Enhancing Care for Older Patients: A Multidisciplinary Approach at Woodlands Unit
Woodlands Unit implemented a multifactorial approach to reduce falls and enhance care for older patients. The initiative included safety huddles, education sessions, environmental changes, and improved communication with families. Positive outcomes were seen, including a reduction in falls, improved staff and patient satisfaction, and better use of resources through enhanced teamwork and communication.
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Elaine Dunne ANP Older Persons Medicine for the Elderly Team members: MDT approach including Nursing, Medical, Physiotherapy, Occupational Therapy, Medical Social Work, Clinical Nurse Specialists, Advanced Nurse Practitioner, Catering and Health Care Assistants
Background Background Woodlands Unit is a 24 bedded acute frailty ward providing care to the older patients requiring both acute care and rehabilitation. The majority of patients are frail with multiple co-morbidites. In 2021, following a number of falls and Serious Reportable Events on the Woodlands Unit, the Multidisciplinary team have taken a multifactorial approach to reduce falls by increasing awareness and providing structured education to staff. A pre audit was carried out on a sample of 10 patients to examine the knowledge of staff regarding aspects of clinical care on the unit. Aim Aim To reduce the number of falls and prevent serious reportable events from falls. Change initiative Change initiative Creation of a 4pm MDT safety huddle at the whiteboard which allowed updates of patient care. Focused education sessions for staff weekly (CNS s and ANP s cover the ward so staff are released to attend) Environmental changes, orientation clocks, signage, walkways, televisions. Dedicated staff members to contact families to arrange window visits and provide detail for the getting to know me document . Completion of staff satisfaction survey Completion of patient satisfaction survey
Key Outcomes What works well No SRE since commencing the initiative. Numbers of falls reduced. Communication with families improved, patient and family satisfaction survey in progress 80% staff intend to remain in the unit, 100% happy in their role at present Improvements to the environment: signage, clocks, televisions,bathroom doors, meal preferences Value- additional outcomes PDD Using the daily huddle at the whiteboard, the MDT have increased the use of predicted date of discharge from 20% to 100% Nursing metrics have improved on Falls prevention, documentation, More appropriate use of continence wear to suit individual needs of patient may lead to cost savings Measurement Outcome Measures Falls per week, Serious reportable events Process Measures Did 4pm huddle take place Did MDT attend Was there education Balancing Measures Did other improvements result Were there negative consequences Sequential PDSA cycles Falls per week Woodlands Unit 6 Jan/Feb 2022 Education and whiteboard huddles continue, additional benefits seen 5 5 5 4 4 4 4 4 Number of Falls 4 3 3 3 333 3 3 2 2 2 2 2 Dec 2021 Weekly education sessions, daily education update at huddle, environmental changes commence 2 1 1 1111 11 1 1 1 11 1 1 1 111111 11 1 1 1 2 0 0 0 00 00 00 00 0 0 0 00 Nov 2021 Audit results, plan of action, staff satisfaction survey, whiteboard MDT huddle commenced 0 1/11/2021 1/18/2021 1/25/2021 2/15/2021 2/22/2021 3/15/2021 3/22/2021 3/29/2021 4/12/2021 4/19/2021 4/26/2021 5/10/2021 5/17/2021 5/24/2021 5/31/2021 6/14/2021 6/21/2021 6/28/2021 7/12/2021 7/19/2021 7/26/2021 8/16/2021 8/23/2021 8/30/2021 9/13/2021 9/20/2021 9/27/2021 10/4/2021 11/1/2021 11/8/2021 12/6/2021 1/10/2022 1/17/2022 1/24/2022 1/31/2022 12/31/2020 10/11/2021 10/18/2021 10/25/2021 11/15/2021 11/22/2021 11/29/2021 12/13/2021 12/20/2021 12/27/2021 1/4/2021 2/1/2021 2/8/2021 3/1/2021 3/8/2021 4/5/2021 5/3/2021 6/7/2021 7/5/2021 8/2/2021 8/9/2021 9/6/2021 1/3/2022 2/7/2022 1 Oct 2021-Establish team, MDT approach, audit of staff, measurement commenced Patient Falls Average
Sustainment Sustainment The project is in early days but staff are committed. In order to continue the initiative the person in charge wears an alarm to remind them regarding the 4pm huddle. Education is planned 8 weeks in advance. This initiative has sustained through Covid-19 outbreaks, staff shortages and continues to grow and embed in practice Value to patients Value to patients Improved MDT communication at the huddle enables efficient planning of care Family involvement from admission improves patient experience, improved discharge planning through PDD Reduction in falls and near elimination of falls with harm ensures safe quality care What we are learning so far What we are learning so far Education is key; small nuggets, face to face in the real world environment will ensure engagement Quality improvement initiative takes energy, enthusiasm and team work to succeed Spread Spread Plan to repeat the audit of clinical care in April 2022 and progress to other areas FALLS PREVENTION IS EVERYONE S RESPONSIBILITY
