Impact of Best Practices on Fall Rates

The Perley and Rideau Veterans' Health Centre, located in Ottawa, Ontario, Canada,  is one of the largest LTC homes, with 200 beds for community members alongside 250 beds for veterans of the Second World War and the Korean War. Throughout its 119- year history, the Perley Rideau, as it is popularly known, has evolved continually to meet the needs of the people it serves.

• Assessment and Management of Pain, 2013, (2nd Ed.)
• Caregiving and Screening Strategies for Older Adults with Delirium, Dementia and Depression, 2010 (two separate BPGs)
• Prevention of Falls and Falls Injuries in the Older Adult, 2011 (3rd Ed.)
• Risk Assessment and Prevention of Pressure Ulcers, 2011 (2nd Ed.)

During 2016, the latest step in this evolution saw the Perley Rideau shift towards excellence in frailty-informed care which included a strategic partnership with RNAO to implement five best practice guidelines (BPGs) as a Long-Term Care Best Practice Spotlight Organization® (LTC BPSO®):

With more than 800 staff and 391 volunteers (approximately) the Perley Rideau enables all residents to live their lives to the fullest in a safe, supported and cheerful environment.

Practice Change

The Falls BPG was the first to be implemented at the Perly Rideau.  An interprofessional team was formed and together they analyzed the current processes related to assessing fall risk at admission, as well as post-fall management. They reviewed falls data and used this information to complete a gap analysis. The team than held a two-day kaizen event ("change for better") and had staff identify the top priority areas related to the practice gaps based on the gap analysis.  Staff identified the following priorities:

• Fall assessment/screening
• Post-fall assessment/care planning
• Interprofessional approach
  • Comfort Care Rounding
  • Falls discussed at ALL care plan meetings
  • Standardization of communication requirements
• Engaging/informing residents and families (in-person and written materials)

To build on the success of a 2015 pilot project, the Perley Rideau continues to expand the process of checking regularly on residents in a structured and strategic way, known as Comfort Care Rounding (CCR). During Comfort Care Rounding staff must:

1. Introduce themselves.
2. Provide any resident care required
3. Assess for four Ps and a T which include: Pain, Positioning, Placement of Personal items and Toileting
4. Address additional comfort needs
5. Ensure environmental safety
6. Close the conversation with: "Is there anything else I can do for you? I have time."
7. Advise the resident when they expect to return.
8. Document.