SLIDE 1
Management of the Fallen Uninjured Person NHS 24
Wednesday 17th December
Ann Murray National Falls Programme Management ann.murray3@nhs.net
SLIDE 2 Management of the fallen uninjured person
From a national perspective:
- Current situation
- Background
- Falls
- National Programme
- Development work in this area to date
- Assessment of the current situation
- Existing pathways for the fallen uninjured person
- Proposed plan
SLIDE 3 Management of the fallen uninjured person
Current situation
- From NHS 24, there have been reports of frail and/or elderly people
being left lying on the floor for long periods of time, after requesting immediate assistance following a fall.
- Historically, and by default, the Scottish Ambulance Service (SAS) has
undertaken the role of assisting an uninjured person from the floor following a fall.
- This has been in the absence of alternative arrangements (and in the
interests of the person). This is not their remit and it can delay ambulance crews from attending life threatening situations. With growing demands, this approach is not sustainable for SAS.
- With SAS continuing to provide assistance for uninjured fallen persons,
in many health and social care partnership areas the need for robust alternative arrangements is sometimes hidden.
SLIDE 4
Management of the fallen uninjured person
Current situation
In many health and social care partnership areas, there are no formal arrangements in place for responding to people who fall in their home, are uninjured, do not have a community alarm/telecare, but require urgent assistance to get up.
SLIDE 5 Management of the fallen uninjured person
Background: why falls matter For an older person a fall can be…
- trivial, profound or fatal,
- the first sign of a new or worsening health
problem,
- a marker for the onset of frailty,
- a ‘tipping point’ leading to loss of
confidence and independence, and increased dependence on family, and health and social services. A fall is a symptom, not a diagnosis.
“I was never the same after the fall” “I suddenly became an old person” “I don’t really feel the same person” “I was thoroughly demoralised” NHS QIS Focus Groups, October 2008
SLIDE 6 Management of a fallen uninjured person
Background : scale and cost
In people 65 years and over:
- Largest single presentation to the Scottish Ambulance Service (over 35,000
attendances).
- One of the leading causes of Emergency Department attendance.
- Responsible for over 390,000 emergency bed days.
- Implicated in up to 40% care home admissions.
- Highest reported incident in hospital settings.
Costs to health and social care services in Scotland estimated to exceed £471m each year (est. rising to £666m by 2020):
– 45% long term care – 40% NHS – 15% care at home ( £39,500 per hip fracture) (Craig 2012)
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SLIDE 7 Management of a fallen uninjured person
Background: National Falls Programme in Scotland (2010-present)
Aims
- To reduce the personal, system and
societal costs associated with falls and harm from falls in Scotland.
- For every health and social care
partnership area in Scotland (32 partnerships) to have a local, integrated falls prevention and management pathway in operation.
- Working with CH(C)P Falls Leads.
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The Up and About Pathway (2010)
http://www.healthcareimprovementscotland.org
SLIDE 8 Management of a Fallen Uninjured Person
Background: the Up and About Pathway (2010)
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The Up and About Pathway (2010)
http://www.healthcareimprovementscotland.org
SLIDE 9
Stages 2 and 4
The evidence base .
SLIDE 10 Management of the fallen uninjured person
Background: not a new issue
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The Up and About Pathway (2010)
http://www.healthcareimprovementscotland.org Stage Three The aim is to provide:
- a rapid response to avoid a
long lie on the floor, and
which includes both: safe and effective management of the immediate situation, and consideration of further health and care needs.
SLIDE 11
Management of the fallen uninjured person
Background: Developments at Stage 3 of the Pathway
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2013 2012
SLIDE 12 Management of the fallen uninjured person
Background: complications of a ‘long lie’
Complications include: – Pressure ulcers – Kidney damage caused by muscle breakdown – Pneumonia – Hypothermia – Dehydration – Psychological harm
- Depression
- Fear of falling
- Anxiety
- Loss of self confidence
– Death
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A ‘long lie’ following a fall is defined as remaining on the ground or floor for
[Todd and Skelton, 2004]
SLIDE 13 Management of the fallen uninjured person
Background: Community Alarm and Telecare Services
- Nearly all services are provided or
commissioned by local authorities.
- Many, but not all telecare
services/community alarm services provide a response service for clients who have fallen and used their alert.
- In many local authorities (24) there is a
charge for this service (£1.10 - £8.40 p/w). There is some evidence that this can deter older people from using the service.
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SLIDE 14 Management of the fallen uninjured person
Background: Stage 3 of the Up and About Pathway
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SLIDE 15 Management of the fallen uninjured person
Background: example in Up and About
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SLIDE 16 Management of the fallen uninjured person
Background: ‘Mapping’ and the Up and About Report (2012)
“A growing number of partnerships are identifying alternatives to an SAS response for fallers who are assessed on telephone triage as uninjured, but are unable to get up from the floor without
- assistance. This is in addition to the
service provided by telecare/community alarm teams to existing clients”.
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Scottish Government, 2012
SLIDE 17
In your CH(C)P is there formal local agreement on which service providers are responsible for assisting an uninjured person from the floor (24 hours/day)? This is for people who do not have a community alarm/telecare service. Don’t Know No Need identified; no work yet in progress Work in progress Yes
N Ayrshire S Ayrshire E Ayrshire SE Highland Angus S Glasgow E Renfrew W Isles Dundee NE Glasgow NW Glasgow Dumf & G’way Stirlingshire Clackmann. Argyll & Bute N Highland Mid Highland Moray N Lanarkshire S Lanarkshire W Dunbarton E Dunbarton Renfrewshire Shetland Borders Aberdeen Aberdeenshire Inverclyde West Lothian Perth & Kinross Falkirk Edinburgh East Lothian Mid Lothian Dunf & WF Kir’dy & Lev Glenr & NEF Orkney
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State of play at end of 2011
SLIDE 18 Management of the fallen uninjured person
A Framework for Action 2014/16
About the Framework
- The Framework describes 16 key actions for health and
social care services across the four stages of the Up and About pathway.
- These actions represent the minimum standard of care
an older person should expect to receive, regardless
- f where and when they present to health and social
care services following a fall.
- At points throughout the pathway, statutory services will
work with third and independent sector partners to deliver the actions described. As such, the Framework is relevant to all partners involved in the falls and fracture prevention and management pathway.
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http://www.scotland.gov.uk/Publications/2014/10/9431
SLIDE 19 The National Falls Programme in Scotland
A Framework for Action 2014/2016
Action 3.1 Responding services have a standard operating procedure for responding to an older person who has fallen and has or has not sustained injuries. Principles
- There is absolute clarity and agreement amongst all local
responding services on arrangements for responding to uninjured individuals following a fall.
- NHS 24 is informed of local arrangements for responding to
an uninjured person following a fall so it can respond to emergency calls appropriately and in a timely manner. Implementation note: Local variation in ‘responding services’ provision often results in the Scottish Ambulance Service becoming the default responder to people who have fallen and only need help to get up again. This is inappropriate use of a service for emergency health care. Local service provision requires to be mapped and understood before a SOP can be agreed.
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SLIDE 20 Management of the fallen uninjured person
Assessment of situation
- Although many people who fall will require a ‘face to face’ assessment
to determine their health status and subsequent needs, there will be a group of people whose status and circumstances can be established
- ver the phone, and an appropriate ‘non SAS’ response arranged. We
have limited data on the size of this group.
- A continued lack of a co-ordinated and consistent approach is placing at
risk people who fall and lie for long periods without assistance.
- There are successful, sustainable care pathways for people who have
fallen and are uninjured in operation in some areas of Scotland. These can provide useful models to help develop and implement pathways elsewhere.
- Partnership areas where robust arrangements are not in place need to
be identified and action taken to bridge this gap in service provision.
SLIDE 21
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Edinburgh example
SLIDE 22 Management of a fallen uninjured person
Edinburgh City
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SAS
65 years + (April ‘09 – Mar ’10)
Community Alarm Service
(Apr ‘13 – Mar ‘14)
Fallen Uninjured Person Pathway
(Apr ‘13 – Mar ‘14)
April 241 358 15 May 258 345 15 June 222 316 5 July 190 370 16 Aug 230 336 11 Sept 279 393 25 Oct 234 384 19 Nov 231 465 22 Dec 305 418 17 Jan 270 430 22 Feb 217 352 21 Mar 222 382 13
TOTAL 2,899 4,549 191
SLIDE 23 Proposed plan
- Framework for Action self assessment of spread (January 2015)
- National Scoping (commencing January 2015)
- SAS Pathways
- Management of uninjured fallen person
- Frailty and Falls Pathways Task and Finish Group (early 2015)
- Recommendations following the scoping
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“The future is already here – it’s just not very evenly distributed.” William Gibson
SLIDE 25
For more information, please contact:
Ann Murray National Falls Programme Manager ann.murray3@nhs.net
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http://www.knowledge.scot.nhs.uk/fallsandbonehealth/the-national-falls-programme.aspx
