Speaker 1: doing that. I want to thank you all for joining in person and also to everybody who's joining online today and also to everybody who's going to be listening to this recording because I know everybody can't be here today. But today I'm going to be talking about visualizing patient safety and using Tableau to analyze fall events specifically. I am Janelle Murable, by the way. I'm the Magnet Program Coordinator here at Sibley Memorial Hospital. We are on our way to our Magnet document submission on June 1st. Very excited to be here. Thank you. I didn't expect to be applauded for that, but thank you so much. It's a very exciting time here and part of our Magnet document talks about our NSIs, so our performance with NSIs such as Falls, CLABSI, CAUTI, HAPI. So we're very happy to be presenting on one of those today, Falls. So we'll advance to the next slide, please. Great. So the objectives for today's discussion, this is really an education session, so I want this to be something helpful that you'll be able to take with you afterwards and be able to use these tools for your own use. I'll provide an overview of Tableau, the uses and benefits of it, in addition to how to use Tableau for fall event review, in addition to the unit organization level as well. We'll review a Tableau case study of one specific patient and then Q&A for all of you. All right. Moving on to the next slide, just to provide additional context here, at Sibley Memorial Hospital between July 1st, 2021 and June 30th of 2022, we had a total of about 190 Falls, but when we removed the duplicates from that, 176 patients fell throughout inpatient, outpatient areas in our hospital. That means we have a lot of data to look through for our Tableau Falls review. So to provide an overview of Tableau, we'll head on to the next slide. Okay. I want you all to know first that Tableau can be accessed from any computer here on site. By accessing this link, it's tableau.jhmi.edu. Once you land there, you can use a search function to find most reports that you'll need. If you type in Falls at the top, you should be able to find the Tableau report for Falls. I like to say that Tableau is like a mirror for Epic because everything that is in Epic is just visualized in Tableau. So it's just like looking into a mirror. You can't edit any of this data. It's literally just reviewing. So using Tableau can help you reduce chart time for reviews, meaning that you don't have to switch between multiple patient charts within Epic. This is what I love about it from when I had to do heavy duty Fall reviews. For reviewing Fall events by location, if you want to look at a specific unit or multiple units at a time, you can also do that within Tableau. If you want to look at a specific month or even by risk demographics for a patient. All of these things combined really help you to identify common trends in Fall events to prevent similar events in the future. This is a picture here of just what that post-Fall flow sheet looks like within Epic. So all of the fields there are also duplicated within Tableau. We'll move on to the next slide. All right. So how to use Tableau. I'll walk you through step-by-step on how to use that. So once you access Tableau, from the link that I shared prior, so just so you know here, navigating Tableau, scrolling across Tableau is similar to scrolling down Epic. So as you see, you'll see the different rows for your post-Fall flow sheet there. Those are going to be across on Epic. So you can have multiple patients on the same screen. So now that we know that, we can move on to the next slide. Okay. So this is what the landing page looks like when you first arrive at the post or for the Fall Tableau sheet. You'll see that there's a big yellow box there where you have to click to show patient data. I'm going to move this pictures over for just a moment. All right. So where I have the number one, that's where you can add your filters for if you're looking at a fiscal year. It defaults to the current fiscal year. So if you wanted to look at prior years, you would change that here. If you wanted to change the month that you're looking at, you can change that here as well. In addition to the unit name, the specialty area is not a function that we have for Sibley, so using the unit name. You could also look at, as you can see, your hospital service, the injury level of the patient, and whether the fall is reported to NDNQI. All of our falls are not reported to NDNQI because all of our areas are not considered nursing areas. For instance, our breast center is not an area that is reported to NDNQI, but we may have patient falls in that area. So after you place your filters, you can then click at the top to show patient data. And we'll move on to the next slide. All right. Let me see if I can just move this little bugger. Okay. We have our Tableau visualization site. We're using our filters here. Again, we can navigate or filter down by the fiscal year, the month, the unit name, hospital service line, injury level, whether the fall is reported to NDNQI, if a rehab staff member was involved, and also by the patient MRN or the CSN. Next slide, please. Okay. So then once you've clicked all those filters and you click show patient data, this is the screen that you'll be able to see. So I've blocked out our patient's names and CSNs and also their MRNs just for privacy here, but you'll see on the left side of the screen that you have the unit name followed by the date of the fall and the time of the fall. This is all captured from Epic and just showing within Tableau. You'll see also the hospital service line, the patient's age, the injury level, and the room number where the room number of the patient, not necessarily where the fall occurred, if it occurred in the hallway or something like that. Also at the bottom here, number three, you'll see here that we can also have we also have a count that's listed at the bottom that shows I have this filtered to the month of January here. So we're only seeing falls from the month of January across all units. So you can see we have a total of seven units that are listed here. We had 11 falls in the month of January. One to two for each of these units. Okay. Heading on to the next slide. So if you wanted to follow one patient or even multiple patients, you would scroll across the bottom where I've indicated with the arrow here so you can see all of those that column within Epic, all of those rows that you filled out, you would be able to scroll across here to see all of them together. Next slide, please. Thanks. So now we'll move into a Tableau case study. So I'll show you how we'll use Tableau for a patient named Mr. William Clark. And this is a fictional patient based on factual fall events. So just to make that clear here. All right. So meet Mr. Clark. William, he goes by Willie. He is 75 years old and lives in northwest Washington, D.C. with his wife Marcia and their dogs, Daisy and Scoot. What a cute picture of them in the park, right? So having a fabulous day. All right. Next slide, please. Fortunately, Mr. Clark was admitted to 7A Medical Surgical after suffering multiple falls at home in July of 2022. His nurse, Michelle, assessed his fall risk score using the J.H. BRAT tool as an automatic high due to the multiple falls at home and discussed fall prevention interventions with Willie. That afternoon, his wife Marcia went home to take care of their dogs. Next slide, please. Around 7.15 p.m., so between shift change, Willie woke up from a nap and got up to go to the bathroom. Bed alarms activated in the room and to the staff home. Michelle saw the exit alarm and immediately went to assist Willie in his room. Michelle and the oncoming nurse arrived to the room and saw Willie on the floor. She uses her Versus badge to call for help. Next slide, please. After Michelle and the oncoming nurse assessed Willie for injury, they notified the provider that he had fallen. Noting that he didn't have any injury, they assisted him back to bed. The RNs then began to conduct a post fall debrief as Marcia, his wife, arrives and they discuss additional fall precautions for implementation to prevent a secondary fall. Next slide. Thanks. So as part of Tableau, we also have a new post fall debrief tool, which is an online tool. So I mentioned our post fall huddle. We can do that online now. This used to be a paper form, but it was actually placed online. So what that looks like, I've included the link here. So this tool really reviews the fall prevention interventions that were in place at the time that the fall occurred. Any medical equipment or supplies or devices that were in place at the time of the fall. In addition to any factors such as patient factors, medication, safety, that may have contributed to this patient fall. Here at Sibley, this tool is linked in our frequently accessed links of our intranet page. So it's under frequently accessed links for the post fall debrief tool. And just to show you what this tool looks like on this slide. So the information that you will be entering here is all of the patient information. So I've entered here a sample with my name, with the patient's MRN of just 1, 2, 3, 4, 5, 6, 7. The patient's name, the date of the fall, the time of the fall, the facility where it happened, the unit where it happened. In addition to identifying whether this was a witnessed or unwitnessed event. And then also including the fall prevention interventions, again, that were in place at the time of the fall. Not that we put in place after the fall, but what was in place at the time when the patient fell. We'll move on to the next slide. So as Michelle completes the post fall flow sheet with an EPIC, documenting the details of the fall and her post fall assessment and plan. These are, again, all of the rows that would be filled out as part of that. Notice here there is also a reassessment section, but that's not included until 8 to 24 hours after the fall has occurred. So we expect that that will be completed maybe by the same nurse if it's at the beginning of the shift, but typically by a different nurse. So I've also linked here an EPIC tips and trick sheet for post fall documentation, which is helpful for both the inpatient and they also have some for outpatient settings and the emergency department is included within that and perioperative areas. All right, moving to the next slide. So this is recommended post fall documentation for entering a HERO here at Sibley. So before ending her shift, Michelle enters a HERO event report for her nurse manager to review. This HERO is assigned a harm score by our patient safety and quality department and it looks like this. This is an example of a HERO. I've redacted some of the information from it, but this was scored, as you'll see at the top, as a harm score of C, meaning that the event did reach the patient, but there was no harm involved. You'll notice that, of course, the date that this event was entered is here as well as the unit where it occurred, in addition to the last person who modified this HERO. So this means that our nurse manager, our lovely nurse manager on 7 AMATOB did enter some follow up on this HERO event. So Michelle entered this HERO saying during shift change the patient was noted to be on the floor and he stated that he was going to the bathroom. You'll notice here that there was an indicator placed that this was an unassisted fall and that this review is then complete. All right, moving to the next slide, please. So what does that look like in Tableau? So after the post fall debrief and the EPIC post fall flow sheet have been updated, they're typically reflected in Tableau within 24 hours. It does sometimes take up to 48. We've seen it take a little bit longer, but typically within 24 hours. And again, I've redacted the patient information here and just superimposed our patient, Willie Clark. So this was unit 7A, the fall date of July 31st. The time we have here, his MRN, his CFN, the hospital service that he was on at the time of the fall, his name, age, and room number. So this is what that information would actually look like within Tableau and we could scroll all the way across to see all of the post fall documentation that Michelle entered within EPIC. Go to the next slide. Okay. That seemed to go by very quickly. But here we are. So I do want to open up for any questions that you have about this. So we reviewed Tableau as a whole. There is much more information available on Tableau. There's different tabs where you can see just by either month or by quarter or by fiscal year what the trends are for falls in a specific area or across the organization. For instance, if you wanted to look at by JHFRAT score, who was falling most often, what was their JHFRAT score, you could look at that within Tableau. Yeah. So there's a lot of features that are available within it that I want to make sure that you all are aware of. All right. Any questions?

Speaker 2: Yes. Yeah. Everybody can access Tableau. The data that you can review there, there's no

Speaker 1: way to edit it. So there's no harm in reviewing that data. These slides will be available on the SHINE conference site, I believe. I'm not sure when they'll be posted, but the link is in there. But I can also email you the link for Tableau. Yeah.

Speaker 2: They are already posted on the CNI website, Janelle, in the on-demand library.

Speaker 1: Okay. In the on-demand library of the CSI website. Yes. Great question. All right.