QI project aim: reduce patient falls in the purple, blue and ambulance triage zones of the Ulster Hospital Emergency Department by 20%, using the yellow blanket as a visual cue of a person’s increased falls risk within 16 weeks.
Aim of the involvement activity was gaining staff, service user and carer perceptions and thoughts of the Think Yellow Falls patient safety initiative by way of facilitating co-production to maximise implementation of the project. We hoped for service user insight into the type of blanket they feel would best highlight the person’s increased falls risk to the Emergency Department’s MDT, but still be tolerable for them. We also wanted to scope how service- users felt about receiving/ willingness to consent to receiving the blanket with connotations of this being that they are of increased falls risk.
From staff we wanted to gain insight into what type of support/training would best facilitate the implementation, as well as the barriers to rolling this out. The feedback gained guided the pre-pilot engagement, awareness and staff education, as well as support throughout the pilot.
Engagement with Service User Network via Trust PPI team, whereby I provided a project brief and feedback sought.
Project brief:
Think Yellow Blanket Falls Prevention Project in UHD Emergency Department:
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year.
The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence, prolonged hospital stays and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs.
According to the NICE guideline recommendations, all people 65 or older who are admitted to hospital should be considered for a multifactorial assessment for their risk of falling during their hospital stay- this is current practice for SEHSCT hospitals. They should also be offered a multifactorial assessment of their community-based falls if appropriate- also current practice in SEHSCT. These assessments may be done together or separately. People aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition are also covered by the guideline recommendations about assessing and preventing falls in older people during a hospital stay- also current practice in SEHSCT and what we hope to enhance with the Think Yellow Blanket project. (Nice Guideline 161, 2013)
During a person’s attendance at the Ulster Hospital Emergency Department the Falls Prevention Service plan support ED Nurses to triage and immediately provide the Yellow Blanket to patients who are of higher risk of falls. The Yellow Blanket is to visually communicate to all staff of a person’s increased risk of falls. Prior to the completion of the multifactorial falls assessment (target for completion is within 6 hours of admission by Health Care Staff) the Yellow Blanket may help with reducing falls by preventative measures being put in place in response to the visual cue. Some proactive falls prevention measures would be:
- Ensuring the person is placed in a bay/cubicle close to the staff station/ easily observable
- Having closer supervision for the person
- Call bell in reach and that it can be used to support communication
- Appropriate footwear and walking aids are available/ used when walking/transferring, if not- referral to physiotherapist
- Highlighting/ discussing the patients with Yellow Blankets at the staff handovers and safety briefs
Staff survey produced and circulated via ED managers prior to launch and half way through pilot period.
Falls Team members undertook ED drop in sessions for compliance audits and staff support visits. All eligible yellow blanket patient’s HCNs were recorded to support circulation of a patient experience survey- being produced by Trust’s PPI team and circulated by Falls Prevention Service May 2025.
Change ideas tested/used during this QI project were:
- Co-production model used to ascertain key stakeholder perceptions and ideas to maximise implementation.
- Service User Network and Staff survey engagement.
- Bespoke Yellow blanket procured, in line with service-user feedback and evidenced based practice.
- ED staff education sessions delivered.
- ED staff education video produced to train off-duty and night-duty staff.
- Hospital wide awareness campaign to inform wider MDT re: Think Yellow Falls- Yellow blanket is a visual cue for a person’s increased falls risk, to support commencement of proactive falls prevention strategies by all MDT staff in the Ulster Hospital Emergency Department.
- Posters produced and erected in the department.
- Falls Team presence in ED for launch and throughout to support embedding of this new way of working.
- Service user and carer education and awareness provided by ED staff and Falls team in the department when eligible patients were offered a yellow blanket.
- Falls team produced an encompass tip-sheet which was circulated in person in the ED and through ED managers to support staff with documentation of the Think Yellow initiative in patient records.
- Regular meetings with the project team: Falls Coordinator, Falls Team Leads, ED Managers, Lead nurse for Unscheduled Care to update and plan ongoing actions.
- Engagement with PPI team to produce a service-user experience survey.
- Falls Team to circulate survey via post, QR code for online completion and telephone completion will be offered also.
Quantitatively: there was a 31% reduction in falls across purple, blue and ambulance triage zones from 02/12/24- 31/03/25, when comparing the 4 months pre-pilot. ED staff compliance with implementation increased to 60% over the course of the 4 months.
Qualitatively:
Staff feedback post-pilot:
“Think Yellow has been an effective efficient way to identify and minimize risk, it takes two minutes to do and we have seen the results”,
“It is a simple visual tool to help keep patients safe in a dignified way, less falls have meant less reactive tasks to complete and more time to care”
Service-User feedback:
“I think this is a great idea and an easy way to highlight a fall risk within a busy department, which is very reassuring”
Learning:
- Use of the word ‘triage’ when applying the x3 think yellow criteria against a patient/ presentation was confusing for nursing staff, as they thought think yell could only be implemented at point of triage into the ED. Therefore we are planning to use different terminology during scale and spread to other clinical areas.
- I gained awareness of the Service-User Network, through liaison with PPI team.
PPI Think Yellow Falls Prevention Project in UHD Emergency Department
Falls Yellow Blanket Table poster 011024
