New Blog Post: Tag Care at Yeovil Hospital

This month we talk to Jo Howarth, Associate Director, Patient Safety and Quality, at Yeovil Hospital, who with colleagues Hilary Brunt, (Clinical Specialist Physio – Elderly Rehab) and Allison Dowding, Senior Sister (Medically Fit for Discharge Ward), created a project to reduce the number of falls at the hospital. Jo Howarth attended the Patient Safety Officer Programme in 2015.
Jo explains “The project started when we saw a spike of 27 falls in February 2016 on the Medically Fit for Discharge Ward (MFFD) (see figure 1). We found that falls were seen as a predominantly nursing problem, with no new learning identified from investigations and consequently no new ideas to prevent a recurrence.

Figure 1: The number of falls per month on the Medically Fit for Discharge ward (purple) and the average across the Trust (green).
In response we held a safety huddle with our professional multi-disciplinary leads, including the Physio, Occupational Therapy, Nursing, Dementia, Patient Safety and Mental Capacity Assessment (MCA) Leads and agreed a number of immediate actions.  Firstly, patients at high risk of falls were mapped across the ward and moved in to high visibility bed spaces and a system of tagging staff implemented to ensure constant staff presence in the bays. Tagging was discussed with the MDT and all staff asked about their unique and professional input in to managing falls risks.  As a consequence of the discussions it was agreed that it doesn’t matter if the staff member is a doctor, nurse, physio, pharmacist or HCA – whoever wears the tag has the responsibility of being aware of any patients who may be about to put themselves at risk of a fall, for example, those patients who may be trying to get out of bed unaided. The use of a number of tools to make it easy for staff to do the right thing resulted in developing the Tag in  Bag concept.
Figure 2: Tag in a Bag – visual cues for use on patient bed boards, a specific falls care bundle, grippy socks and the yellow falls tag lanyard.

The outcome of this Quality Improvement Project has been a 78% reduction in falls on MFFD, and all wards that have implemented have seen a reduction in falls. We have seen a real benefit for patients: the environment is now calmer, with less reliance on falls alarms, and a proactive rather than reactive approach to managing risks. We’ve seen an increase in clinical reasoning and improved team working between professions.

Going forward we will review and revise the process. We’ve seen a real cultural change – new staff adopt the tag care approach automatically and that has helped increase multi-disciplinary team working. A standard operating procedure underpins this approach and reiterates that tagging is not a permanent state of managing risks but can be stood up or down depending on patient behaviours, changes in cohort and ward level activities throughout the day and night.
 
We see the project as sustainable and as having a long term impact and although both successful and innovative, the project has been cost effective in reducing need for 1:1 enhanced care.”