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Life in Long Term Care

Falls prevention at Burton Manor

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A resident-centred approach to safety and well-being, while reducing falls at Burton Manor

Location: Burton Manor, Brampton, ON

In 2019, Burton Manor Long Term Care started a transformation with two objectives: eliminating restraints and reducing falls. Five years later, the Primacare Living Solutions long-term care home has not only met these seemingly opposing priorities but earned its spot as a Registered Nurses’ Association of Ontario’s (RNAO) Best Practice Spotlight Organization® (BPSO®).

RNAO’s Best Practice Guideline (BPG), Preventing Falls and Reducing Injury from Falls (2017), served as the blueprint for Burton Manor’s BPSO plan. From 2019 to 2023, the long-term care home implemented a host of alternative fall prevention tools and techniques from the BPG that enabled its team to eliminate the use of physical restraints (e.g., bed rails, seatbelts, lap trays, etc.) while reducing fall risks and injury severities.

“Some families believe that restraining a resident will prevent falls, but they may not be aware of the potential negative consequences of such measures,” says Jyothi Martis, Director of Care for Burton Manor. “Restraining residents limits their normal activities and can lead to increased agitation.These restraints may also have harmful effects, such as residents injuring themselves while trying to climb over bed rails or, in severe cases, risking strangulation with seat belts.”

Implementing the RNAO’s Preventing Falls and Reducing Injury from Falls BPG meant adopting several alternative approaches to restraints. Depending on the resident’s risk profile, these include:

  • High-low adjustable beds can be lowered to help residents safely transfer from their mobility equipment into or out of their beds.
  • Bed and chair alarms that alert team members to help residents trying to leave their beds so they can assist.
  • Hip protectors worn by residents to reduce injuries from falls.
  • Non-skid socks worn by residents to help prevent slipping and falling.
  • Fall mats to soften the impact of falls.
  • Bone protection medication (e.g.,Vitamin D, Prolia (denosumab) and Actonel (risedronate sodium), prescribed to residents who are deemed susceptible to falls based on an initial consultation with physician and pharmacy teams.

Numerous fall prevention and injury reduction practices have also been implemented. For example, Burton Manor now places a “falling star logo” on the doors of fall-risk residents to identify those who require additional support and check-ins throughout the day. Additionally, Burton Manor staff conduct Intentional Comfort Rounding every hour to ensure these residents’ safety and needs are monitored and attended to.

“Monitoring involves more than just briefly checking the resident’s room and then leaving: it requires a thorough and attentive approach,” says Martis Instead, she explains, these rounds are meant to be a time when team members engage with residents to ascertain their comfort and safety as it relates to 4Ps: Pain, Position, Peri-needs and Possession.

Continued monitoring and assessments are important to the ongoing success of Burton Manor’s BPG implementation. For this reason, the home has also tapped various team members to serve as BPG champions. These individuals monitor and assess the home’s fall prevention measures and practices, share their insights at monthly falls and restraint committee meetings, and contribute to the committee’s review process.

“Our champions play a crucial role in our efforts,” says Martis. “They conduct audits on the floor, make sure the falling star logos are displayed, and verify that all fall prevention measures in our residents care plans are being implemented. Additionally, they provide valuable peer-to-peer education, which proves to be highly effective.”

All told, becoming a BPSO for fall prevention and injury reduction has required a foundational shift in how fall risks are identified, addressed and monitored. As Dr. Frank Welland Burton Manor’s Medical Director. observes. “[There has been] a huge shift in the culture of the home. Burton Manor has excellent program committees supervised by a nursing leadership team that has helped it excel in all quality indicators. This has a huge impact on improving the quality of care of our residents.”

Encouraging outcomes

Burton Manor launched its RNAO BPG initiative with an important question: Can resident falls and injuries be reduced without the use of restraints? According to data collected throughout its multi-year journey, the answer is a confident “yes.”

For background, the Preventing Falls and Reducing Injury from Falls BPG implementation results were measured using the Nursing Quality Indicators for Reporting and Evaluation® (NQuIRE®) data system. This methodology enabled the team to track the number of restraints used on residents, the percentage of residents screened for falls risk, and the percentage of residents who fell in the past 30 days.

The data speaks for itself. From 2019 to 2023, restraint use dropped by 16.5% (16.83% to 0.33%) and Burton Manor successfully became a ‘zero-restraint home as of March 2023. Moreover, the percentage of residents who fell “in the last 30 days” dropped by 6.96% (from 18.78% to 12.8%) and there was an increase in the percentage of residents screened for falls risk.

Burton Manor’s results resonate on a provincial level. Program data indicates that fall rates in all quarters from 2022 to 2023 were significantly lower than the provincial average, as were the percentage of residents who experienced worsening pressure injuries (Pls).

Feedback from the BPG implementation has been equally encouraging. Lisa Rosenberg, Burton Manor’s Family Council President, shared her experience in a recent presentation: “A few years back, Mom fell a few times (and) the Burton Manor team implemented many interventions to prevent my mother from falling again….

Burton Manor has done their utmost in making sure my mom is comfortable and that her quality of life is preserved.”

Obstacles in every journey

Transitioning into a zero-restraint home is no small challenge, even with RNAO’s Best Practice Guidelines to point the way. At the onset of Burton Manor’s BPG implementation program, for example, one of the biggest barriers was getting residents’ family members on board with the idea, particularly those who may have seen their loved ones restrained for their safety in other health care environments.

“Some families are understandably reluctant,” Martis says. “Sometimes families come to us concerned about frequent falls and ask why we’re not using restraints, as their loved one was restrained in the hospital. We respond by explaining that this is their home. and we don’t use restraints. Instead, we suggest trying alternative approaches and evaluating their effectiveness.”

Building trust among family members is key during any resident-care initiative. For Burton Manor, this is achieved through ongoing communication with all stakeholders while altemative fall prevention measures are being used when accidents happen.

“After each fall, we contact family members to inform them and address any questions they might have. We also review the interventions we ve implemented, so they understand our actions and how these measures are designed to prevent future falls, says Martis.

Aligning home teams with alternative fall prevention and injury reduction practices can pose a challenge. Again, Burton Manor benefits from providing consistent education and feedback sessions for its staff and empowering BPG champions to keep those practices in play

“Achieving zero restraints is not easy.” says Martis. “It can be challenging, but reflecting on our success, it’s clear that it was the collective effort of everyone – along with the support of families and residents – that made it possible.”

This teamwork has also been key to sustaining RNAO’s BPGs and driving ongoing improvements.

One year after obtaining its BPSO status in June 2023, the Burton Manor team continues to pursue additional fall prevention strategies, such as setting up cameras and an Al system to detect and analyze the root cause of falls, reducing the use of antipsychotics among residents (where appropriate), and exploring various staffing and team configuration strategies.

Reducing the risk of fall injuries is a never-ending mission. If there is one lesson Burton Manor has learned throughout its Preventing Falls and Reducing Injury from Falls BPG implementation, it’s that there are ways to keep residents safe without limiting their movements.

Says Martis: There are alternative approaches we should explore to ensure the best quality of care for our residents, as this is their home. They deserve to live comfortably and enjoy a normal life here, experiencing the quality of life they deserve.”