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    Cqi Presentation

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    The document outlines a proposed 25-week continuous quality improvement plan to reduce falls in an inpatient rehabilitation setting through implementing a multicomponent fall prevention program. A multidisciplinary team would conduct staff training, comprehensive patient evaluations, education, and post-testing to measure outcomes. Key metrics such as fall rates and patient satisfaction would be tracked to evaluate the effectiveness of the fall prevention strategies.

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    Cqi Presentation

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    The document outlines a proposed 25-week continuous quality improvement plan to reduce falls in an inpatient rehabilitation setting through implementing a multicomponent fall prevention program. A multidisciplinary team would conduct staff training, comprehensive patient evaluations, education, and post-testing to measure outcomes. Key metrics such as fall rates and patient satisfaction would be tracked to evaluate the effectiveness of the fall prevention strategies.

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    The document outlines a proposed 25-week continuous quality improvement plan to reduce falls in an inpatient rehabilitation setting through implementing a multicomponent fall prevention program. A multidisciplinary team would conduct staff training, comprehensive patient evaluations, education, and post-testing to measure outcomes. Key metrics such as fall rates and patient satisfaction would be tracked to evaluate the effectiveness of the fall prevention strategies.

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    Download as pptx, pdf, or txt
    191 views17 pages

    Cqi Presentation

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    api-580425291
    The document outlines a proposed 25-week continuous quality improvement plan to reduce falls in an inpatient rehabilitation setting through implementing a multicomponent fall prevention program. A multidisciplinary team would conduct staff training, comprehensive patient evaluations, education, and post-testing to measure outcomes. Key metrics such as fall rates and patient satisfaction would be tracked to evaluate the effectiveness of the fall prevention strategies.

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    You are on page 1of 17

    CQI:

    Fall Incidence in
    Inpatient Rehab
    An Nguyen and Bailey Knudsen
    TABLE OF CONTENTS

    Situation/Problem Project Team


    01. Statement Members 03.

    02. Key Metrics Project Timeline 04.


    01. Situation/P
    roblem
    Eye-opening Statistics Regarding Falls in
    Inpatient Hospitals

    1 in 4 10% 30-50%
    adults ages 65 and older of patients who fall in inpatient of in-facility falls result
    experience a fall each year settings also experience
    (Samardzic et al., 2020) adverse events (Kobayashi et al., 2017)
    in injuries (Miake-Lye et al., 2013)

    2 Billion Dollars Multicomponent


    (Miake-Lye et al., 2013)
    fall prevention programs can
    30,000 Dollars
    Is the cost of falls in the decrease risk for falls by as estimate for the price of one
    much as individual’s hospitalization or
    elderly population per year
    (Samardzic et al., 2020) rehospitalization (Samardzic et al., 2020)
    30%
    More Research Regarding
    Falls in Inpatient Hospitals
    ● “Falls are among the 20 most expensive medical conditions (Samardzic et al.,
    2020)”

    ● Even without physical injury, falls can induce fear of falling,


    anxiety, distress, and decreased physical mobility (Miake-Lye et al., 2013)
    ● Falls are more likely to occur in hospital rooms, when patients are
    wearing slippers, and in the evening/overnight (Kobayashi et al., 2017)
    ● Fall rates are often underreported in inpatient hospital settings (Miake-Lye
    et al., 2013)
    Team Responsibility: Investigating the causes of falls

    “Systematic reviews have consistently


    suggested that multifactorial assessments
    linked to appropriate interventions may
    reduce falls in hospital by 20–30%.7–9 The
    optimal combination of components is not, as
    yet, clearly defined but the assessment of
    mobility, toileting and continence needs,
    medication review, vision, confusion
    (dementia and delirium) and orthostatic blood
    pressure are important. Similarly, the
    provision of mobility aids (sticks and walking
    frames), minimising clutter, clear (pictorial)
    signage coupled with attention to appropriate
    footwear, spectacles and hearing aids are
    simple ways of reducing the potential impact
    of environmental risk factors.” (Morris &
    O’Riordan, 2017).
    Internal Drivers External Drivers
    ● Organization mission and values ● Prevent penalties for high readmission rates.
    ○ Prioritization of high quality care ○ Fines for excessive readmission averaged
    ○ Promotion of patient safety $217,000 for a hospital in 2018, according
    ○ Preventing patient readmission to Congress' Medicare Payment Advisory
    Commission, or MedPAC (Rau, 2021).
    ○ CMS stopped reimbursing patients for
    hospital acquired falls.

    Currently in our initial evaluation, there is no fall screen for patients within
    24 hours of admission to the hospital.
    The high prevalence of falls, the adverse events that follow
    falls, and the internal /external drivers for our organization
    justify the need for a continuous quality improvement (CQI)
    Therefore... plan. Implementation of a CQI in this setting will decrease
    falls in the inpatient hospital setting.
    02. Key Metrics
    Comprehensive Evaluation
    ● Comprehensive evaluation to determine patient’s necessary level of assist during length of stay at inpatient
    rehab:
    ○ PT:
    ■ Fall Risk Assessment and Screening Tool (FRAST) -
    https://cdn.ymaws.com/www.fpta.org/resource/resmgr/imported/Renfro_FRAST_2011.pdf, (free, public use, minimal
    training, 5-8 minutes of initial eval to administer)
    ■ Berg Balance Index
    ■ Bilateral lower extremity manual muscle testing
    ○ OT:
    ■ visual and perceptual screening
    ■ Observation of occupational performance (ex. dressing, toileting, etc.)
    ■ AMPS Assessment of Motor and Processing Skills- The AMPS does require licensing and training to administer, but it is
    grounded in evidence-based research, and is considered a gold standard in ADL assessment
    ○ Speech:
    ■ Cognitive Assessment of Minnesota (CAM)
    During the Length of Stay...

    Strategy training:
    ● Adequate lighting during in-room mobility
    ● Use of socks with grip bottoms
    ● Staff training following patients’ level of
    assistance as indicated by clinical judgement
    from therapist evaluations, keeping call light
    in reach of patient
    ● Patient education on transfer techniques/use
    of mobility devices hazards to look out for,
    impact of medication
    CQI Post-Testing
    ● Post-testing to measure effectiveness of CQI:
    ○ Patient survey at end of length of stay to measure qualitative data regarding satisfaction and feelings of safety:
    ■ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey - (1st national,
    standardized publicly reported survey of patients’ perspectives of hospital care, includes qualifiers for patients
    satisfaction and self assessment of feeling safe. (Requires $$, staff training, but can be input into national
    database as a comparison tool)
    ○ Assessment to gather quantitative data regarding number of falls during length of stay:
    ■ Application of Percent of Residents Experiencing One or More Falls with Major Injury
    03. Project Team
    Members
    Complete a systematic literature review about fall prevention in an inpatient hospital setting in order to find strategies to decrease falls and assessments
    OT to determine required level of assistance for in-room mobility.
    Manager
    Train OT, PT, and SLP staff in use of comprehensive evaluation assessments

    Come up with an estimate for costs to develop the program: licensing fees, training hours, basic equipment like non slip stockings, installing more
    lighting, cost of standardized assessments

    Interpret data following compilation

    Head of Team up with OT manager to provide onsite training for CNAs and nursing staff on fall prevention strategies (i.e., give patients socks with
    grip bottom, hospital slippers with grip)
    Nursing
    Train nursing and aides to use room whiteboard communication system to follow patients’ indicated level of assist requirements

    OT Training on standardized assessments for fall risk (functional)

    Patient education and administering fall prevention program

    PT Patient education on using mobility devices such as a walker or a cane, safe transfers, how to get up safely from the floor, etc.

    Training on standardized assessments for fall risk (physical)

    SLP Training on standardized assessments for fall risk (cognitive)

    aides Patient education and administering fall prevention program

    Compile CQI data


    04. 25 Week CQI
    Project Timeline
    Six Month Timeline (25 Weeks)
    Week 1 Complete literature review
    Week 2 Complete budget worksheet with anticipated costs
    Week 3-4 Create a team for the project. Train staff on outcome measures adopted to assess quality of
    fall prevention program. The team’s responsibility will also include identifying environmental
    barriers and/or situations that can lead to falls.
    Week 4 Revise fall incident reports to include specifying factors that contribute to falls (e.g., high-risk
    medications, overnight, poor lighting)
    Week 5-6 Design a curriculum incorporating evidence based interventions for fall prevention

    Week 7 Review and modify curriculum as final draft after input from team members
    Week 8-11 One month trial with patients from one inpatient hospital unit with ongoing monitoring on
    pros and cons.
    Week 12-19 Use process metrics for the team through metrics performance, completed in 2 monthly
    cycles, for the team to study, revise, measure, and check again on fall prevention program,
    while comparing results from the previous year.
    Week 20 Review data to see if program reduces fall rates
    Week 21-24 Meeting with various leaders from other hospital units. Create a database to coordinate with
    other hospital units to disseminate lessons learned from “post-fall” reflection in order to
    identify root causes. Implement results from CQI program.

    Week 25 Compare results of fall incidence rates from previous year at the same period of time. Present
    findings to hospital CEOs and CFOs.
    References
    ● Kobayashi, K., Imagama, S., Inagaki, Y., Suzuki, Y., Ando, K., Nishida, Y., Nagao, Y., &
    Ishiguro, N. (2017). Incidence and characteristics of accidental falls in hospitalizations.
    Nagoya journal of medical science, 79(3), 291–298.
    https://doi.org/10.18999/nagjms.79.3.291
    ● Miake-Lye, I., Hempel, S., Ganz, D., Shekelle, P. (2013). Inpatient fall prevention programs
    as a patient safety strategy: a systematic review. American College of Physicians Annals of
    internal medicine, 158(2) 390-396.
    ● Rau, J. (2021, October 28). Medicare punishes 2,499 hospitals for high readmissions. Kaiser
    Health News. https://khn.org/news/article/hospital-readmission-rates-medicare-penalties/.
    ● Samardzic, V., Jaganjac, A., Kovacevic, K., & Kraljevic, B. (2020). Occupational therapy in
    fall prevention: Case report. International Journal of Medical Reviews and Case Reports,
    4(4), 103-107. http://dx.doi.org/10.5455/IJMRCR.occupation-therapy-vesna

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