SUMMARY OF FELLOWSHIP:
As a geriatric rehabilitation nurse who is passionate about improving care for my patients, I was excited to begin my fellowship, which focused on engaging clients and families in falls prevention. Falls are the predominant cause of injury for older adults across Canada, accounting for over 85% of all injury-related hospitalizations (RNAO, 2011). Baycrest Health Sciences, a Best Practice Spotlight Organization® (BPSO®) selected falls prevention and client centered care as the main quality improvement initiatives in the organization for 2016/2017. The RNAO/AMS fellowship stream which emphasizes caring and compassion, was a perfect fit for bringing these two initiatives together and for developing my understanding of including client voice in falls care planning. My fellowship took place on the in-patient Slow Stream Rehabilitation unit, which was selected as a pilot for the falls prevention project. Individualized care planning for falls was identified as the main change idea that would facilitate improvement. As per the literature, it is essential to engage clients in designing individualized falls prevention care plans tailored to the specific needs of the patient (RNAO, 2015; Tzeng, 2015). To address this need, interdisciplinary safety huddles took place on two patients/week at the bedside, and I evaluated these huddles with the patients to assess client satisfaction, level of engagement and if they were more informed about their plan of care. I was also involved in developing and piloting a Falls Risk Self-Assessment Questionnaire that was interview administered to all patients within the first week of admission to help translate self-identified risk factors into falls prevention strategies and individualized care plans.

The overall learning goal of my fellowship was to: enhance my knowledge and skills surrounding the inclusion of person centered care within a falls program through championing clinical, educational and interprofessional activities or initiatives to create an environment that fosters compassionate care. To increase my knowledge and expertise of person centered care and client engagement in falls prevention, I conducted literature reviews, participated in educational opportunities and site visits, spoke with experts in the field, took part in various leadership responsibilities under the guidance of my mentoring team (such as conducting key informant interviews and safety huddle evaluations with clients and families, interdisciplinary staff education and focus groups on client engagement and individualized falls care planning), and consulted and collaborated with staff, patients, my mentoring team and the BPSO® Falls Working Group. Through all the learning opportunities that this fellowship provided, I feel more confident and competent in my understanding and practical application of incorporating person-centered care approaches within clinical initiatives.

OUTCOMES:
There were many positive outcomes for the client population as a result of the fellowship. Completing the falls risk self-assessment increased awareness and knowledge of patients’ falls risk (87.5%). This was significantly higher (p =.001) among patients with falls risk self-assessments who checked off over 9 (out of 15) items on the falls risk self-assessment. Patients were not aware of all the risk items listed in the self-assessment and felt it was useful to review. “Good to review falls risk and understand my own falls risk.” and “…helpful to reinforce falls knowledge.” The patient falls risk self-assessment is useful in engaging clients in the falls care planning process, and can assist in increasing patient awareness and knowledge of falls risk factors. The questionnaire is also helpful for informing safety huddles of patient self-identified falls risk factors. Patients rated high satisfaction with the safety huddles. Based on the patient evaluation, the process for setting up a safety huddle was revised to better inform patients and support families in attending the huddles. Feedback from patients was very positive… “Team was interested in what happened and came to follow up after incident”, and “Increased patient’s confidence in care”.

Results from a survey given to nurses indicated that the self-assessment was moderately to very helpful (97.9%) in translating patient identified falls risk factors into interventions for individualized patient care plans. The falls risk self-assessment questionnaire has been recognized by the team as a useful tool to identify specific patient needs and risks (from the patient’s perspective) and is starting to be used as part of the safety huddles to help inform the care plan. At the conclusion of my fellowship I will be presenting the project results to the unit manager and staff with a plan for sustainability to incorporate the falls risk self-assessment into the safety huddle process. Baycrest has recognized the positive outcomes that have resulted from this fellowship, and I have received additional funding from the Canadian Centre for Aging and Brain Health Innovation (CC-ABHI) to continue the RNAO falls project until the end of March. During this time, I will be providing additional support and education to staff in order to build capacity around patient engagement in falls care planning.

OVERALL EXPERIANCE
Person/client-centered care has been recognized as an essential element of healthcare. This fellowship has taught me the value of incorporating the patient voice into care planning to foster an atmosphere of caring and compassion to enhance patient outcomes. It has been most empowering to witness staff engage patients in falls prevention and care planning, which in turn has increased client satisfaction and has positively impacted client care practices. I am deeply grateful to the RNAO and for the support that I have received from my mentor and mentoring team, as well as others within my organization for this incredible learning opportunity. I feel very fortunate to have been chosen for this fellowship, and I look forward to sharing my experience with others.

References:
Registered Nurse Association of Ontario (RNAO) (revised 2011). Prevention of falls and falls with injury in the older Adult. Toronto, Canada: Registered Nurses Association of Ontario. Retrieved from: https://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injurie...

Registered Nurse Association of Ontario (RNAO) (2015). Person- and family-centered care. Toronto, Canada: Registered Nurses Association of Ontario.

Retrieved from: https://rnao.ca/sites/rnao-ca/files/FINAL_Web_Version_0.pdf Tzeng, H. M., & Yi-Yin, C. (2015). Patient engagement in hospital fall prevention. Economics, 33(6), 326-334. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/26845821