 Good morning or good afternoon, depending on where you are joining us from. One moment while I... We appreciate you registering and joining us in advance of this final quarterly webinar of the 2019 year. Our expert presenter today is Marty Moore. She joins us as the co-chair of apps number 14, the Patient Safety Movement's fall prevention, and today's presentation is titled A Call to Action Fall Prevention and Prevention. Representing the Patient Safety Movement Foundation is myself. My name is Hailey Golden. I'm the program and event manager at the foundation, along with Ariana Longley, our chief operating officer, as well as Donna, our chief clinical officer. So we thank you for joining us and running through just a bit of housekeeping items next. Firstly, here's our disclosure statement just through that there's no disclosure information, no conflict of interest. The learning objectives to highlight today are that you as a participant are the latest evidence and best practices on health and injury prevention, as well as evaluating influences that contribute to falls that are both known and unknown. And finally, being able to examine a model that can be utilized for development and implementation of actionable solutions for your particular organization. Just as a housekeeping, everyone is muted upon entry and we do that to maintain good audio. This webinar will be posted online to our YouTube channel for reference. At the end of the presentation, we will have a question and answer session and we ask that you participate in one of two options. The first thing, if you are a web user, you're able to raise a virtual hand and Ariana will be monitoring that. So just if you do have something you'd like to bring up to Marty and just as a discussion point, please do raise your hand and we will acknowledge you for your question and unmute yourself or we can help unmute you to post that question. The second option is a bit easier, just anytime throughout the presentation if you have a comment or a question, feel free to use the chat feature to enter that and then we can acknowledge your comment during this question and answer time. Next, we're pleased to announce that this webinar is available to claim continued medical education or continued nursing education units. So at following this presentation, you will receive an email from the Patient Safety Movement with which you'll be directed to MedStar who's our accrediting body to claim those CMEs. And quickly a look at the agenda. So just this time now is to introduce Patient Safety Movement Foundation and describe our actionable patient safety solutions or for short apps. Following that will be a 40 minute presentation led by Marty Moore as the expert presenter and then as mentioned, 10 minutes for question and answer. A bit about the Patient Safety Movement Foundation, we are a global nonprofit with a bold goal of zero preventable patient harm and medical errors worldwide. We understand that one patient death is too many and so we are working towards zero. We're based on commitment. So there's no membership, no fee, something like that. We ask that hospitals and different bodies that they commit to our hospital and share their data, their findings. A little bit about who can take action. The first being hospitals and healthcare organizations. We ask that they share their information, their processes that are in place, that are actual work that is data driven showing how they are reducing morbidity and mortality rates. And we ask that they do this through making a commitment to our organization. The next being committed partners. So a way that this has been described is different organizations, such as agencies, societies, nonprofits that are willing to advocate and wave a patient safety flag. We ask that they commit to us by sending a commitment to Action Letter that just notifies that they stand with us in our mission. The third is healthcare technology companies. And with this, we ask that our focus is on operability and sharing of data. And so we focus on healthcare tech companies and we ask that they sign an open data pledge that says that they will not willingly or knowingly block data from being shared or willingly knowingly add a charge to different devices that then can share data. So this helps, again, from the healthcare technology standpoint push towards zero number. This is patient and family advocates. We understand that critical harm does face all of us. We're not susceptible to that. And we ask that patients and their families share their stories on our website and utilize resources to build the momentum of what it means to be a patient advocate and how this is important. And here's a look at our actionable patient safety solutions, or again, apps for short. We have 18 in total, but there are subtopics under each one of these and that totals into 34 different challenges. For each of these, we have created an executive summary checklist which allows a organization to run through a hospital, to run through and identify where they're missing the mark and where places that change can come about to, again, increase their patient safety efforts and lower those morbidity and mortality rates. These are available for free to download and share on our website. The link is there at the bottom. So we encourage you to take a look at this. Here's a graph showing our impact to date. And so we're very proud to show that from our start in 2012, these are the different hospitals that have publicly committed to our initiative of zero. And so last, we reported out 4,710 hospitals in our network. We're looking to continue to grow that as we move forward. And then again, our lives saved annually. So these are numbers reported out by hospitals using methodology, so they're self-reported. And last year, we report that over 90,000 lives were saved, again, through commitments to these actionable patient safety solutions. And introducing Marty Moore, she is an expert on this topic of actual patient safety solution number 14, falls and fall prevention. Her education background is with the background of science and nursing, as well as a master's in organizational management. She's also served as an adjunct faculty member for many different universities, the most recent being George Fox University in healthcare administration. She is an award-winning nurse with over 30 years in leadership as a chief nursing officer, as well as a nurse educator, senior vice president of quality, both magnet and a corporate chief nursing officer. Most recently at Medline in her role as CNO, she led the initiative to develop an advanced quality and patient, inpatient safety. And then prior to that was with Providence Health and helped confirm the third and magnet accreditation through the American Nurses Credentialing Center. She has a lifetime of dedication to nursing, as well as being the recipient of the Daisy Foundation Extraordinary Nurse Award. We're really pleased that she is in our network, and presenting on this as the chair of Action Will Patient Safety Solution number 14, which is falls and prevention. And would you please welcome me as I turn it over to Marty Moore. Thank you very much, I appreciate it. So a couple of you have noted that I had my video on and thank you, I appreciate that. You will see me sip a cup of tea because I probably like some of you were blessed at Thanksgiving with having lovely friends and family around who also brought viruses. So I have a bit of a cold and for that I apologize and please give me grace. You have the objective in front of you. We're gonna talk about what the latest evidence is that's out there and what we're seeing on best practices. We're gonna look at how you influencers can impact your falls programs. And additionally some biases that's associated with falls. So I think it's really important to kind of step back away from what we think we know and start to open our minds to really what is the unknown. And then we're gonna talk about models that you can utilize and think about how you move change and how you really influence your culture into action. So with that if we can move along please. So what we know is the totality of falls in the United States isn't a small number. As a matter of fact, in 2015 CNS reported that the cost of falls was $31 billion. If you think about that in relationship to healthcare within the acute care and the post-acute setting it's about $18 billion. Now the projections for 2020 coming out of the Centers for Medicaid and Medicare is $54.9 billion. Let me just kind of hang out with that for a moment. $54.9 billion associated to falls, injuries, morbidity, mortality, loss of income, loss of life. What we know is that CDC reported that there was over 30,000 lives last year as reported through them. And what we also know is that the long-term effects of that because the fall isn't necessarily a short-term injury that might result in death. Sometimes they do. What we absolutely now know is that many times a fall will occur let's say in a hospital setting and yet the death occurs maybe six months to nine months later. And I'll talk a little bit about that when you're looking at trending data because it's really important for you to now start thinking longitudinal and really be looking at what's happening. Now, when we step away from the United States moving on, please, what we know also is that the rest of the world is struggling with the issues of falls. I was very privileged. And if we can move on to the next slide, please. I was very privileged to be able to present actually on behalf of the Patient Safety Movement Foundation over in the United Kingdom. And in the United Kingdom, what we know there is is that they too are struggling. As a matter of fact, it's a major initiative. I actually am not seeing the next slide on this point but I'm going to be very creative. Bring it up here, hoping that you all are seeing it. Are you seeing it on your side? Well, we're having fun here. All right, so let me just share the story of that because they're gonna flip through it. I had the opportunity to present over in the United Kingdom and doing so I met with healthcare leaders and healthcare leaders. In essence said the very same thing that I had said and we have all said is that they're struggling. They're struggling with how to assure safety. They're struggling with falls. Nobody wants it on their watch. And yet, when you listen to the leadership of those specific countries, they're also projecting the same amount of issues that we're seeing here in the United States. They're projecting within the United Kingdom 4.4 billion pounds. Australia is projecting 500 million Australian dollars. I couldn't do an equivalent for you. I apologize on that to what that means. And the Western Pacific Asia region is projecting double digit increase, not only in costs but associated in depth. I also had the opportunity to spend time in Japan working with the hospitals there. And they too also were very much thinking about how that they can prevent falls, not only within their health systems, but they're very much looking at them within the home settings because much of the care is actually done in the community. And I'll touch a little bit on that. So when we think about that, if we can move along please, we start to understand that this is a global issue. And it's one that is imperative for all of us to be thinking about. Now, I wanna step back for a second and tell you about my own story. My own story was one of, as a healthcare leader, I've been a chief nursing officer for over 20 years. I actually brought into my practice a thought that maybe falls are just what happens in hospitals. I mean, we commit people to sleeping, not anymore so much, but it used to be that we would put them in with a stranger and sleeping in an unknown setting and we give them medications and we do all these things. And so I had this bias in my head. And there was an incident that occurred. I was, it was Mother's Day. I was going up actually to my own parents' place. They live on a farm in Oregon. And I received a phone call and the phone call was with Marty, we wanna let you know about code. And the code was a woman whose name they all loved her called Nana. And Nana had had cerebral fusion, knew to get up and to call before getting up, knew to get up with assistance as I was saying. And yet for some reason, Nana got up and was found on the floor. There was a series of events. Nana ended up with tracheal edema. The best surgeons, the best anesthesiologists just happened to be in the hospital and yet for some reason nobody could intubator. And Nana died. And when I met with the family, the family was helpable in their anger, helpable in their thoughts about really how this could have been prevented. And I remember, and by the way I needed to share with you, the family was a family of six attorneys. And so it was probably one of the topest meetings I've ever had because not only of the emotion, but additionally they wanted to know and understand and I couldn't answer. What I said to them is that I don't know the causative agents yet. I don't know why this occurred, but I will tell you that I will carry this and I will use that as my leadership. And that actually started me on my own journey to think about and to understand falls. And I had to look in the mirror and ask the question myself about, do I view falls as one of the things that's just happened in a hospital setting? I'm gonna tell you, I've came to conclusion that I don't believe it should happen in a hospital setting and it is so hard. There is no silver bullet to this, but it is one that it has to be constantly woven into everything you do. So what do we know about falls and fall prevention? Well, we have our usual suspects, right? That increase fall risk. As a matter of fact, if you look at the risk screenings, you'll look at physical changes, medication, blood pressure. But I wanna challenge you that we've become too comfortable really and truly in the falls risk. As a matter of fact, it's almost become part of our routine. And when it becomes part of our routine, it becomes part of our memory muscle. And we start to think and look at it from the numbers or from what we know. But let's step back for a second and think about what is it that you don't know? What we're starting to see in the research and I believe actually was a contributing factor to my story that I shared with you is the fact that malnutrition plays a huge part in people's weakness and their inability to work on their gait and their balance. And then additionally, we also know is this hydration plays a huge part. And the combination of the two are now actually being seen as a higher contributor to factors that can increase fall risk. What we also know is is that over the age of 65, almost 65% of patients lying in a hospital that are malnourished. Yet we also know is that less than 10%, like around 3% are actually seen by the dieticians. So the vast majority of those out there really and truthfully are malnourished and are dehydrated and it's not on our risk screening and it's not something that we're taking a look at. The other thing that I shared with you already is about memory muscle. And when we look at our intake and our assessment process, we've failed to really think about the brain and how the brain's programmed. And let me give you an example. I shared with you that I was very privileged to speak in the United Kingdom about falls. What I didn't share with you is that probably one week before my aunt passed away associated from complications, pneumonia, from a fall, she broke her hip. Now in looking at what had happened and trying to understand her bathroom is always on the left. Where did she try to get out of bed? On the left. Where was the bathroom in the hospital? On the right. Everything that she had, that she needed to maneuver around like her bedside table and all those things were on the left. And yet it's not a question that we ask as we're doing part of assessment in thinking about safety. So I want you to just kind of highlight that and look at how is that in your assessment, you start to weave in kind of what's already there in memory muscle of the individual patient. Because it plays a factor in starting to really create a safety zone and thinking about safety. Now the other thing around what we know about falls and falls prevention is is performance gaps and preventing falls. Many times as I've traveled throughout the United States, even as I traveled globally, I saw so many times where it preventing falls was seen as a nursing initiative. In DNQI, it's a nursing sensitive indicator. I've monitored it almost all my career and looked at it. And when I stepped back and thought about safety and when I stepped back and thought about how do we prevent falls? It has to be an organizational imperative. And I'm gonna come back to that in a few minutes but I also want you to start that because if you're not having an organizational conversation, if you're not having a really and truthfully awareness, I call it organizational kind of consciousness around the fact that we all have to think about and look at preventing falls. Environmental services as they're cleaning the room. We talked about replacing things. Remember I just shared with you about memory muscle and do we even ask where the bathroom is at home and then we create safety zones to where maybe they don't have to try to get out to the end of the bed and try to get around it to get to the bathroom. It's all those kinds of things. And again, I'm gonna touch on that in a few moments. And then think about using appropriate tool. Coming soon to you, here's a teaser. We're working on maternal newborn falls. Newborn drops while small in numbers are very detrimental to organizations and very detrimental to the loved ones and to the infants. And so we're thinking about and really looking at how do we help you to continue to expand that safety zone? Well, what we know about appropriate tools not only for maternal newborns, but also for adults is that in many ways those tools can now become embedded into our EMRs and they just kind of become a tactic. You have to think about are they patient centers? Just gave you an example around where's the bathroom place. But additionally, there's other things that I'll share with you in a few minutes around patient-centered practices that the tools necessarily are not driving the behaviors that you want. You also have to think about congruency. Nursing is the one that typically does the assessment tool. What we're starting to find now in the research, Dr. Morris is doing a beautiful work around gait and mobility and core strength. Very few times that we have therapists really assessing for strengths and weaknesses of gait and mobility and core strength. And that's where that organizational focus has to come together. It has to be kind of that whole village mentality around how do we assure we prevent falls. And then lastly, I've touched on this, but the tools that were used to reduce the probability of an anticipated physiological fall many times gets put into an assessment, many times, and I hate to say this, I've seen it gets cut and pasted. I know we don't want that, but we do. And we don't really and truthfully have the right conversations about safety. And so I want you to kind of start that because I'm gonna come back to it. So if we can move on to the next slide, please. So here's many times the considerations often missed. One I've touched on is the organizational knowledge. Have you had a conversation in your organization across the board, don't forget your volunteers, around we don't want falls, not in our walls, not in our community. And so we need you to be part of that visual look and then use visual queuing. Many times there's been yellow socks and there's been gowns. I've been successful with using different color gowns, but there has to be some way, even preserving patient privacy, that people know that this is a person who might be high risk for falls. Some organizations have taken the staff that all people are high risk for falls. If you've taken that staff and you're not using some sort of visual queuing, you then have to elevate the conversation around consciousness in your organization. That means all eyes are watching. That means people speak up if they see somebody who might be looking fidgety and additionally, that has to be an organizational focus. And I'm gonna bring that a little bit later now into the safety huddles. But if you've taken that stand, what we're seeing as best practices is, is then it is a constant conversation. It's embedded into orientation. Don't forget your academic settings if you're teaching hospital, it has to be embedded into your residence as well. I watched a time where two residents, I didn't watch it, but I followed up on it, didn't understand really truthfully what our falls initiative was and watched an elderly woman get up, get out of bed and fall. They were standing there and looking at them and many times you would say, well, why wouldn't they move into it? Think about when you were a student nurse or think about when you were in med school or when you were in your training. So many times you were kind of afraid to do anything that might be out of step. So that's what they did. And that brought to me and I took on the onus that I needed to do a better job of really creating organizational knowledge. Now, the other consideration that's often missed is the fall risk status of being continuously communicated and updated. Do we in report talk about the fall risk status? Do we have on our whiteboards what the risk status is so the family knows and do we engage in that conversation? And I'll talk a little bit about patient and family engagement in a few minutes, but many times we seem to want to kind of self-contain it to our work versus really and truly that partnership that has to be there. And then that fall risk status being continuously communicated and updated brings it also into organizational consciousness. On the move versus instead of stationary and secure there is fabulous research that's starting to come out now that we really have caused more harm and hurt by trying to keep people secure in bed. We have alarms, we have everything that that we have tried to do low beds and believe me folks I've done them all sitters to keep people stationary and secure. Remember earlier I was talking about the influences that are often missed and one of the things is that by keeping people stationary and secure we in many times are actually contributing to weakness. So malnutrition, dehydration and not getting them up and moving. So one of the things and one of the movements that's starting to happen is and people are starting to see some really good research or results on this if they're getting them up and moving up. They're getting them up and walking. They're getting them up and ambulating. Instead of getting them out of bed into a chair trying to keep those muscles engaged. The other part by the way about on the move is is that protein plays a major factor. Now you still have to think about renal considerations of those things but what we also know is is that muscles may protein, right? And we do a poor job in really and truthfully monitoring protein intake to help those muscles continue to move and that nutritional side. And so a couple of organizations that I'm watching the results from and I'm really liking are doing protein shots with MedTask. So they get like 15 grams of protein and a 30 CC so they're monitoring and tracking and that way they're able to work on the other nutritional aspects of the dietary trait. It's really fascinating to see what's happening with this because people are healing faster, incisions are healing, but they're getting up and moving and they're starting to see some downtrending in their falls, which I love. I love that fact. Now I wanna bring you into safety huddles and here's what I wanna ask you. In your safety huddles, do you bring it to your organizational safety huddles? And most people are now talking about we had a fall but do you bring your near misses around falls? And do you kinda create again that organizational consciousness? When you do your safety huddles within your specific department, are you talking about who you feel is the highest risk? Who have you noticed is kinda agitated that you really want extra eyes on? Are you bringing that forward into that deeper conversation? And then also around safety huddles is, are you sharing what is happening when you do your debrief? A lot of times organizations will do debriefs but they don't drive it out and share what the results are of the debrief. I had my own personal experience where we had a fall and we did the debrief and I was doing organizational rounds and again, I stopped into environmental services and environmental services, I was just doing a town hall and I said, I said, you know, we had a fall at her last week and here's what we've learned so far about it. I would love to hear your insight, your perspective. And one of our associates raised her hand and she said, well, I noticed that he was really getting kinda agitated probably about 30 minutes before the fall. And I said, did you feel like you could tell that you could bring it forward? And she's like, well, no, I mean, you know, she did the just word and I hate the just word. She said, I'm just the housekeeper and I said, no, you're part of the team. And so listen for that just word and move that out because that's actually a challenge for you in really working on your elevation of safety. And what I found was that she had valuable knowledge that potentially don't know that could have changed maybe an outcome. So help people to understand what they're looking for. Build that into your organizational framework. Think about all the people that come and go out of that space. Don't assume it's a clinical issue. It's an organizational issue. And then person and family engagement. And this is where I wanna talk really deeply about how do we partner? If we can move to the next slide, please. Person and family engagement, first of all, if you have not downloaded CMS's white paper on person and family engagement, I would highly encourage you please do. They have given you their roadmap of where they are going in their quality plan and they really outlined what they wanna see happen around person and family engagement. This is my own personal perspective. I watched the same actions around patient experience, primarily start as patient satisfaction, patient experience. They started with a white paper. They started conversations about it and then it moved into where it became part of the value-based care and reimbursement. I'm not so sure that we're not on the same trajectory. So for me personally, it's the right thing to do but I would also tell you in prepping your organization of where CMS is going, it's the right thing to do. So when we talk about person and family engagement, one of the things that I'm not seeing happening a lot and yet excited as best practice and those that really do partner and do a great job are achieving reduction in their falls and that is you individualize the safety plan with the individual and the family. Now understand something, CMS has taken a pretty bold step considering in the past and the bold step is that they define family broadly to include participants in that person's care as anybody, informal and formal caregivers. Family is no longer related to DNA. Family is defined by the individual and that is a whole different kind of step that CMS is taking to recognize is that we did no longer have kind of the nuclear family but family's very broad. Again, I have watched many times in organizations where family's been narrowed and yet there was a family friend who had fabulous information about the habits and routines and the partnership that we were working to develop, they knew a lot of information about. So when you think about person and family engagement it really requires transformation of culture and strategy. So if you think about developing an individualized safety plan and in today's fast world and how we're trying to move people through many times people feel like, well, we do that now. I'm gonna share with you, we don't do that as much as we should and the questions that we should be talking to the family about and working with them on a partnership to reduce the falls of their loved ones are not necessarily the traditional questions we're asking. I gave you an example about where is the bathroom within the individual's home. Some other questions that people are starting to utilize within their care settings is really listening and saying, tell me about your loved one. Tell me what, have you seen them stumble? Are they weaker in the evening? Are they weaker in the morning? Do they complain to you about dizziness? And it's really getting kind of that information from the family and then developing what we should be doing for safety for that individual and then we put it up on the whiteboard. So here's our plan, here's what we're gonna do. We talk about call, don't fall, those kinds of things but many times the family has different information that they can share with you around how to keep their relationship safe around how to keep their loved ones. Some organizations have gone into partnership contracting to where it's like, okay, here's the things we're gonna be doing. Here's the things that we would love for you to be doing when you're in the room. Bring to us safety issues if you notice them, if you come into the room and you notice that the safety things aren't, the side tables not where it should be or certain other kinds of things aren't there. Bring those to our attention immediately. Many times families are afraid to speak up and you have to invite that because they're afraid of retaliatory and they're afraid of being listed as the family that complains too much. Really changing that person and family engagement is starting to see some remarkable. The other thing that I've also noticed is that at times when somebody becomes a little bit more agitated, a lot of times families will say, I'll sit with them and having that loved one close to the patient or close to the person, in many ways actually then calms them down and helps them. Now, the partnerships for safety also have to be developed at the first point of contact and that's where your emergency department comes in. Think about the places that people that you're caring for come into your organization and start to work on that reduction of falls, prevention strategy at every point in contact. One organization that I worked with did a fabulous job with EMS. EMS and what they started to do is they pushed out beyond their walls and realized that falls is a community issue and they did a fall prevention at all of their grocery stores. They worked with EMS, EMS knows who's the frequent fliers, their terms are fine. Apologize if that is a term that people don't enjoy but one of the things with it is that they would many times stop in and seeing those individuals that were routinely coming into the emergency department. By doing that, they actually had incredible insight into the home setting, into the tripping hazards, into the lack of food. I mean, there was just so much. And so if you think about if you're in a community where EMS is very much community oriented, that might be a partnership. The other thing that I loved in the UK was in last fall, they did a public service announcements around falls are all our issues because there are a lot of ones and they pushed out again into the community to help people to really have more consciousness and awareness of falls and what they can be doing to help prevent that within the community setting because it contributes then into the hospital setting. Next slide, please. So this is my own personal hashtag that I'm sharing with you. I'd love for you to take it and use it for yours and it's hashtag leadership matters. Here's what I know, when I kept my focus on falls and I worked hard on falls. One of the things that I identified was that that kind of leadership focus really and truthfully was more keeping the organization more engaged. When I then kind of diverted over into whatever was happening at the time, whether it was CAUTI or reduced CAUTI or whatever, falls kind of went away. And it told me in many times that I needed to think about how it is that I keep that consciousness raised in the organization. And that's where I started to look at really and truthfully what matters in leadership and hashtag leadership matters. So the first thing is that the culture of safety does matter. And if you're not working on that, I encourage you, I encourage you to look at the Actional Patient Safety Solution because this is your transformational work. When you do that, start to set up kind of a methodology to where you're always talking about the things that you're working on to keep people aware of the fact that this is important to the organization, this is who we are, this is what we're doing. The other part is that it matters. And in many times organizations are not tracking falls throughout their whole organization. And so the question I would ask you is, is are you tracking falls throughout your organization? That includes your emergency departments, that includes radiology, that includes your ORs. Are you tracking falls within your clinics, your physician offices? Are you tracking data that comes back or that they're collecting actually in that where they're noticing maybe more muscle weakness or complaints of dizziness? Are you able to kind of bring that together? Because many times that starts to tell patterns that you can start to do some predictive modeling. And that's where some of the newest research is going as well is looking at predictive modeling to start to understand who might be higher risk, not necessarily based on assessments, you still need to do that, but also what you now are understanding about the community. So that's where your social determinants comes in, what you're understanding about your community and what you're understanding about your population health and those matters. When we look at high reliability matters as we think about hashtag leadership matters, what we also know about high reliability is that processes and systems are designed to ensure that human beings do the right things at the right time. And in today's environment, it's really hard to remember to do all the things that we are supposed to be doing. I would encourage you also, Penn State just brought out design thinking and it's under the school of nursing. And what that gives you are tools to help, to utilize with your teams around, how can you improve your processes to where it's really human centered? It brings in that behavioral science side of it. Because many times the tools that we're developing are not necessarily designed in such a way that it really guides best practice or really guides kind of what you want people to do. And then lastly, I really wanna talk about engagement matters. And this time I wanna talk about your employee engagement. This is where so many times as we're doing our fall risks and we're looking at and thinking about the tactics that we engage the head. And by engaging the heart, we now know and there's absolutely correlation and the research is clear that employee engagement either drives quality, drives your safety programs or impedes it. And engagement is not about satisfaction. Engagement is about my willingness to give you discretionary energy. As we think about reduction of falls, as we look at fall risk assessments, those are tools, they're tools that individuals are utilizing. But it's really and truthfully whether they choose to utilize that tool to take the next step. And that's the body of work also that I actually put employee engagement not under human resources, I put it under cultural safety. It's your safety work of how do you continuously work to improve your workplace environment and to engage the head and the heart of everyone around how is it that we can reduce falls in our organization? Next slide please. So one of the things that I wanna share with you and is the Actional Patient Safety Solutions. Challenge four is falls and fall prevention and it's being revised, it's gonna be released in 2020 the World Summit which is in March. In it we have kind of the executive summary checklist, we have tools, we have technology in there, we have action plans for you to use. Even though it's being revised right now, I would encourage you check it out. Because so many times when we're looking at how we can design a fall prevention program that's sustainable, we have a tendency again to rely on the tactic side of it because the cultural transformation side of it is incredibly hard work. I also wanted you to think about and listen for and I wanna give you a model that I want you to take. Next time as you're out and about your organization just engage in a conversation with people about fall prevention. Ask them three simple questions. The first question is, do you fundamentally believe we can ever reach zero? Most will answer no. Open the door then to say, tell me what? Tell me more. Engage in that dialogue around why is that belief there? One of the things that I have done an extensive research around is the moral distress and the emotional distress that caregivers feel when a fall happens on their watch. I would encourage you as part of your fall prevention program is to develop a support system for your employees so that they're able to feel supported but also able to process. One of the other questions that I want you to also ask is do you feel the risk assessment we're utilizing guides you into being able to make an individualized safety plan? Most will answer to you no or yes or maybe but it starts to engage a conversation around what is missing. Then lean into that design thinking I told you about and look at what is it that you can do to assure that that assessment tool is bringing forward the information. Maybe it's how you're doing your safety huddles. Maybe it's your shift to shift report. You know your organization is the best. And the third thing is do you share the learning of a debrief with your colleagues? Share with you the vast majority of the organizations that I also have had the opportunity to work alongside, keep their debriefs self-contained. What I find interesting is that there is incredible richness and knowledge that could be gained by openly sharing, by openly being transparent because what's happened in one department will duplicate itself into another. Additionally, I gave you kind of a little bit of a heads up in that you're working on mother, baby, or maternal newborn. And some of the work that's happening around that with our Actional Patient Safety Solution is really looking at the assessment tool. And as I shared with you, it's designed for adults. It's not designed necessarily for maternal. And so we're asking organizations to start looking at and working on developing a reliable validated assessment tool for maternal child. But there's some really interesting things that are happening now there for infant safety bundles coming soon to you in 2020. Next slide, please. So in summary, one of the things that I want to share is that this is a global imperative. Do not just look to the research here within the United States. Canada is doing some fabulous things. Australia is doing some fabulous things. And the UK also is moving very heavily into thinking and looking at what we can do differently. Additionally, fall prevention requires an orchestrated universal approach to saving lives. Think about how it is that you can create an organizational conversation. How is it that leadership, I don't care if you're over facilities or where you're at, really thinks about safety and thinks about fall prevention. You have to do reverse thinking to transform your cultures. And reverse thinking means is that, what are the biases? You ask the question, what are the biases that are holding our organizations back around reducing falls? And I gave you one that's a very simplistic one about the belief system that falls occur in hospital settings. How do I tell you, I think that's still out there. I think it's kind of a deeply entrenched. But the other thing that you want to look at is when you think about reverse thinking to transform your cultures, is what are the unspoken biases? Confirmation biases is one. If you think about confirmation biases, we have a tendency to label somebody as, oh, this person is high risk for falls. And then you look for all the things that are high risk for falls. And by doing that, you're confirming that they're high risk, except maybe there's some subtleties that were missed. Maybe there's some subtleties that could have changed an outcome. If I have more time, I could actually share one more story about that. What I want to say to you is, is that many times we get stuck in our lanes of thinking and it's when we step out of those lanes that we're able to really do transformation. Let hashtag leadership matters be your personal hashtag for safety and fall prevention is not a program. It is the DNA of your actions for safety. And with that, I would ask you to look to the Actional Patient Safety solution. And next slide, please. Thank you so much, Marie. This is the Patient Safety Movement Foundation. We want to thank you for a wonderful presentation. And at this time in closing, we're going to direct it to question and answers. I'm going to turn it over to Ariana who has been monitoring the commenting feature. Great. So thanks everyone who's been commenting in the chat box. Remember, please, you can still submit questions. We should have time to address them all. And if you're on the web and would like to speak your question, if you hover over your name, a little hand that looks like it's waving should appear and you can click that, which means that they can unmute you and allow you to speak. So the first question is, maybe you just understood the statement, why is it not suggested to have the patient move and instead have them sit down? We think that maybe others might have misheard it. Marty, if you could just reiterate what your intent was and if maybe there was a misunderstanding there. Oh yeah, there's definitely a misunderstanding. What it is, is the patient should be moving as a matter of fact. That's what the latest research is. As a matter of fact, Dr. Morris's research, I think it's coming down in 2020, has demonstrated that when you get the patient out of the moving and ambulating and working on that core strength, you look at gait and balance that actually there's a reduction in falls. So there's direct correlation. So I apologize if there was a misunderstanding. I was really saying we've worked so hard to keep them safe and secure in their beds that in essence, we actually might have influenced them following when they try to get out of their beds. Great, thanks Marty. Second question is from someone with the username Y849849 and they say, I'm a quality RN facilitating fall prevention in our hospital. What are your thoughts on a fall when seemingly we have taken all actions to prevent that fall? An example, a confused patient with sitter jumps out of bed so fast and forcefully that the sitter was unable to stop him safely. Patient was not tolerant to more sedatives or restraint. Do you feel all falls can be prevented? Yeah, that's a great question. And I think all of us have had that experience where somebody's physically standing there and they bolt out of bed. Here's one of the things that I would encourage you to think about. The question is, can all falls be prevented? There's a lot of debate in the research on that. I personally believe that we must keep digging deeper and deeper and deeper about why was the fall. So let's say that kind of patients, what we know is this one in four med search patients have an underlying behavioral health issue or maybe a diagnosis. Have you brought in your behavioral health teams to help you to really look at, why would the all sudden agitation like that? Why would somebody suddenly jump out? You're geropsych people, you have to be leaning into them and go deeper into those debriefs maybe utilizing them and looking at, most places have done now, they're drug-drug interactions, they've got pharmacy on board if you don't get them on board. But expand the horizons and think about what's the causation of this individual doing that and who's the experts that might understand that and bring that in. Each time that's a shared learning that's gonna help you to elevate your fall prevention. The other thing is, it's the family. I talked about person and family engagement. Ask them really and truthfully the kinds of behaviors this is what they're seeing. Why are they seeing it? What was the agitation causation from? Really engage in that deeper dialogue and a lot of times in debrief we don't do that and we do our fish, we'll do our cause and effect diagrams and we don't keep digging deeper and deeper and I know it's time but in those cases where you really don't have a clear understanding, look for it. Think about yourself as being Sherlock Holmes and really try to uncover the mystery of why. Great, thanks. Another question from the same person. Do you have any statistical information? And sorry, as questions come in, it jumps me down the page. So do you have any statistical data on correlation between RN staffing and fall rates? Oh yeah, there's a ton out there. I don't have it off the top of my head right now but there is a lot of work. Linda Aiken actually is gonna be releasing some work in the next 30, 60 days I think that has looked at RN staffing in correlation to fall prevention and the number of people. It's an ongoing debate. I think it'll continue to be an ongoing debate. What we have seen though in California is that there really hasn't been that much of an influencer, meaning decreased fall prevention with a mandatory ratio. Now the one thing I would share with you is the organizations that have seen fall prevention as the organizational initiatives have seen reduction. So again, don't focus it that it's just about nursing. It really is an organizational imperative and many eyes, many people understanding what you're working on with safety actually creates a stronger safety net. Great, all right, another question. I'm interested in learning about fall risk scoring tool that's not subjective and has room for patients who don't appear like fall risks but have risk factors such as hemodynamic changes. The Schmid score is very subjective and does not capture those patients. Yeah, no, I totally agree. There's a few that I'm aware of that is currently being studied and one of the things that I'll do is just try to do a little research for you on that and maybe post a follow-up to give you the answer on that. I don't wanna pull it off on the top of my head but I agree that there is, well there's a lot of work that's being done. Whether it's ready now for use is the question I've got in answer. Great, thanks Marty. So we have a question or a comment from Karen Curtis who is the co-chair of this actionable patient safety solution from the patient advocacy perspective. So Karen, thanks for joining today. She made a comment just saying that campaignzero.org offers fall prevention checklists to share with patients and families so they know what to watch for and do to help prevent their loved ones from taking a fall. Also quickly explains fall risk and why shared vigilance with the entire care team for their loved one is important. So I wanted to make sure that those people who are on the phone who might not have seen Karen's comment would know about the resource of campaignzero.org. Yeah, that's excellent. Great, some other questions we have lots here from McGahn. This person asked, do you know of programs that use safe patient handling equipment to facilitate earlier mobility? Yes, as a matter of fact, there's several programs out there for safe patient handling that you can, AHRQ has one that has guidelines around safe patient handling. And there's several others that you can utilize. And I apologize, I actually should have touched on that, that safe patient handling to get people up and mobile is absolutely part of the kind of total fall prevention aspect. One of the things that we know though is nurses have a tendency to not utilize scales or to elevate them if they have to go and get them. And that's that human centered design of looking at your processes in your sentence, make sure that you have the right tools just immediately available to kind of go into that workflow. And then thinking about how do you utilize people really in kind of that move team is one of the things that I've seen where people are just literally kind of working to get people to move and they're kind of going throughout the hospital instead of the lift teams or the transfer teams, which is kind of cool. It's a cool idea. They're partnering up with universities that have training programs for physical therapist. So something to think about, but yes, safe patient handling has to be part of that. Great, so we do have a few more questions. We'll try to get through them all. One question that's been repeated is will the slides be available, does the presentation be available? Yes, it will be on our website within 24 hours as well as on YouTube for you to share. Another question is an earlier slide showed number of lives saved annually. How is this measured? I'm happy to handle that. So when we ask for hospitals to commit to the Patient Safety Movement Foundation, they share with us their processes around patient safety initiatives. And if those initiatives have a standardized way of calculating morbidity or mortality, the hospital has the opportunity to share that, providing background if they're not using the methodology that we use in advertised and enlist in our actionable patient safety solution. So it's self-reported on an annual basis by those hospitals. Someone asks, can you repeat the Penn State reference? Oh, yes, absolutely. It's called design thinking, coming out of the School of Nursing, College of Nursing at Penn State. But if you put in design thinking, they have developed the course to where it's downloadable, it's free, it's fabulous, it's based on IDO's work, which is incredible around human centered design. Great, and I know we're right at the top of the hour, it just turned 11 o'clock Pacific time. There's one more question that I think is relevant. When Delilah asked, I work in a facility where a majority of patients don't have family, how do we go about that after your family's suggestion? You know, yeah, that's the challenge in today's environment, there's no doubt. What I would ask is, is broaden the terminology of family? Is there a friend, a loved one, somebody that's involved in this individual's life? And broaden that family component to where you can then engage in them. You know, many times families live apart and there's somebody then that the individual is close to who knows them. And that may be the individual that you have the conversation with. It's hard, I totally agree, but it is something to really work hard on. Wonderful, well, thank you so much for Marty for your presentation and for everyone in attendance for posing those questions. Just in closing, I wanna highlight that the Patient Safety newsletter is available to those who sign up online at patientsafetymovement.org and mark follower progress. It's a great way to stay up to date on patient safety movement events, initiatives, and different articles and spotlights we like to highlight. Secondly, our upcoming 2020 World Patient Safety, Science, and Technology Summit is to take place on March 5th through the 7th in Huntington Beach, California. We encourage you to follow our website. Find some more information on that. We hope to see you in attendance. It'll be a wonderful event. And then finally, our next quarterly webinar to open up the 2020 year will take place probably mid-March following the summit. We hope that you guys will be in attendance. Again, following this will be a survey to just capture some comments and feedback on this webinar. We thank you for your time and appreciate you joining us. Thank you. Thank you. Thank you, everybody.