The Acute Rehab Unit Introduces:

The Coach Caution

Falls Program

BackroundBackround

Rehab facilities’ national average falls: 7-12/1000 Rehab facilities’ national average falls: 7-12/1000 patient days.patient days.

Loyola’s Rehab unit average falls: 12.8/1000 Loyola’s Rehab unit average falls: 12.8/1000 patient days (occurred in the first nine months of patient days (occurred in the first nine months of 2006 fiscal year).2006 fiscal year).

Statistics prompted the formation of a Statistics prompted the formation of a multidisciplinary committee to revise the current multidisciplinary committee to revise the current fall prevention program. fall prevention program.

Goal was to have a fall rate equal to or less than Goal was to have a fall rate equal to or less than 7/1000 patient days.7/1000 patient days.

Fall Data AnalysisFall Data Analysis

MYTH #1: MYTH #1: Cognitively impaired Cognitively impaired patients have the highest fall rate.patients have the highest fall rate.MYTH#2: MYTH#2: Most patient falls occur Most patient falls occur

during change of shift.during change of shift.

FACT #1: FACT #1: Highest incidence of falls Highest incidence of falls occur due to elimination needs.occur due to elimination needs.

FACT#2: FACT#2: Patient falls occur at random Patient falls occur at random times. times.

Coach Caution Fall Prevention Coach Caution Fall Prevention Program DevelopedProgram Developed

• All Rehab Unit patients are classified as Level II All Rehab Unit patients are classified as Level II protocol under Loyola’s hospital policy.protocol under Loyola’s hospital policy.

• Our Rehab Unit needed to further classify patients Our Rehab Unit needed to further classify patients

that were fall risksthat were fall risks..

• Committee developed Level III and Level IV

protocols, otherwise known as “Coach Caution.”

Implementation of “Coach Implementation of “Coach Caution”Caution”

• Fall Assessment every shiftFall Assessment every shift• Team member signs (Level III & Level Team member signs (Level III & Level

IV) IV) • Player’s GuidePlayer’s Guide• Whistle band (multi-colored vs. red)Whistle band (multi-colored vs. red)• Toileting flow sheet Toileting flow sheet • Bed alarm monitorsBed alarm monitors• Level II protocolsLevel II protocols

Program Roll Out Program Roll Out

Fall prevention program initiated on Fall prevention program initiated on

April 1April 1stst, 2006., 2006.

All staff was in serviced on the Coach All staff was in serviced on the Coach Caution elements and their role in the Caution elements and their role in the program. program.

A short quiz given to all staff.A short quiz given to all staff.

Program EvaluationProgram Evaluation

Five months after implementation: Five months after implementation: o Rate was 5.3 falls/1000 patient days.Rate was 5.3 falls/1000 patient days.

Nine months after implementation:Nine months after implementation:o Rate was 8.1 falls/1000 patient days.Rate was 8.1 falls/1000 patient days.

Acute Rehab Fall ProgramFalls per 1000 Patient Days

Jul-0

5

Aug-0

5

Sep-0

5

Oct-0

5

Nov-0

5

Dec-0

5

Jan-

06

Feb-0

6

Mar

-06

Apr-0

6

May

-06

Jun-

06

Jul-0

6

Aug-0

6

Sep-0

6

Oct-0

6

Nov-0

6

Dec-0

6

Jan-

07

Feb-0

7

Mar

-07

5

10

15

20

25

30

UCL = 30.89

Mean = 12.28

UCL = 21.49

Mean = 7.77Project Target = 7

"Coach Caution" Program Initiated (4/06)

Staff Inservice (1/07)

Acute Rehab Fall ProgramFalls per 1000 Patient Days

Jul-0

5

Aug-0

5

Sep-0

5

Oct-0

5

Nov-0

5

Dec-0

5

Jan-

06

Feb-0

6

Mar

-06

Apr-0

6

May

-06

Jun-

06

Jul-0

6

Aug-0

6

Sep-0

6

Oct-0

6

Nov-0

6

Dec-0

6

Jan-

07

Feb-0

7

Mar

-07

5

10

15

20

25

30

Mean = 12.28

Mean = 7.77

Project Target = 7

"Coach Caution" Program Initiated (4/06)

Staff Inservice (1/07)

Program AdjustmentProgram Adjustment

October 2006 showed an increase in falls and continued October 2006 showed an increase in falls and continued to trend slightly upward.to trend slightly upward.

Program interventions and compliance were reviewed Program interventions and compliance were reviewed and adjustments were made.and adjustments were made.

Staff was re-inserviced on the “Coach Caution” program.Staff was re-inserviced on the “Coach Caution” program.

February 2007 showed a rate of 6.9 falls/1000 patient February 2007 showed a rate of 6.9 falls/1000 patient days. days.

Continued monitoringContinued monitoring

The Acute Rehab Unit continues to The Acute Rehab Unit continues to monitor the Coach Caution Falls monitor the Coach Caution Falls

Program Program

through QI in order to keep our through QI in order to keep our

patients’ safety a priority. patients’ safety a priority.