How to reduce the number of falls and their consequences ? Using CHwapi as an example.

CHwapi, Tournai, conducts a particularly innovative fall prevention policy by putting the patient at the center. Meeting with Patrick Dewaele, head nurse.

« In 2019, the CHwapi accounted for 844 reports of unwanted events related to falls. In 2020, we counted 574 such events. Of course, some of the decrease must be Covid related, but there is still a real reduction in incidents » explained Patrick Dewaele, head nurse chair of the Committee to Prevent Falls.

How did the Centre Hospitalier de Wallonie picarde (CHwapi) decrease the number of falls in their institution between 2019 and 2020 by almost one-third?

The Committee to Prevent Falls

A multidisciplinary task force coordinates the entire quality approach around the prevention of falls. This is the Committee to Prevent Falls.

« All trades related to the patient are represented », says Patrick Dewaele.« This starts with the reception staff in charge of admitting the patient to the hospital and continues onto the physiotherapists, occupational therapists, caregivers, doctors, and even the cleaning staff, because they all form a chain that must to be strong and consistent around the patient ».

The Committee meets regularly in order to evaluate the effectiveness of the measures implemented and above all, to create a form of internal audit on the falls. There is an analysis of root causes to identify what is the caregiver’s responsibility, as well as what is a result of the patient’s actions, and the general environment (extrinsic causes).

Work in symbiosis with the committee for using restraint:

« Restraint can be traumatic for patients; it is put in place as a method to avoid falls or relapses. Some restraint may be needed, but the overall objective should be to have to use the least amount of restraint possible », Patrick Dewaele explained.

« It’s a very big machine, but the numbers show that it works: we reduce the number of falls, and as importantly, we also reduce the consequences (fractures, hematomas …) »

Continuing staff training

As Chair of the Committee to Prevent Falls, Patric Dewaele takes the time to make a detailed catalogue of all adverse events: context analysis, consequences, and return to the units. One to twice a month, the CHwapi staff is invited to reflect on the causes of the falls.

« Once to twice a month, we take 10 minutes to analyze a fall around the CQQOP in a service meeting, for example: who, how, and where did this patient fall? What could have been done differently to avoid falling or so that the consequences of the fall could have been less severe. The goal is to enhance and increase the practical training. This allows you to change behaviors. For nurses, it’s very concrete. It’s a moment of exchange and time to reflect on our practices. It also helps to increase quality of life at home ».

Increase how well caregivers adhere to best practices and their vigilance:

We must continue, we must maintain the effort and constantly reinforce these ideas with the caregivers. It is the responsibility of the quality manager to maintain vigilance.

Experience for caregivers: the particular issues brought about by aging

To help them understand the elderly, the CHwapi Committee to Prevent Falls offers all CHwapi employees the chance to absorb and understand the challenges the elderly face by using experimentation.

« By understanding the effects of aging, the caregiver can see more from the patient’s point of view and understand the boundaries of elderly patients. Elderly patients are hindered by a whole series of elements, limited in their movements. The caregiver can then understand that « when I get older, I will also have to fight this gravity, this feeling of heaviness ».

« Aging awareness is carried out in collaboration with occupational therapists. The latter sensitize the adaptation of the environment to limit the disability situations (for example a lack of strength or the knee pains can be offset by a raised bed at the time of transfer or a chair with armrests etc … ) ».

Conclusion : After having experienced these situations, the caregiver is more vigilant when leaving the room of an elderly patient, making sure to check that everything the patient could need is placed close at hand and easily accessible.

The identification, monitoring and support of the falling patient

In terms of fall prevention, the institution emphasizes the screening and identification of patients on several levels :

  • Through the use of the Morse scale, nurses can identify patients at risk of falling.
  • Then, patients who are at risk, or very at risk have a particular bracelet to make them visible.
  • A marker in the Electronic Health Record (EHR), indicates that the patient is at risk of falling.
  • The EHR also incorporates the patient’s follow-up activities subsequent to the fall (what has been done to remedy it, how the situation has evolved)
  • An accompanying care plan of expertise, understanding and what has occurred is established. For example, the caregiver must « know and explain the pathologies that can increase the risk of falling ».

Skills that also concern the patient

As part of the accreditation in particular, the patient is central, and must become a partner that is more involved in finding the solutions. It is therefore necessary to understand the risks of falls and the provisions that reduce them.

Partner with families as well

When a family comes to visit a patient, they may move some things, for instance perhaps the bed barriers are removed. When the family member then leaves the room without warning caregivers, that can jeopardize the patient.

We must therefore establish a real partnership between the patient and the caregiver staff, as well as between the family and the caregiver with a concrete understanding of what must be done, and not work on assumptions. The CHwapi has developed media (posters and pamphlets) that are aids to make this happen.

« But you have to go above and beyond; we have to support the family by explaining the approach. For example, we must take the time to explain how to develop a safe space that is secure for a senior who has undergone and is recovering from an operation ».

In general, it is about adopting a quality approach

The Hospital in Tournai recently obtained Accreditation Canada, proof of its commitment to quality management. « This is the result of existing practices that put the patient at the center of our approach », Patrick Dewaele added.