Provena St. Joe's staff ham it up for safety's sake

June 15, 2011

YouTube video is part of a serious, multiprong effort to reduce patient falls

"Look at that fellow, he's wearing yellow. Time to spot, spot, spot."

Sporting bright yellow sunglasses and leis, dozens of Provena St. Joseph Medical Center caregivers shimmied for the camera to their new safety jingle "Spot, Spot, Spot."

Set to the music of Calypso classic "Hot, Hot, Hot," the "Spot, Spot, Spot" video promotes the new ARC Angel program, which has helped reduce falls by 50 percent in two pilot units at the 480-bed hospital in Joliet, Ill. The video is not the most important tool in Provena St. Joe's fight against falls, but it certainly is its most hilarious.

"Everyone volunteered on a Sunday ready to act crazy," said Lynn Watson, nursing quality and safety coordinator. "It definitely makes you laugh."

Provena St. Joe's introduced the ARC (Accountability, Responsibility and Commitment) Angel program in February 2010 after seven patients fell in one unit during a single weekend.

"I'm not a crier, but I must admit I cried when I learned about those falls," said Chief Nurse Executive Jackie Medland. "I realized the environment was not that safe. But I'm not a person who yells and screams and beats people up. What I wanted to do was understand the problem better, so we could tackle the issue in the right way."

Medland, the hospital's vice president of patient care, knew the elderly, men and patients on certain medications fall at higher rates, but she was curious what unique factors in specific units contributed to falls. She recruited caregivers from every corner of the hospital from therapists to certified nursing assistants to transport techs to investigate the problem and develop solutions for two pilot units — an acute rehab unit that serves patients recovering from strokes and other patients with cognitive and physical limitations, and a medical telemetry unit with a turnover of almost 50 percent per day. Both units serve fall-risk patients, and their fall incidents reflected this.

Using the Johns Hopkins Comprehensive Unit-Based Safety Program, the ARC team developed some key practice changes involving assertive toileting, team communication, yellow gowns and weekly falls forums to promote learning.

The ARC team discovered that over half of the patient falls are related to toileting, in particular to patients going unassisted to the bathroom. Though Provena St. Joe's had an hourly rounding policy, nurses simply did not have the time to consistently address the three Ps — pain, positioning and pottying. The ARC team recommended caregivers perform safety-wellness checks every two hours and that the certified nurse assistants take charge of toileting.

"They did the math and looked at what is reasonable in terms of scheduling to support good patient care so they could get in and conduct meaningful rounds, not just popping their head in," said Watson.

The team also created proactive scripting for caregivers to follow.

"Before we critically evaluated our existing practice, staff would say, 'Mrs. Smith, do you have to go to the bathroom?' Mrs. Smith would say 'no,' and then five minutes later, not wanting to interrupt the nursing staff, Mrs. Smith tries to get up on her own." So instead of asking, Watson said, the CNA now says, "Mrs. Smith, it's been two hours since you've gone to the restroom. I'm here to take you now."

A personalized safety plan is written on the dry-erase board in every patient room so the patient, all visitors and any caregiver who enters the room are aware of appropriate precautions to prevent falls. The admitting nurses develop the plan, which is updated every shift to address changing risk factors.

"The data shows patients frequently overestimate their strength," said Watson. "We really reinforce that with patients and their families — 'Leave this job to us. That is what we have in place to ensure your loved one's safety.'"

Patients previously wore yellow wristbands to identify them as high fall risks, but team members decided yellow gowns send a louder message, and the change was made.

"It was a huge hit," said Watson. "It was an easy visual clue as the patient travels across the organization."

Caregivers meet weekly to discuss methods to screen patients for fall risk and to dissect circumstances that contributed to patient falls.

"When a patient falls, the nurse and the CNA and anybody else who is really involved in that patient's care have immediate remorse," said Watson. "The idea for a falls court came up and we said, 'No, it can't be punitive.' We want to share what the learning was."

By September, fall rates had plummeted in both units. There were no falls with injuries in the inpatient rehab unit; the overall fall rate was down 55 percent. The medical telemetry unit also experienced a 45 percent drop.

Provena St. Joe's has since added two more units to the program and it plans to introduce the ARC program house-wide by the end of this year.

"While reducing falls was going to be an outcome of our work, it was not the focus of our work," said Medland. "What we wanted was to provide an environment of safety for our patients. I'm delighted to say that is what we are accomplishing."


Copyright © 2011 by the Catholic Health Association of the United States
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