Louisiana success stories

LA Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

We encourage you to read the success stories, contact us for more information, and also let us know if you have a Quality Insights' success story to share.

Princeton Place Reduces Restraints, Increases Safety

2/18/2015
Recently, at a Louisiana nursing home, one Director of Nursing (DON) took Leonardo DaVinci’s quote to heart, "I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do."  That is exactly what Debi Faulk did when she came aboard at Princeton Place in Ruston on August of 2012.  She embraced and embodied the “urgency of doing and to-do” the hard work or restraint reduction. 
 
When Debi began her role as DON at Princeton Place, their restraint rate was 27%, which was one of the highest in the state.  Debi was determined that their rate would not remain that high for long.  “I wanted to improve as quickly as we could,” she felt the urgency of change.  At this point, they began in earnest.  The Louisiana Quality Improvement Organization (QIO) provided resources that included Family Restraint Educational brochures, a step-by-step guide to reduce restraints, restraint coding cue cards, and a set of complete set of DVD’s from “Untie the Elderly”. 

At that initial meeting, and the subsequent meetings thereafter, eQHealth Solutions, the Louisiana QIO facilitated a complete system analysis that drilled down to the resident level.  That facilitated discussion resulted in determining what alternatives could be tried.  As Debi puts it, “we didn’t even know what our average was until the QIO provided accurate data.  Our electronic tracking/QA reporting system was not giving us a true picture of our actual rates.”  Two representatives from the QIO, Julie Kueker, Quality Improvement Specialist and Kim Byers, Quality Improvement Manager, explained their quality data in detailed interpretive terms. 

Then Debi and her team began the urgency and hard work of change.  This group of dedicated ladies include: Debi Faulk, RN, DON, Rebecca Norton, RN, ADON, Debbie Pye, LPN, MDS Coordinator and Tina Turner, CNA Supervisor.   Debi singles out the MDS coordinator for keeping up with care plans and making sure coding was correct – “to get to the bottom of things”.

They began by using the QIO provided Root Cause Analysis tools, which they determined were very helpful.  “As a team, we analyzed our admission form, and found that there were check boxes for lap trays, lap buddy’s, restraints, side rails, all the things they wanted to eliminate.”  They determined that this easy check box was a major contribution to the initiation of restraints on admission.  Debi also felt that once the box was checked and the staff was used to using the device, it could be quite difficult to remove.  So now, the admission form no longer has the restraint boxes.  They don’t want restraints to be added to a resident without the team approach, and the care-giving team’s input.  “We changed our protocols.”

In addition, they used the Restraint DVD’s that the QIO provided, at their pay-day in-services.  “We watched most of the videos to educate us on the merits of restraint reduction.  Those DVD’s educated us on how to use fewer restraints, as we move to our goal of becoming restraint free. We wanted everyone to buy-in, which included the housekeepers, the CNA’s, nurses, and even the dietary.”

Having the QIO come back for detailed visits, kept us on track.  “It was easy to get lost in the day-to-day projects.  On the QIO visit days, it reminded us to stop and refocus on the importance of the project, to re-motivate us to improve.” 

By May 2013, their restraint rate is 1.2%, which is a 96% improvement.  An impressive timeline for the amount of work required.  This involved training of staff, purchasing of new equipment, and education of families,

Debi explains that some of the residents had their restraints for so long, that the staff saw it as an assistive device.  And they were fearful that the removal of the restraint would be harmful to the resident.  They felt that the resident needed it and couldn’t do without it.  “For example, we took the lap tray away and would put them in front of the nurses’ station for better observation, where everyone could walk by and make sure the resident was doing okay.”

In addition, Debi want other nursing homes to not let falls be a fear to your restraint reduction journey.  “We are deeply committed to preventing falls, and we meet every morning to see what else we can do for our residents.  When our restraint rate started dropping, our fall rate never went up.  It is still low, even with a very low restraint rate.”

There are a few set-backs to the journey.  “We would come into work to find a lap tray or lap buddy placed back on the resident, and wonder, where did that come from?  The CNA’s had to get that from the warehouse.  So, we would start education again, and start reducing to reach our goal.”  In the end, Debi and her dedicated staff understood that knowing was not enough, they had to change their practice.  They knew their restraints had to be reduced for the safety of their most precious elders.  Louisiana is proud to have Princeton Place as a success story and a mentor for other homes on their restraint reduction journey.