When people ask me what I do for a living, I always find myself telling them that “I’m just a nurse in a nursing home”. This is the reaction I usually receive, whether that be from hospital nurses, GP’s or the lady in the local supermarket. The thing is the “just” is totally unjustified.
I work in a nursing home called Fieldhead court, Thornhill (West Yorkshire). We are a 45 bedded nursing home with a mixture of nursing and residential clients. Our client base has changed dramatically in the last year and we had begun to record more and more falls on a weekly basis. Prior to starting safety huddles, we, on occasion, had as many as 3 falls in one day!
We approached the NHS Improvement Academy with a plan; reduce falls in the home by whatever means necessary. It turned out that the necessary was to introduce safety huddles. The safety huddles are quick; usually finished in 5 minutes. The aim is to highlight any deterioration in our clients which may increase risk of falls. We discuss these as a whole team; all staff in the home are present.
The safety huddles began in December 2016, since that point we have managed an incredible 38 days consecutively without a fall! The reduction is an amazing achievement for all and a great benefit for all our residents who feel safer, are safer and even join in with our celebrations when reaching targets.
Since we began the safety huddles we have followed the same routine each morning. The staff noticed however, that we had become slightly complacent, discussing the same issues day in, day out. Always talking about the same residents and never discussing certain changes which may have increased risk of falls for some of our other clients. This was identifiable as we were only achieving around 7 days without a fall. As the structure for safety huddles are not set in stone we decided to “mix it up”, change the process and hopefully beat our 38 day run without a fall.
Following the patient safety conference in London, which myself and my manager attended I had a few ideas. Unsure if these would work as they were caffeine fuelled, late night train journey thoughts, I discussed them with team leaders and we decided to give them a try. We have since started to operate a ‘ traffic light’ system. The green indicates people who have a low falls risk score, the amber indicates people who have a variable risk; those who may become distressed and agitated during periods of infection and the red indicates people who are at very high risk of falls. Informing and educating all staff on risk factors which may increase a residents risk of falls have allowed us to pay closer attention to those at risk and rearrange staffing to support these residents and reduce risk. The aim of the safety huddles is to encourage all members of the team working together with a common aim (in our home this is to increase patient safety and reduce the number of falls). My manager and I actively encourage other members of staff to host the safety huddles and for all those with concerns to speak up.
An example of non-clinical members of the team assisting to reduce falls happened recently. An employee who works in the kitchen had noticed something strange one day. A resident’s meal tray (this resident eats meals in the lounge and is unable to mobilise safely without assistance of 2 people), had been found at the opposite end of the lounge after breakfast and lunch. The staff member thought this was strange, thus decided to go to the lounge after tea and see what was happening. It transpired that the resident was mobilising across the room unaided, carrying the tray. The resident stated they were trying to help the staff. The member of staff carried the tray and summoned some assistance to assist the resident back to their seat safely. Following this incident staff didn’t leave this client with a tray and ensured that all used plates/cups were removed immediately after meals. It may seem like a small change, however, this resident has not attempted to mobilise unaided since and risk has decreased.
Nursing homes generally receive a lot of bad press, I can’t recall the last time I opened a newspaper and saw something positive about nursing homes. Headlines usually read “nursing home deemed inadequate by CQC”, “but there are many managers, nurses, carers, domestics, laundry staff, kitchen staff, maintenance staff who are working really hard every single day to improve the lives of people in their care! These are the people who go that extra mile, who think of innovative solutions to problems, provide care and comfort to those at the end of their lives and the important people in their lives, who put safety, security, dignity and respect above all else…wouldn’t it be nice if just once we read an article about them?! Well here’s one!
Patient safety is not just an issue for the NHS and with an ageing population more and more people are going to require care within our nursing homes. We need to encourage and educate all nursing homes to put patient safety first. Managers and nurses must use all resources to educate others alongside their daily roles and responsibilities. To dream up ideas, be dynamic, inspirational and not be afraid of changing the system, regardless of negativity and people saying “this will never work”. Negativity can’t be listened to and nurses in nursing homes must keep pushing, make a change and show people that you are in fact far more than…
just a nurse in a nursing home.
Since this blog was written, the team at Fieldhead Court has achieved an amazing 54 days without a fall and counting!