Cypress Health Region Collaboration sur la prévention des chutes de la Sask.

Cypress Health Region Coin sud-ouest de la Saskatchewan Population de 43 000 personnes Superficie de 44 000 km2 1 hôpital régional (80 lits) 4 hôpitaux ruraux 484 lits dans 12 établissements de soins de longue durée The Cypress Regional Health Authority was established on August 1, 2002 with the proclamation of The Regional Health Services Act. The Authority assumed the operations of the former Rolling Hills, Southwest, and Swift Current Health Districts as of this date. The Cypress Regional Health Authority (RHA) is one of 12 Regional Health Authorities that exist within the province and is located in the southwest corner of the province of Saskatchewan. Since being established, the Cypress Health Region has been supplying southwest Saskatchewan with quality services through a dedication to excellence in all areas of healthcare. The Cypress Health Region offers a variety of exciting and challenging careers and believes in hiring exceptional candidates.  The Cypress Health Region provides health services to nearly 80 rural and urban municipalities in the geographically diverse southwest corner of Saskatchewan. The region stretches from the South Saskatchewan River (its northern border) to the United States of America (southern border) to Alberta (western border) and east until the Morse/Mankota area. The region is spread over a land mass of approximately 44,000 square kilometers and serves approximately 43,000 people.   The region has a diverse population including 30 Hutterite communities (approximately 50% of all Hutterite communities in Saskatchewan) and one First Nations community. Cypress Health employs approximately 1,700 staff members who provide a wide variety of facility-based and community-based programs and services in the region’s 20 facilities, communities, and individual’s homes. The regional office is located in the city of Swift Current, which is the largest community in the region and the location of its only specialized Regional Hospital. The Cypress Health Region offers a full range of services that include: acute care, home care, community and population Health, long term care, mental health, addictions services, support services, and emergency services. Each area of service acts as a complementary component of the holistic care provided in the region. 

Cypress Health Region Le plus grand centre urbain de la Cypress Health Region est Swift Current qui a une population de 16 322 Plus de 60 % de la population dans la région de Cypress Health vit dans des collectivités dont la population est inférieure à 3 000 Les principales industries sont l'agriculture et le pétrole Population huttérite - 6,3 % de la population de la Cypress Health Region vit sur une colonie huttérite. La moyenne provinciale est de 0,6 % (CHR Pop Health Status Report 2011) 17,2 % de la population totale de la région sanitaire a 65 ans et +. Taux plus élevé que la moyenne en Sask. de 13,1 % (Statistique Canada, 2012) High usstomer Senior and Hutterite c Care for their own, but use our services.

Prévention des chutes commu-nautaire Cypress Health Region Au cours de cette présentation, je vais vous guider à travers le voyage de prévention des chutes de la Cypress Health Region Prévention des chutes Soins de courte durée Soins de longue durée Soins à domicile / Urgences Prévention des chutes commu-nautaire

Leaders de l'excellence en santé rurale Cypress Health Region Vision : Leaders de l'excellence en santé rurale Mission : Au sein du système de soins de santé de la Saskatchewan, Cypress Health offre des services de qualité et sécuritaires à chaque individu. Valeurs : Sécurité Compassion Respect Redevabilité Excellence

Ligne de temps Prévention des chutes Ligne de temps 2004 Thérapie communautaire 2007 Swift Curent - Soins à domicile 2010/fév Soins de courte durée 2010/juil Site pilote SLD 2010/oct Visite d’accréditation 2011/avr Lancement des soins de santé mobiles 2011/mai Collaboration provinciale 2012/mar SLD mis en œuvre à 100 %

Santé communautaire Augmentation des traitements d’aînés qui ont subi une chute Partenariat avec les soins à domicile afin d'évaluer les clients à risque utilisant le « dépistage » TUGTM (Timed Up and Go) Liste de vérification d’évaluation des risques de chute et de contrôle de la sécurité à domicile créée Séances d’information communautaires commencées Dissémination dans les zones rurales de la Cypress Health Region Community Therapy started seeing increasing prevalence in seniors falling in their home As community care providers we realized that a good portion of our therapy time was spent assessing and providing rehabilitation for seniors who had fallen and suffered an injury s/a hip or wrist #.  It was always heart wrenching when a senior who was previously independently living in the community suffered a fall that resulted in a loss of independence in the community or admission to LTC.  Our team now includes seniors, community advocates and all professions within health.  As a team we felt we could make an impact for the health of our seniors. What was the goal of the program?  Initially we partnered with seniors and home care to identify fall risk and assist seniors to set goals to reduce their fall risk.  The goal was to screen all home care clients once a year or when their health or living situation changed.  Currently we are working with home care and EMS to identify seniors who have fallen or seniors who are at risk of falling and we follow a specific algorithm of care that helps our seniors to reduce their risk.  What resources were available to assist in implementing the program?  Human resources have been the biggest factor in our program.  Extra funding has been very limited.  We have worked hard to “change the way we do business” and always go the extra mile to provide the best geriatric care possible.  Falls prevention is on our radar!!  We received seed funding through the SGI community Grant program for equipment and to assist us in developing a Seniors Safety Expo in Swift Current. This event has now been rolled out to multiple rural communities within the region.  We are currently organizing the expo for Shaunavon and expect over 150 seniors will attend.  A group of seniors attend a twice weekly exercise group with the goal of reducing their fall risk. What type of data was collected?  Home Care clients screened each year and their TUG scores. Number of seniors who attend the Safety Expo events. Number of Physical and Occupational Therapy clients who received falls prevention education and intervention. Number of Clients who were attended to by EMS after a fall – results of the investigation of their fall episode – interventions provided.  Clients identified as fall risk who did not experience a fall but were identified as being at risk.  Clients attending the Eastend exercise group were all assessed using the Berg Balance test both before the exercise intervention and after 8 weeks of participation. What is the biggest change you have seen in the Region/Province since the program was implemented?  WOW – a huge tidal wave of falls prevention activity is taking place throughout the province.  What is the biggest challenge you faced in the falls work that you have done?  Realizing that not all seniors are able to embrace the concept of falls prevention and some at risk will ultimately fall with devastating results. How are you involved in Falls Prevention provincially?  I have developed a network of peers who are working clinically or in the research realm who continue to keep me abreast of the most recent research and share their clinical expertise.  This occurs mostly through the Virtual Saskatchewan Falls Collaborative and The Saskatoon Falls Prevention Consortium.  The Virtual Collaborative has been instrumental in engaging health regions in multiple levels of PDSA activity.  I have learned so much, especially in the past couple of years!! Anything else you would like to add?  The majority of seniors are very keen to participate in education and activities to improve their wellbeing and safety.  Seniors appreciate the teamwork that goes into helping them stay well.  They make what we do very satisfying and FUN! Initially we partnered with seniors and home care to identify fall risk and assist seniors to set goals to reduce their fall risk.  The goal was to screen all home care clients once a year or when their health or living situation changed.  Currently we are working with home care and EMS to identify seniors who have fallen or seniors who are at risk of falling and we follow a specific algorithm of care that helps our seniors to reduce their risk

Santé communautaire « Partez du bon pied » Réponse très positive de la part des clients et des familles Expositions sur la sécurité des aînés Pas de changement important dans les données de notification des incidents As community care providers we realized that a good portion of our therapy time was spent assessing and providing rehabilitation for seniors who had fallen and suffered an injury s/a hip or wrist #.  It was always heart wrenching when a senior who was previously independently living in the community suffered a fall that resulted in a loss of independence in the community or admission to LTC.  Our team now includes seniors, community advocates and all professions within health.  As a team we felt we could make an impact for the health of our seniors. What was the goal of the program?  Initially we partnered with seniors and home care to identify fall risk and assist seniors to set goals to reduce their fall risk.  The goal was to screen all home care clients once a year or when their health or living situation changed.  Currently we are working with home care and EMS to identify seniors who have fallen or seniors who are at risk of falling and we follow a specific algorithm of care that helps our seniors to reduce their risk.  What resources were available to assist in implementing the program?  Human resources have been the biggest factor in our program.  Extra funding has been very limited.  We have worked hard to “change the way we do business” and always go the extra mile to provide the best geriatric care possible.  Falls prevention is on our radar!!  We received seed funding through the SGI community Grant program for equipment and to assist us in developing a Seniors Safety Expo in Swift Current. This event has now been rolled out to multiple rural communities within the region.  We are currently organizing the expo for Shaunavon and expect over 150 seniors will attend.  A group of seniors attend a twice weekly exercise group with the goal of reducing their fall risk. What type of data was collected?  Home Care clients screened each year and their TUG scores. Number of seniors who attend the Safety Expo events. Number of Physical and Occupational Therapy clients who received falls prevention education and intervention. Number of Clients who were attended to by EMS after a fall – results of the investigation of their fall episode – interventions provided.  Clients identified as fall risk who did not experience a fall but were identified as being at risk.  Clients attending the Eastend exercise group were all assessed using the Berg Balance test both before the exercise intervention and after 8 weeks of participation. What is the biggest change you have seen in the Region/Province since the program was implemented?  WOW – a huge tidal wave of falls prevention activity is taking place throughout the province.  What is the biggest challenge you faced in the falls work that you have done?  Realizing that not all seniors are able to embrace the concept of falls prevention and some at risk will ultimately fall with devastating results. How are you involved in Falls Prevention provincially?  I have developed a network of peers who are working clinically or in the research realm who continue to keep me abreast of the most recent research and share their clinical expertise.  This occurs mostly through the Virtual Saskatchewan Falls Collaborative and The Saskatoon Falls Prevention Consortium.  The Virtual Collaborative has been instrumental in engaging health regions in multiple levels of PDSA activity.  I have learned so much, especially in the past couple of years!! Anything else you would like to add?  The majority of seniors are very keen to participate in education and activities to improve their wellbeing and safety.  Seniors appreciate the teamwork that goes into helping them stay well.  They make what we do very satisfying and FUN! Initially we partnered with seniors and home care to identify fall risk and assist seniors to set goals to reduce their fall risk.  The goal was to screen all home care clients once a year or when their health or living situation changed.  Currently we are working with home care and EMS to identify seniors who have fallen or seniors who are at risk of falling and we follow a specific algorithm of care that helps our seniors to reduce their risk

Soins de longue durée Équipe multidisciplinaire de qualité des soins de longue durée active Besoin identifié d'aborder la prévention des chutes en soins de longue durée L'accréditation est devenue une force motrice - nouvelle pratique organisationnelle requise Nous avons attendu avec impatience la trousse SSPSM de prévention des chutes

Soins de longue durée Le Centre de soins Swift Current est un site pilote 3 outils d’évaluation différents mis à l’épreuve Outil de filtrage des risques de chutes Scott Former le personnel Needed to address falls Manager that was extremely engaged and volunteered to take on the challenge of being the Pilot site. This manager is keen to take on many pilots and often explains herself as having Pilotitis. Occupational Therapist knew many of the residents that were recently admitted as she works on both Home Care and Long Term Care Spring of 2010 met several times as an interdisciplinary team to discuss how we were going to do this! We were like deer in the headlights! I was very new in my role with Patient Safety, our team was very anxious but we didn’t understand that we needed to start a program one piece at a time. The bundle wasn’t yet available!! In May 2010 we started by trialing 3 different assessments with the residents. The OT on the team (Cynthia Philip) had researched for a risk tool specific to Long Term Care. She discovered the Scott Risk Tool. The team trialed the Scott along with the other tools . Based on the Therapist’s knowledge of the Residents form the community (as she works in both areas) she instantly knew that the Scott tool would be the most accurate for LTC. We contacted Vicky Scott to ask for permission to use it and went from there. Our next step was to educate the staff. The team knew that all staff needed to be educated

Prochaines étapes en SLD Dissémination de l'initiative dans 11 autres installations La trousse SSPSM est maintenant disponible Identifier les champions qui formeront les formateurs Mars 2011 : nous avons commencé à recueillir des données de 6 installations Spread to 6 LTC facilities with assistance with LTC falls champions. Based on provincial direction (100% facilities implement by March 2012 Slowly rolled out to the other 5 LTC sites. Had the champions to provide education and gather data.

Prochaines étapes en SLD La collaboration sur les chutes a permis aux équipes de se concentrer Utilisation des cycles PEÉA Rencontrer les champions des chutes en SLD chaque trimestre Le personnel utilise les données pour inciter les améliorations Collaboration sur la prévention des chutes de la Sask. Réduire les chutes, réduire les blessures dans les milieux de soins de longue durée et à domicile

Réussites en soins de longue durée Taux de blessures liées aux chutes de 0 % sur un des sites de SLD Nombre de chutes ↑ mais taux de blessures ↓ Transparence Le personnel accepte l’importance des données Personnel au courant de la prévention des chutes Western Seniors Citizens Centre – Taux de blessure Résultat Objectif

Gestion visuelle quotidienne en SLD This is another success in LTC. We are beginning to use Daily Visual Management across our region and one LTC facility has taken the initiative to use falls as part of their daily visual management. Over the past year falls have increased in this facility but we have seen their injury rate decrease. They are using this “huddle” as one of their strategies to decrease their falls. They started meeting weekly to review incidents around falls as a multidisciplinary team (nursing, housekeeping, kitchen staff) and try to put in place corrective actions in place to prevent the fall from occurring again. Recently the huddle has been moved from weekly to daily to discuss the falls that occurred in the last 24hrs.

Chutes en soins de courte durée 5 installations de soins de courte durée dans la CHR Hôpital régional Cypress - 80 lits Site intégré Herbert – 6 lits Hôpital Shaunavon -10 lits Hôpital Leader– 10 lits Hôpital Maple Creek -10 lits

Chutes en soins de courte durée L’unité de chirurgie médicale de l’hôpital régional Cypress a commencé la prévention des chutes en soins de courte durée Méd/chir. est une unité de 48 lits La « maison » Plus de temps pour les soins Service efficace Hygiène des patients Procédures des infirmières Visites des patients Modules de processus Observa-tions des patients Admissions et congés prévus Change-ment de quart Repas Médica-ments Trousse à outils Modules fonda-mentaux Savoir si nous réussissons Service bien organisé État des patients vu d’un coup d’oeil

Les chutes en soins de courte durée Croix de sécurité pour afficher les chutes Afficher les données à la vue du personnel Audit « TLR » – est-ce que le sigle dans la pièce correspond au plan de soins? Déterminer qui est « à haut risque de chute » Calendrier des incidents de chutes Mois : octobre Point rouge = incident

Les chutes en soins de courte durée Procédure opérationnelle normalisée : programme d’aide de nuit Suite à l’analyse de nos données de chute, nous avons trouvé que 70 % des chutes méd./chir. se produisent la nuit. Veuillez vous assurer que les mesures suivantes sont en vigueur afin de prévenir les chutes et pour protéger les patients à haut risque durant la nuit : Chambre du patient Marchettes placées à proximité des patients Libérez le passage menant aux toilettes Laissez la lumière des toilettes allumée Aide pour aller aux toilettes Visites des patients toutes les heures pour vérifier les besoins Personnel pour aider les patients à 22h, 2h et 6h Commode à côté du lit

SPU/Soins à domicile Services de santé mobiles Mars 2011 - projet pilote à Eastend, SK. Les SPU ont commencé à aider avec les soins à domicile L’équipe provinciale de la Collaboration a été formée avec des membres issus des soins à domicile, des thérapies et des SPU

SPU/Soins à domicile Processus de prévention des chutes SPU Une personne âgée fait une chute Le SPU assiste Formulaire de rapport sur la chute Interventions appropriées Navigateur clients All Referrals for home safety checklist and falls risks assessments are accepted, clients do not need to have a history of falling to be accepted EMS is able to complete the Falls Risk Assessment and Home Safety Check list Services de thérapie Services infirmiers à domicile Médecin de famille Diététiste Optométriste Pharmacien

Fiche de renseignements en cas d’urgence SPU/Soins à domicile Fiche de renseignements en cas d’urgence EN CAS D’URGENCE

Réussites de Cypress Health Region Les 12 établissements de SLD ont mis en œuvre la trousse de prévention Soins de santé plus sécuritaires maintenant! Les champions SLD des chutes se rencontrent face à face trimestriellement – leurs discussions portent actuellement sur les dispositifs de retenue Éducation en santé mentale L’unité Méd./Chir. continue de surveiller les chutes sur une base mensuelle Collaboration entre les services (SPU/Soins/thérapies) Changement sur le plan de la sensibilisation du personnel de première ligne - la sécurité est la plus grande priorité de Cypress Health Region L'engagement communautaire

Réussites de Cypress Health Region Sensibilisation sur le plan provincial Hoshin Kanri / stratégie de déploiement - les dirigeants de l'établissement ont identifié la prévention des chutes comme priorité Participation à la Collaboration sur la prévention des chutes de la Saskatchewan L’occasion de disséminer nos réussites et défis à l'échelle nationale Les relations de travail avec d'autres organismes tels que l’Institut canadien pour la sécurité des patients et Soins de santé plus sécuritaires maintenant

Défis de Cypress Health Region Durabilité et dissémination Échéancier du ministère Dotation - champions et gestionnaires en soins de longue durée Priorités concurrentes - la construction de nouvelles installations, la philosophie Eden. Le personnel se sent dépassé par le nombre de projets d'amélioration La communication entre les zones de service offrant des programmes de prévention des chutes Engagement du personnel « Un autre morceau de papier à l'admission » «Les gens vont tomber de toute façon »

Défis de la Cypress Health Region Ressources - personnel et argent Les coûts supplémentaires pour nos résidents - protecteurs de hanche / vitamine D Déterminer un taux acceptable de chutes dans les milieux de soins de longue durée, de soins à domicile et de soins de courte durée Mesures non représentatives du travail qui se fait en SLD

Prochaines étapes pour la Cypress Health Region Travail standardisé en SLD - protecteurs de hanche, examen de l'outil de risques Scott, vitamine D, contrôles environnementaux Sites ruraux de soins de courte durée - la dissémination des idées d'amélioration à partir des sites méd./chir. vers les sites de courte durée ruraux Dissémination des services de santé mobiles Unité méd./chir. à l’hôpital régional Cypress (CRH) - collaborer avec la pharmacie pour traiter l'impact des médicaments et des chutes Unité des femmes et enfants à l’hôpital CRH - la prévention des chutes grâce à la péridurale en marchant (« IHI ») Gestion visuelle quotidienne

Objectif de Cypress Health Region Le but de l’établissement est d’atteindre 0 défaillance Est-il possible d’avoir 0 chute?

Merci Personnel et direction de Cypress Health Region Membres de l’équipe de prévention des chutes de la Cypress Health Region Institut canadien pour la sécurité des patients Soins de santé plus sécuritaires maintenant Saskatchewan Health Quality Council Ministère de la Santé de la Saskatchewan