As I have noted before, one of the benefits of travelling the continent for conferences, consultations, and workshops is that I get to meet so many dedicated professionals, passionately engaging volunteers to help make the world a better place. Last year, I met Eileen Pelletier, who is Co-Director of Volunteer Services for Hartford Hospital in Hartford, CT. She and her colleagues shared a program in which they have engaged volunteers as active partners with hospital staff in preventing patient falls by visiting rooms, talking with patients, and ensuring that protocols have been followed. The program continues to be very successful with tangible results. Eileen and her two colleagues, Kelley Boothby, Co-Director of Volunteer Services, and Chris Waszynski, Geriatric Nurse Practitioner, agreed to be interviewed so we could feature their organization in our ongoing series of case study in our blog. We believe this is a powerful and useful example because the program addressed a tangible and pressing need and did so while also providing volunteers with a valuable volunteer position. The results demonstrate how impactful a volunteer-staff collaboration can be. We think it will inspire you to think outside the box and find innovative ways to engage volunteers in solving real issues for your organization.

JFFixler Blogger Beth Steinhorn interviewed the team. Here are some highlights from their conversation.

 Jill Friedman Fixler

Beth:   Please tell us about the program and how it began.

Chris, Eileen, and Kelley:

Before we launched this program, we had a "fall prevention" committee and a protocol for hospital staff to follow to prevent inpatient falls. At intake and every shift thereafter, each patient was assessed for fall risk by the nurse. All patients who had a high risk score received a wristband and their rooms were equipped with a bed alarm and chair alarm, and marked with a green triangle on the door. But, in truth, protocol wasn't being followed as consistently as it should have been.    So, we decided to firm up our protocol and then see if fall rates decreased.  We thought this would be a great role for a volunteer.

We started with two students and trained them on fall prevention, how to check a room for compliance, and how to speak with patients about fall precautions. From this experience, we developed a whole checklist and volunteer training. Now, we have a team of volunteers who go on rounds, visiting every room with a green triangle. They introduce themselves as members of the safety team, and then explain how to call for assistance if they need to get up. The volunteer also scans the room against a checklist to ensure compliance with the fall prevention protocol, for example, confirming that the patient is wearing the proper bracelet, that the chair and bed alarms are being used properly, and that the call bell and the person's belongings are within reach, etc. The volunteer corrects any deficiencies immediately, such as turning on a bed alarm or moving a phone within the patient's reach. Patients are reminded of their high fall risk status and that they are not to get up without staff assistance. Lastly, the volunteer asks if the patient needs anything else at this time, summoning staff as appropriate. 

The important piece of this program is that the volunteer's job doesn't end there. Accountability is built into the protocol.  After completing rounds, the volunteer goes to the large white board and notes the name of the nursing care team responsible for any patient whose room was found to be deficient in fall prevention protocol compliance, and then shares that information with the nurse manager. In this way, we use this program as an audit tool as well as an intervention opportunity. It's been very effective. The nurse manager has the information right then and there and can go directly to the person responsible for the breach in protocol to discuss the issue.  A copy of each rounding is returned to the volunteer office. At the end of each month, we produce a graphic report that shows bed alarm compliance and chair alarm compliance, by unit and hospital-wide, and, in this way, we can show how each unit and the entire hospital has improved over time.

Beth: What results have you seen?

Chris, Eileen, and Kelley:

When we started in April 2008, we were at 54% compliance for bed alarms and 30% for chair alarms. Two years later, in spring 2010, we were at 80% compliance for bed alarms and 90% for chair alarms! But of course, the real goal is reducing falls. Within 6 months of launching the program, we saw a 74% reduction in falls amongst patients that had been identified as fall risks.

Of course, the Risk Management Department loves this program. In fact, last spring, we held a celebration because we reached the lowest number of injurious falls in April ever and lowest falls total ever.  Protocol compliance continues to grow - from 40% to 90%.  It works.

Beth: How has staff responded the program?

Chris, Eileen, and Kelley:

Nurse managers want their staff members to look at this as a positive thing-that we are all working together towards patient safety. They have worked to ensure that staff reacts with an appreciation for having someone else to follow up on them. Many note that "this program has helped make complying with the protocol more second nature." We are very careful to never have the volunteer confront the staff about deficiencies, but they often provide positive feedback for a job well done. We leave it to the nurse manager and the resource nurse to speak directly with staff who has violated protocol. Now, with monthly data showing results, friendly competitions have arisen between units for compliance rates. It's all positive.

Beth: What do you recommend for others who are considering a program like this?

Chris, Eileen, and Kelley:

We know of a few other hospitals that have launched similar programs, and we have shared this advice:

1.       Communicate early and often. It is important to do the groundwork ahead of time and to determine the goals and then communicate them. In this case, early communication ensures that staff understands that we are working with them from the start-so they see it as a positive rather than punitive.

2.       Give feedback throughout. At all levels, sharing the impact of the volunteer program is crucial. With staff, with volunteers, with the administration. Everyone should know how the program is doing and the impact that it's having.

3.       Have a staff champion. Having a staff champion is the most important thing - it's paramount. In our case, it was Chris Waszynski, Geriatric Nurse Practitioner, APRN. She identified the need and partnered with the Volunteer Services staff to develop and implement the program, and now collects the data and shares the program impacts with staff, volunteers, and the administration. As Chris does, a staff champion partners with the Volunteer Services Department, models the collaboration, and follows through with the rest of the hospital staff.

For more information on the Fall Prevention Program at Hartford Hospital, emailEileen Pelletier or Kelley Boothby.