Case Studies

How to reduce the number of falls and their consequences? The example of the CHwapi

16 Apr 2021

The CHwapi in Tournai has a particularly innovative falls prevention policy that puts the patient at the centre. Interview with Patrick Dewaele, nurse manager.

"In 2019, the CHwapi had 844 declarations of adverse events related to falls. In 2020, we counted 574. This has to be linked to Covid, but there has been a real decrease," explains Patrick Dewaele, nurse manager and chairman of the falls committee.

How did the Centre Hospitalier de Wallonie Picarde (CHwapi) reduce the number of falls by almost 1/3 from 2019 to 2020?

The Falls Prevention Committee

A multidisciplinary task force coordinates the entire quality approach to falls prevention. This is the falls committee.

"All the professions involved with the patient are represented," says Patrick Dewaele. "This ranges from the reception staff in charge of admissions to the hospital volunteers, including physiotherapists, occupational therapists, carers, doctors, and even surface technicians, because it is a chain that must be strong and coherent around the patient.

The committee meets regularly to evaluate the effectiveness of the measures implemented but above all, to create a form of internal reflection on falls. There is a root cause analysis to identify the responsibility of the carer, but also of the patient and the general environment (extrinsic causes).

Continuous training of staff

As chairman of the falls committee, Patric Dewaele takes the time to give detailed feedback on all undesirable events: analysis of the context, the consequences and feedback to the units. Once or twice a month, the CHwapi staff is invited to reflect on falls.

"In 10 minutes, we analyse a fall once or twice a month around the CQQOP in a department meeting, for example: how, who, what or why did this patient fall? What could have been done differently to avoid the fall or to reduce the consequences? The aim is to carry out a short practical training course. This helps to change behaviour. For the nursing staff, it is very concrete. It's a time for exchange and feedback on our practices. It also contributes to increasing the quality of our work.

Experience for carers: the ageing combination

To help them understand the elderly, the CHwapi Falls Committee is offering all CHwapi employees the opportunity to put themselves in their shoes through an experiment.

"By using an ageing suit, the carer is placed in the perception and limitations of the elderly patient. He is hampered by a whole series of elements, limited in his movements. He can thus say to himself "well, when I'm older, I'll have to fight this heaviness".

"Awareness of ageing is raised in collaboration with occupational therapists. The latter raise awareness of the need to adapt the environment in order to limit handicaps (e.g. lack of strength or knee pain can be compensated for by a raised bed when transferring or a chair with armrests, etc.).

Identification, monitoring and support of the patient who falls

In terms of falls prevention, the institution emphasises screening and identification of patients at several levels:

- Via the use of the Morse scale, the nursing staff identifies patients at risk of falling.

- Secondly, patients who are at risk or even very much at risk wear a certain bracelet to make them visible.

- A marker in the computerised patient record (CPR) indicates that the patient is at risk of falling.

- The dpi also includes the follow-up activities of the patient who has fallen (what has been done about it, how the situation has changed)

- A care plan of support on knowledge, skills and attitudes has been established. For example, the carer must "know and explain the pathologies that can increase the risk of falling".

Skills that also concern the patient

In the context of accreditation in particular, the patient is central, he becomes a partner and is more involved. They are therefore led to understand the risks of falls and the measures that can be taken to reduce them.

Building a partnership with families

When a family comes to visit a patient, things may be moved, bed rails may be removed. When the family leaves the room without informing the carers, they can put the patient at risk.

A real partnership must therefore be established between the patient and the nursing staff, but also between the family and the nursing staff on the basis of concrete things. The CHwapi has developed media (posters and booklets) which are supports to achieve this.

"But we have to go beyond that, we have to accompany the family by explaining the process, by explaining how, for example, to arrange a safe interior for an elderly person who has undergone an operation.

In general, the aim is to adopt a quality approach

The Chwapi is one of two Belgian hospitals recognised by Accreditation Canada International with the Platinum level, proof of its commitment to quality management. "This is the concretisation of existing practices that put the patient at the centre of our approach," adds Patrick Dewaele.