‘Throne project’ could be a life-changer One nurse’s analysis of falls hazards has made bathrooms safer for patients, says Alison Moore
SUMMARY
Marked reduction
TIM GEORGE
Falls in hospital can be disastrous for patients, leaving them seriously injured and curtailing their independence. But reducing the harm from falls requires an in-depth understanding of who falls and where it happens. At Colchester Hospital, falls prevention nurse Carrie Tyler found that a significant proportion of falls (between 15 per cent and 18 per cent over the past four years) in the hospital occur in the toilet and bathroom – about 200 cases a year. With the support of senior nurses, occupational therapists and estates staff, Ms Tyler has introduced the ‘Throne project’ across the hospital to help nurses identify patients at risk of falling and improve the environment in the bathrooms. Ms Tyler’s analysis found that only a minority of patients who fell in the bathroom were confused – a statistic that surprised her and her colleagues. Two thirds of the patients who fell were ‘insightful risk takers’ who were able to understand their limitations, but did not call for help. Some patients were affected by medications they were taking, by underlying diseases such as Parkinson’s, or by the muscle
need for more consistent provision of equipment such as stools for the showers and washbasins. Audits were fed back to sisters, together with hyperlinks to allow them to order additional equipment. The estates department quickly came on board with improvements. ‘They made a promise that every upgrade that happened from then on would be Throne-approved,’ Ms Tyler says. Improvements included motion sensitive lighting, falls alarms and the replacement of some clinical waste bins with single-use bags. Keys to the bathroom were made available on the wall outside, enabling patients to lock the door, but to be reached in an emergency. ‘We wanted dignity to be upheld, but we wanted safety for our patients as well,’ says Ms Tyler.
Falls prevention nurse Carrie Tyler and patient Lee Chaplin
Colchester Hospital falls prevention nurse Carrie Tyler has introduced the ‘Throne project’ and implemented simple, inexpensive changes to the hospital’s bathrooms that have reduced the number of serious falls experienced by patients. Author Alison Moore is a freelance journalist
fatigue that comes with long periods of bed rest. She also discovered that patients who fell in the bathroom were disproportionately likely to experience serious injuries. In 2010, six patients experienced moderate harm, one severe harm, and one died. This was due partly to the environment – patients were more likely to hit something if they fell in a confined area. With the help of the occupational health department, Ms Tyler carried out an audit of equipment in each of the hospital’s 200 bathrooms. This highlighted the
The cost of these changes – for example, £10 for a raised toilet seat – was relatively tiny. Treating a patient with a fractured neck of femur – a common consequence of a serious fall – costs more than £9,000 and often means the patient has to move into institutional care. Nurses are also encouraged to take lying and standing blood pressure readings on each patient. Postural hypotension could trigger a medication and fluids review, as well as pulse readings. Nurses also remind patients not to stand up too quickly and to wait for a moment before they start walking. Since the changes were introduced, there has been a marked reduction in falls causing serious harm. In 2013-14, just one patient experienced moderate harm and none were severely injured. Ms Tyler’s approach has now been shared with other hospitals and she suggests it could be adapted to other institutional settings, such as nursing and care homes. With a little planning and relatively minor expenditure, life-changing falls can be avoided NS
NURSING 4 other :: vol uses 29 no 27 :: permission. 2015 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Dec 12, 2015. For personal use march only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
SUMMARY
Marked reduction
TIM GEORGE
Falls in hospital can be disastrous for patients, leaving them seriously injured and curtailing their independence. But reducing the harm from falls requires an in-depth understanding of who falls and where it happens. At Colchester Hospital, falls prevention nurse Carrie Tyler found that a significant proportion of falls (between 15 per cent and 18 per cent over the past four years) in the hospital occur in the toilet and bathroom – about 200 cases a year. With the support of senior nurses, occupational therapists and estates staff, Ms Tyler has introduced the ‘Throne project’ across the hospital to help nurses identify patients at risk of falling and improve the environment in the bathrooms. Ms Tyler’s analysis found that only a minority of patients who fell in the bathroom were confused – a statistic that surprised her and her colleagues. Two thirds of the patients who fell were ‘insightful risk takers’ who were able to understand their limitations, but did not call for help. Some patients were affected by medications they were taking, by underlying diseases such as Parkinson’s, or by the muscle
need for more consistent provision of equipment such as stools for the showers and washbasins. Audits were fed back to sisters, together with hyperlinks to allow them to order additional equipment. The estates department quickly came on board with improvements. ‘They made a promise that every upgrade that happened from then on would be Throne-approved,’ Ms Tyler says. Improvements included motion sensitive lighting, falls alarms and the replacement of some clinical waste bins with single-use bags. Keys to the bathroom were made available on the wall outside, enabling patients to lock the door, but to be reached in an emergency. ‘We wanted dignity to be upheld, but we wanted safety for our patients as well,’ says Ms Tyler.
Falls prevention nurse Carrie Tyler and patient Lee Chaplin
Colchester Hospital falls prevention nurse Carrie Tyler has introduced the ‘Throne project’ and implemented simple, inexpensive changes to the hospital’s bathrooms that have reduced the number of serious falls experienced by patients. Author Alison Moore is a freelance journalist
fatigue that comes with long periods of bed rest. She also discovered that patients who fell in the bathroom were disproportionately likely to experience serious injuries. In 2010, six patients experienced moderate harm, one severe harm, and one died. This was due partly to the environment – patients were more likely to hit something if they fell in a confined area. With the help of the occupational health department, Ms Tyler carried out an audit of equipment in each of the hospital’s 200 bathrooms. This highlighted the
The cost of these changes – for example, £10 for a raised toilet seat – was relatively tiny. Treating a patient with a fractured neck of femur – a common consequence of a serious fall – costs more than £9,000 and often means the patient has to move into institutional care. Nurses are also encouraged to take lying and standing blood pressure readings on each patient. Postural hypotension could trigger a medication and fluids review, as well as pulse readings. Nurses also remind patients not to stand up too quickly and to wait for a moment before they start walking. Since the changes were introduced, there has been a marked reduction in falls causing serious harm. In 2013-14, just one patient experienced moderate harm and none were severely injured. Ms Tyler’s approach has now been shared with other hospitals and she suggests it could be adapted to other institutional settings, such as nursing and care homes. With a little planning and relatively minor expenditure, life-changing falls can be avoided NS
NURSING 4 other :: vol uses 29 no 27 :: permission. 2015 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Dec 12, 2015. For personal use march only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
