

• 75.3% of our inpatients stating that they received all services needed.
• 56.2% of our ER patients stating that they received all services needed.

Falls are one of the top reasons that the elderly are admitted to hospital. Studies show that one in three people 65 and older will fall at least once a year.  Falls cause more than 90% of all hip fractures in seniors. Possibly the most distressing statistic is that one in five seniors who fractures a hip will die within a year of the break.

Preventing the fall in the first place takes awareness and education, and at Niagara Health, the spotlight is on falls prevention as part of our Quality Improvement Plan. Currently, just over 12% of Complex Care patients (patients in hospital with complex medical conditions) fall during their hospital stay. In the next year, the healthcare team is targeting reducing the number of patient falls by 10%.

“We’re aiming to do a better job at identifying our patients who are at risk for a fall and ensuring they get the attention they need to prevent that fall, both in hospital and after discharge,” says Health Program Director Wendy Robb. “In Ontario, every 10 minutes at least one senior comes to an ER as a result of a fall. In Niagara, that translates into almost 4,500 seniors a year. We have the highest volume of ER admissions due to falls in our LHIN.”

Identified at risk for a fall is Shirley Andrews, a Complex Care patient at Port Colborne Site in early June. At home with her husband William, the 79-year-old Port Colborne woman uses a walker to get around, but after a bout of pneumonia left her weak and short of breath, she was admitted to Port Colborne Site. While in hospital, Shirley is regaining her health and benefitting from an increased focus on falls prevention.

“Because I have lupus, osteoporosis and rheumatoid arthritis, I use a cane and a walker at home, so I know I am at risk for falling,” Shirley says. “Fortunately, I haven’t had a fall yet. I want to keep it that way.”

Safer environment

Physiotherapy and nursing staff are working on strengthening and balance exercises with Shirley. Staff members teach her how to get up properly from a chair by pushing down on the arms of the chair to maintain balance.

“I’m slowly getting back my strength and my breath. I’m looking forward to going home, but my husband’s going to have to take care of me a bit now,” Shirley says with a smile.

At home, the couple have already made some changes to create a safer environment, such as removing scatter carpets and reducing clutter. Other items to reduce falls at home include wearing non-slip footwear, proper lighting in hallways and stairs, grab bars and railings in bathrooms and stairs, and outside the home smooth sidewalks/pathways and thorough ice/snow removal.

More education

Inside our hospital walls, the falls prevention program is ramping up, particularly in Complex Care areas. “We’ve created a simple orange triangle poster, which will be posted at the bedside of patients who are at risk of a fall,” Wendy explains. “We’re increasing our education beyond nursing staff to include all those in the hospital who interact with patients, including hospitality aides, dietary aides and volunteers. If they see a patient struggling to get out of bed or up from a chair, they will assist or quickly get assistance to prevent a fall.

“We’re also increasing the involvement of patients and their families so they see the importance of following the tips in the falls prevention brochures we give them on discharge,” says Wendy. “We are taking a team approach to preventing falls because it’s so important that everyone becomes proactive, both in the hospital environment and in the community. Falls don’t have to happen – everyone can play a role in ensuring the safety of our seniors.” «