Falls risk assessment • modifiable risk factor • falls risk prediction scores (numbers) checklists (prompts)
Attention to the environment “ Ensure that aspects of the inpatient environment that could affect patients’ risk of falling are systematically identified and addressed.” Including: • flooring • lighting • furniture • fittings such as hand holds
Use the skills of your occupational therapists & physiotherapists to look at fittings, flooring and lighting as if they were conducting a home hazard assessment, and order minor works to improve the environment
D. After a fall 8 NHS | Presentation to [XXXX Company] | [Type Date]
All are important …… Falls aftercare ‘Have they hurt themselves falling, or fallen because of new illness?’ Post-fall review and care planning ‘How do I stop THIS patient falling again?’ Root Cause Analysis (RCA) ‘How do I learn from this fall to help stop OTHER patients falling in the future?’
Essential care after an inpatient fall • Have a post-fall protocol specifying: • Checks for injury before moving • Safe manual handling if fracture • Neurological observations • Timescales for medical review • Provide: • Flat-lifting equipment • Glasgow Coma Scale formats • Fast track to CT/x-ray/theatre
Leadership for falls prevention Dr Frances Healey, RN, PhD Senior Head of Patient Safety Intelligence, Research & Evaluation NHS England
FallSafe Regional Quality Improvement project “Can a ward-based nurse influence all disciplines to embed evidence-based falls prevention care bundles into regular ward practice using a quality improvement approach?”
FALLSAFE Baseline +12 months +18 months EXTENDED EVALUATION 1 Call Bell in reach 95% 100% 99% 2 Cognitive screen 60% 82% 70% 3 Asked about fear of falling 31% 76% 78% 4 History of falls taken 85% 99% 97% 5 Lying Standing BP 30% 70% 52% 6 Medication review 49% 75% 82% 7 Night sedation not given 66% 87% 90% 8 Safe footwear on feet 93% 98% 99% 9 Urine dip-test 55% 84% 83%
60% certain last fall was reported 16 77% certain 14 last fall was reported 12 10 8 6 4 2 0 Reported falls rate per 1000 bed days + rolling 12 month average Reported injurious falls rate per 1000 bed days + rolling 12 month average Falls rate ratio 12 months before full bundle v.12 months after 0.75 (0.68-0.84), p<0.001 Injurious falls rate ratio 12 months before full bundle v.12 months after 0.86 (0.71-1.03), P=0.11
What was different about the FallSafe approach? • Giving each FallSafe lead enough education and support to make them a confident and knowledgeable specialist within their ward team • Making sure the basic equipment they would need was available • Implementing the care bundle in stages rather than all at once, so improvements became manageable rather than overwhelming • Measuring how well the bundle was being delivered at least every month – but using the results to learn and improve, not to criticise or blame • Giving the FallSafe leads encouragement to be adaptable and deliver improvements in ways that suited their patients and their teams • Creating a community where they could exchange ideas with leads who were working in other hospitals and other specialities
What makes a good ward leader? Ten ward sisters were chosen from different wards, one from each trust whom we agreed were “great”. The consultancy spent a day with each sister, working with them, following them around and asking them lots of questions. Their matron and line manager were also interviewed. They then distilled this information and developed the profile: 13 strengths emerged and every ward sister who participated demonstrated each one.
What makes a good falls prevention leader? • Use the same technique • Think of someone whose LEADERSHIP in falls prevention/safety/older people’s care you really admire • Discuss and compare with the experience of your neighbours in the room • What shared qualities/strengths do all the leaders you admire have in common? • Write those qualities/strengths one per sticky note
If you were curious… “Is providing excellent nursing care and getting the basics right one of your deepest beliefs? Do you love developing others to become excellent at what they do? Is making a difference and doing the right “Caring” did not emerge in the profile…..but instead an thing fundamental to absolute need to do the right thing. These people are not you? If your answer rule breakers by nature, nor are they naturally assertive; to these questions is they are modest and self-effacing. But because doing yes, the ward the right thing for their patients is so important, they will sister/charge nurse break the rules if they feel they have to (always ensuring patient safety is not compromised) − they just don’t role may be right for you.” enjoy doing it.
Nearly done …..
Key UK falls resource links: • www.patientsafetyfirst.nhs.uk • www.nice.org.uk/CG161 • www.nrls.npsa.nhs.uk/alerts • www.rcplondon.ac.uk/resources/falls-prevention-resources • http://www.ageuk.org.uk/professional-resources-home • http://www.nos.org.uk/ Easy reading with hyperlinks to other resources http://britishgeriatricssociety.wordpress.com/2013/05/16/all-down-to- numbers/ http://britishgeriatricssociety.wordpress.com/2013/12/19/fallsafe-are-culture- clashes-good-for-us/ (or google Healey BGS blogs)
I can’t promise you that you can prevent every fall I can promise there is always something more we can do to prevent falls Thank you for listening @FrancesHealey frances.healey@nhs.net
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