Client Falls Reduction and Injury Prevention Strategy
Carewest is committed to client safety. Our clients have many risk factors for having falls and we support an environment of least restraint. To manage that risk, Carewest has a Strategy for Client Fall Reduction and Injury Prevention that applies to all Carewest programs. We have specific policies that provide direction to staff to assess and implement care plans when falls risks are identified.
STRATEGY COMPONENTS
Carewest staff must assess each client’s risk for falling on admission; following any change of status, or review risks after a fall has occurred to decide if there have been any changes.
A standard Falls Risk Screen form is used across the organization to supports clinical decision making to determine appropriate interventions to manage falls risk.
Carewest staff have tools to communicate client safety risk to other team members, the client and family and other providers who may be in contact with the client. Falls Risk is specifically documented on the Care Plan, shift reports, care conferences and transfer of care. Clients who are discharged home receive information about their falls risk and tips to minimize a fall.
Carewest provides annual education about Falls Safety. Staff can access the Falls Reduction and Injury Prevention Resource Binder which summarizes the Strategy and draws on best practice from international resources.
The educators are available to help meet specific Falls Education needs, using resources consistent with the Carewest strategy. Orientation reinforces staff roles related to falls risk assessment, prevention, reporting and management, including documentation falls risk.
Carewest educates clients and families about client safety, through admission handbooks and the Client Safety brochure that is provided to all new admissions.
The interdisciplinary team reviews falls to decide whether the Care Plan needs to be adjusted. There are also site based Fall Review Committees that look at fall trends for individuals and across the site. The committees, in turn, report to the Quality Improvement Risk Management Committee so that Carewest can learn about trends across the sites.
At Carewest, we know that even with our best efforts, falls will happen because of the frailty of our clients. We have policies ensuring that clients have a quick response with safe and respectful care to minimize any further risk of injury. While any staff member may come to the initial aid of a fallen resident, there are processes for our professional nursing staff to follow to assess for and respond to injuries.
Carewest has a quality assurance process to support safety learning. Consistent forms guide data collection and investigation of falls to help the team learn which factors may be contributing to the fall. This data is collected within the requirements of Section 9 of the Evidence Act that supports confidential reporting and investigation. However, Carewest will share learning with the client and their decision makers to keep everyone informed about how and why the Care Plan may be revised.
Carewest’s Frame of Reference supports continuous learning and ongoing quality improvement. Site Falls Review Committees assess the effects of interventions for individual clients.
- The Quality and Safety Report documents trends in specific indicators
- Falls Rate per 1,000 bed days
- Falls with Minor Harm
- Falls with Significant Harm requiring transfer out for care
- Falls resulting in Fractures
Each site can monitor its trends to assess whether or not interventions are working. Successful sites can share learning with others to improve trends across all sites.
- The Quality Improvement Risk Management committee also reviews the Quality and Safety Report to identify where sites may have to explain trends or can share learning about positive improvements.
- The Quality and Service Improvement portfolio supports staff in planning quality improvement initiatives to help improve their falls indicator results.
