Quality of Care Report - Ballarat Health Services

Preventing Fallsin HospitalPatient falls are a challenging safetyand quality of care issue in the hospitaland residential setting where an ageingpatient population and persons withphysical and thinking limitations areexposed to unfamiliar and potentiallyhazardous surroundings (Tzeng, 2008).Falls prevention strategies at BHScentre on timely assessment, referralsfor intervention where needed andreassessment to evaluate improvement.National ComparisonFalls data is submitted to the AustralianCouncil on Healthcare Standards(ACHS) biannually and is thenbenchmarked against otherorganisations. At Ballarat HealthServices, the sub-acute and residentialservices areas were identified in 2007as being of most concern regardingfalls prevention.The Falls Minimisation Working Grouphas considered a number of strategiesto address the falls risk in these areas.These include:• A trial of hip protectors;• Investigation of medication relatedfalls; and• Individual resident and client falls riskprofiles.Funding was also sought and approvedto commence a project in the subacutesetting to explore intrinsic andextrinsic risk factors for falls.Researchsub-acuteA study was commenced in July 2008to explore current practices around fallsassessment and prevention in the subacutesetting. This study which isscheduled to be completed at the endof 2009 should assist the organisationto reduce the incidence of falls in thisarea.ResidentialBallarat Health Services is part of amulti-centre trial run by the NationalAgeing and Research Institute (NARI).This trial is funded through theCommonwealth Department of Healthand Ageing and will be exploring therelationship between dementia andfalls. It will run from January 2008 toDecember 2009.Ballarat Health Services records all fallsinto a centralised management system,to enable analysis of falls across theorganisation. This contributes to theimplementation of strategies needed toaddress any issues.ReferencesTzeng Huey-Ming, Chang-Yi YinNurses’ solutions to prevent inpatientfalls in Hospital patient roomsNurse Econ. 2008: 26(3): 179-187Janetti Publications, Inc.Preventing PressureUlcersPressure Ulcers or bed sores are acommon problem in hospitals, and arerecognised internationally as one of thefive most common causes of harm topatients. Patients at greatest risk ofdeveloping pressure ulcers are thosewho are frail, elderly or immobile forlong periods of time. These are criteriathat fit many of the patients who aretreated at Ballarat Health Services andalmost all of those who live in ourresidential facilities.From 2003-2006, BHS participated in asurveillance program run by theVictorian Quality Council, collectinginformation on the incidence of skinbreakdown. This was the Pressure UlcerPoint Prevalence Survey (PUPPS). Theinformation was used to planprevention strategies and trackimprovement. In March 2008, the SkinIntegrity Harm Minimisation Grouprepeated the surveillance programlocally.The March study showed a 7.5 percent decrease in pressure ulcerprevalence from 2006. The statewidemean pressure ulcer prevalence in 2006was 17.6 per cent.Patients who are unable to movethemselves independently (immobility)were found to be most at risk ofdeveloping a pressure ulcer.Ballarat Health Services has introduceda number of systems and assessmentsto reduce pressure ulcers. A majorfactor in reducing pressure ulcerincidence is having a pressure ulcer riskassessment done as this then promptsstaff to put pressure relieving devices inplace if needed. Since the PUPPSsurveys began BHS risk assessment hasimproved significantly from 52 per centto 74 per cent in the most recentsurveys.Future DirectionsRecommendations arising from thelatest survey include:• Local ward initiatives to improveresults;• Consideration of need to purchasemore pressure relieving devices;• Increasing risk assessment education;The Department of Human Services hasnow mandated that organisationsreport pressure ulcer incidence and therate of risk assessment completion.Ballarat Health Services report theseseparately for the Base Hospital andQueen Elizabeth Centre sub-acute siteswhere they will be compared to similarorganisations.Key Findings PUPPS 3 PUPPS 32006 2008Summary DataPrevalence of patients with pressure ulcers 19.90% 12.40%Proportion of patients with pressureulcers present on admission (only) 42% 40%Primary associative risk factor Immobility ImmobilityPrevention and ManagementPressure ulcer assessment tool completed 52.60% 74%Use of pressure relieving devices 60.50% 85%Ballarat Health Services Quality of Care Report 2007-08 34