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Implementing the MMEDS Implementing the MMEDS bundle to reduce falls in bundle to reduce falls in

Services for Older PersonsServices for Older Persons

Ms Teresa O CallaghanMs Teresa O CallaghanNational Quality Improvement AdvisorNational Quality Improvement Advisor

teresa.ocallaghan@hse.ieteresa.ocallaghan@hse.ie

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Breakthrough series model for Breakthrough series model for improvement approach improvement approach

Complex adaptive approach Complex adaptive approach

Inclusive of all stakeholdersInclusive of all stakeholders

Approach aligned to national vision Approach aligned to national vision

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What is a Collaborative What is a Collaborative approach ?approach ?

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Overview Overview

Topic Topic Reducing falls in SFOP ( SMART aim ) Reducing falls in SFOP ( SMART aim ) faculty faculty Steering group Steering group Participating team Participating team Improvement advisor/ ANP in SFOP Improvement advisor/ ANP in SFOP Change packageChange packageModel for improvement Model for improvement

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Services Services

Six services for older people across two Six services for older people across two countiescounties

Core steering group – to guide, govern and Core steering group – to guide, govern and support the participating teamsupport the participating team

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Aim Aim To To reduce fallsreduce falls by by 30% by February 201530% by February 2015in Services for Older Person across Cavan & in Services for Older Person across Cavan &

Monaghan Residential services using the Monaghan Residential services using the MMEDS bundle. MMEDS bundle.

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RESULT RESULT

We achieved a We achieved a 58%58% REDUCTIONREDUCTION in Falls across the service. in Falls across the service.

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Overall Results Across Six Overall Results Across Six Units: Units: 58% Reduction in Falls58% Reduction in Falls

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Overall results Baseline Median

58% of Falls Reduced

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Driver Diagram Driver Diagram

Primary Drivers

(Structures, Processes, Cultures)

3.1 Establish team – all staff / carers / family / residents.3.2 Provide education to staff and service users.3.3 Implement Prevention Tool.3.4 Visual Communication Plan.

Secondary Drivers(Components & activities leading to 1º drivers)

1.1 Review falls risk assessments and compliance with the Care Bundles.

1.2 Log falls in Incident Report Book.1.3 Three monthly risk assessments completed or when condition changes.

Driver Diagram

4.1 Collect and analyse daily data.4.2 Review compliance with prevention tool.4.3 Adjust tools / assessment as required.

2.1 Establish local team to engage with all relevant staff.2.2 Review documentation in agreed timeframes.2.3 Appropriate referrals for specialist assessment if relevant.

AIMReduce the

numberof falls by 30%

byFebruary 2015

1. Assessment of risk for all patients is undertaken.

2. Identify and address risk of falls.

3. Actively reduce falls

4. Review impact of initiatives , monitor and learn.

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Tasks involvedTasks involved Form a local steering group – key multidiscipline Form a local steering group – key multidiscipline

leadsleads Identify the participating team – front line Identify the participating team – front line System analyses - Identify variation in process and System analyses - Identify variation in process and

outcomes / base line dataoutcomes / base line data Set and agree the aims – all teamSet and agree the aims – all team Set and agree the tasks- all team ( W, W, W, W, H)Set and agree the tasks- all team ( W, W, W, W, H) Establish measures – process – outcome- Establish measures – process – outcome-

balancing balancing Select & agree test to implement the MMEDS Select & agree test to implement the MMEDS

bundle - changes using PDSA cyclesbundle - changes using PDSA cycles

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Tests of change - PDSATests of change - PDSA Safety stick – data for improvement Safety stick – data for improvement Falls checklist ( RCPI UK) – to improve no. of falls Falls checklist ( RCPI UK) – to improve no. of falls MMEDS bundle (HSE,2015) – to improve no. of falls MMEDS bundle (HSE,2015) – to improve no. of falls Standardised definitionStandardised definition Standardised risk assessment - FRATStandardised risk assessment - FRAT Prevention Record – to evidence interventions & Prevention Record – to evidence interventions &

patterns ( Forever Autumn) patterns ( Forever Autumn) Risk Identifiers – (Forever Autumn)Risk Identifiers – (Forever Autumn) Education sessions-(Physio/OT/Dietician)Education sessions-(Physio/OT/Dietician) D Roger- ANP in older person services presentationD Roger- ANP in older person services presentation Communication campaign – posters/information leafletCommunication campaign – posters/information leaflet

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MMEDS Bundle ( NQID, MMEDS Bundle ( NQID, 2015)2015) M - Medication – are you on 4 or more?M - Medication – are you on 4 or more? M - Mobility – FRAT score (Falls Risk M - Mobility – FRAT score (Falls Risk

Assessment Tool)Assessment Tool) E - Exercise - for bone strength and agilityE - Exercise - for bone strength and agility D - Diet: what is the MUST scoreD - Diet: what is the MUST score S - Safety: personal safety/ environment S - Safety: personal safety/ environment

safety considerationssafety considerations

Process & Outcome Measures Process measuresCommunication Awareness in Risk assessment

Outcome measuresCompliance with MMEDS bundleNo of falls

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Balancing measuresBalancing measures Cost: Resources vs FractureCost: Resources vs Fracture Increased use of sensor mats, equipment Increased use of sensor mats, equipment

and beds for at risk residents. and beds for at risk residents. Falls & hospitalisations are prevented as a Falls & hospitalisations are prevented as a

result of appropriate equipment before the fall result of appropriate equipment before the fall occurs!occurs!

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Value for moneyValue for money Conservative cost of a hip fracture for one patient Conservative cost of a hip fracture for one patient

= €12,600 (Irish Falls Strategy 2008: Acute care = €12,600 (Irish Falls Strategy 2008: Acute care only)only)

29 patients on this project at risk of falling would 29 patients on this project at risk of falling would cost = €365,400 (Acute care only)cost = €365,400 (Acute care only)

Versus:Versus: Bed monitors for at risk residents cost Bed monitors for at risk residents cost

= €200 each= €200 each 29 patients on this project at risk of falling cost29 patients on this project at risk of falling cost

= €58,000= €58,000

Total savings = €307,400Total savings = €307,400

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Next stepsNext steps Spread and sustainabilitySpread and sustainability

Currently collecting data for improvement Currently collecting data for improvement throughout the unit and in other unitsthroughout the unit and in other units

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Graph 2.0 Sustainability Data Graph 2.0 Sustainability Data Record & Overall ResultsRecord & Overall Results

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Overall results Median

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To ConcludeTo Conclude Leadership role and support for this work Leadership role and support for this work Collective responsibility for all staff engaging Collective responsibility for all staff engaging

in falls preventionin falls prevention Not to reinvent the wheel regarding good Not to reinvent the wheel regarding good

practice elsewhere, great shared learning practice elsewhere, great shared learning among the group.among the group.

Align this work to national and local prioritiesAlign this work to national and local priorities