Insights from a reducing falls project at the University Hospital Southampton

Summary

At a recent Patient Safety Education Network meeting, Karen Male, ward leader at the University Hospital Southampton, gave a presentation on how she reduced falls on her ward. We asked Karen to share her journey and insights in a blog for the hub.

The Patient Safety Education Network is a informal voluntary peer network for those in patient safety education and training roles. It provides a monthly drop-in session with guests to talk through issues of importance to those in patient safety education and training roles and now has over 470 members. You can find out about the network here.

Content

The challenge

I joined the ward 14 months ago at a time when there was a high number of falls. In one year there was 72 falls, including four high-harm falls, and we would regularly have three falls a day. Falls prevention and staff confidence was low in the management and assessment of falls, and policies and procedures were not being followed. The ward layout was challenging—a corridor with three-bedded bays, long and narrow. Many of the patients were older and there had been a lot of Covid infections.

My goal was simple: to reduce the falls in our ward.

What I did

I organised an entire ward awayday focusing on falls education, prevention, management of falls, and policies and procedures—everyone attended at the same time. This allowed the staff to discuss the way they worked ('work as done'). Back at the ward a Baywatch bay and a PHUDD scoring system was set up with the aim to reduce falls, particularly unwitnessed falls, by identifying if someone is high, medium or low risk of falling.

The ward is a long corridor so one to two Baywatch bays are required. The PHUDD scoring system was used to identify those patients most at risk and to identify where they can go on the ward for the safest outcomes and if additional support is needed. It’s completed at least once daily for patients. On the PHUDD scoring system, 1 point was given to each question where the answer is yes. A point was added for any fall in the hospital. This was then used to decide which patient needed to be in the Baywatch bay. This score is on the handover and reviewed daily and at catch ups.

Outcomes

We have significantly reduced our falls—there has been 61.7% reduction in falls. There has been two long periods with no falls (one for a 48-day period and one for a 50-day period).

Since the education day, we have had 1 or 2 falls a month rather than 5-11 falls every month. In the last 4 month we have had 6 falls instead of the potential 44. Staff are now educated on policies and procedure around the prevention of falls and the management of falls. Staff are proactive in the prevention of falls.

Everyone knows that the Baywatch bay is the priority. And then everyone has their ends of the bay but we all cover each other. We have signs to say that’s it’s a Baywatch bay—for staff but also for relatives to say we can’t leave this bay.

PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed.

Night staff feel empowered to move patients who were most at risk to higher observation beds as they are the staff group most affected by falls on the ward.

Bay nursing introduced handovers conducted outside of the bays, which enhanced the communication as opposed to being in an area away from the patients.

We have completed a falls After Action Review and were praised for our significant improvement in post falls management and documentation. Senior management across our Trust have asked to learn more about the falls reduction plan.

Barriers faced

I met barriers. Staff were not acting in the way I wanted so I met resistance. But I was very honest with them. Told them what the consequences were. Got the most resistant on board first and then everyone else was easier.

At the beginning the staff were demotivated and didn’t feel part of a team. We need to keep our teams valued and motivated. It’s an ongoing commitment to staff. We are always looking at how we can improve and asking staff what their ideas are.

I think the biggest thing I did was look at what was my one main priority. And that’s what we focused on—falls. Now we are moving to pressure ulcers. If you pick one big thing to work on it’s easier. Give it a big focus and then, once sorted, move on to the next thing rather than trying to do everything at once.

Next steps

Training and education is essential—this has continued regularly from the ward leadership team.

I’d like to do some simple quantification—more cost effective, efficient. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed.

We are now doing another nurse-led trial setting daily goals for patient mobility. We are very clear what the goals are, to increase mobilisation, and these goals are on the handover sheets for everyone to see.

Further reading on the hub

• Yellow kits - an innovation to reduce the risk of falls in Accident and Emergency departments
• "The greatest part of this adventure has been the sharing of information." The Patient Safety Education Network one year on
• Implementing the aSSKINg pressure ulcer care bundle – a blog by Susan Martin

Have you implemented a new initiative in your organisation? Have you improved patient safety where you work? We would love to hear from you and share on the hub your journey. If you are a member, you can share directly on the hub or please contact [email protected] to discuss further.