...

Producing Evidence to Make Healthcare Safer: Implementation and Evaluation of Multi-Team Systems to Decrease Fall Risk in Critical Access Hospitals

by user

on
Category: Documents
17

views

Report

Comments

Transcript

Producing Evidence to Make Healthcare Safer: Implementation and Evaluation of Multi-Team Systems to Decrease Fall Risk in Critical Access Hospitals
Producing Evidence to Make Healthcare Safer: Implementation
and Evaluation of Multi-Team Systems to Decrease Fall Risk in
Critical Access Hospitals
Katherine J. Jones, PT, PhD; Anne Skinner, RHIA, MS; Victoria Kennel, MA; and Robin High, MBA, MA
Background/Purpose
Context: The 1,333 Critical
Access Hospitals (CAHs), which
are licensed for 25 beds or less
and serve rural areas of the
U.S., are exempt from nonpayment for hospital-acquired
conditions. Yet, they care for a
high proportion of older adults
who are at greatest risk for injury
from falls.
Methods
Results/Conclusions
Results: Total and injurious falls/1000 patient
days decreased from 5.9 to 4.1 and 2.1 to 1.4
respectively despite an emphasis on reporting
assisted falls and more rigorous definition of
injury during the intervention. Coordinating
team effectiveness in developing and
implementing policies/procedures (e.g. post-fall
huddles), educating staff, and communicating
with other component teams was significantly
and negatively associated with fall rates.
Component team member perceptions of the
intervention varied depending upon their
participation in post-fall huddles.
2011 - 2012
Conduct Gap
Analysis
Fall rates are labeled a nursingsensitive outcome. However,
falls are multifactorial in etiology,
and evidence indicates that
interprofessional teams are most
likely to sustain successful fall
risk reduction programs.
Local Problem: In 2011, we
found that the risk of falls and
fall related-injury was
significantly greater in
Nebraska’s Critical Access
Hospitals (CAHs) than in its’
larger hospitals that receive
payment under the prospective
payment system (PPS).
2012 Assess
Organizational
Context
Focus Group / Interview Topics
Awareness of Gaps
Accountability for Outcomes
Ability – Knowledge to Bridge Gaps
Action – 3 Things to Improve
However, after adjusting for
volume, hospitals in which
teams learned from data and
integrated evidence from
multiple disciplines had
significantly lower fall rates than
hospitals in which teams did not
perform these coordinating
activities.
Purpose: The purpose of
Collaboration and Proactive
Teamwork Used to Reduce
(CAPTURE) Falls was to use a
multi-team system (MTS) to
implement and coordinate fall
risk reduction in 17 small rural
hospitals in Nebraska. An MTS
is made up of two or more
interdependent component
teams that work together to
achieve a common goal.
A second purpose was to
produce a toolkit that
complemented the existing
AHRQ Preventing Falls in
Hospitals Toolkit.
Conclusions: Consistent with MTS theory, interprofessional teams that coordinate activities of
component teams may be an effective structure to make healthcare safer. Post-fall huddles are a
coordinating mechanism that facilitates a shared mental model of the fall risk reduction interventions
and goals for component team members. AHRQ’s most recent annual update on HACs reported limited
progress in decreasing injury from falls. More widespread adoption of an MTS fall risk reduction
strategy may accelerate national progress in reducing injury from falls.
2012 - 2014
Standardize Event
Reporting & PostFall Huddle
2012 – 2014
Implement
Evidence-Based
Practices
The Multi-Team System Approach to Fall Risk Reduction
Coordination Among Multi-Team System Components to Decrease Fall Risk
This project is supported by grant number R18HS021429 from the Agency for Healthcare Research and Quality and by
subgrant number 17050-Y3 from Nebraska Department of Health and Human Services Division of Public Health Medicare
Rural Hospital Flexibility Program.
For more information, please contact Katherine Jones ([email protected]), Victoria Kennel ([email protected]), or
Anne Skinner ([email protected]) at the University of Nebraska Medical Center.
2014 – 2015
Evaluate and
Finalize Toolkit
Context
Input
Process
Product
SCAN QR Code to reveal the CAPTURE Falls Toolkit
Or enter www.unmc.edu/patient-safety/capturefalls
Fly UP