Wednesday 23rd September HEAT TARGETS: NETWORK EVENT Fall and fracture prevention

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1 Wednesday 23rd September 2009 HEAT TARGETS: NETWORK EVENT Fall and fracture prevention Ann Murray Falls Programme Manager Practice Development Unit NHS Quality Improvement Scotland

2 Prevalence of falls and fractures Based on a local authority and PCT population of 300,000, which may include 45,000 people over 65. Of these: 35% (15,500) will fall each year 15% (6,700) will fall twice or more 15% (2,200) of fallers will attend an A&E department 15% (2,200) of fallers will call the ambulance service 7% (1,100) will sustain a fracture, 2% (360) to the hip From: Falls and fractures: effective interventions in health and social care (DoH 2009)

3 Older people who fall: A&E attendance Falls are under-reported: the consequence of the fall, namely the injury or fracture, becomes the diagnosis and subsequent code for the episode of care Over one third of falls go unreported in computerised A&E records In practice this results in the wider use of falls preventions becoming overlooked From: Urgent Care Pathways of Older People with Complex Needs, Best Practice Guidance, DoH 2007

4 Hip fracture Over 6,000 hip fractures in Scotland each year Costing on average 12,163 per admission (excl cost post discharge) Estimated cost to NHS Scotland 73 million From: SIGN 111 management of hip fracture in older people (2009)

5 Falls are not an inevitable consequence of old age; Falls are nearly always due to one of more underlying risk factors Recognising and modifying these risk actors is crucial in preventing falls and injuries Multifactorial targeted interventions, based on risk assessment, can reduce falls by up to 30% From: Falls and fractures: developing a local joint strategic needs assessment. (DoH 2009) In people with osteoporosis, the risk of further fracture can be halved by anti-resorptive drug therapy From: The care of patients with fragility fracture (British Orthopaedic Association, 2007)

6 The National Picture Rehabilitation and Falls HDL 2007 (13) CHPs need to appoint a falls prevention lead or co-ordinator ordinator to work along side the rehab coordinators NHS QIS Falls Programme Two year programme Working with identified CH(C)P Falls Leads Work programme identified by key stakeholders

7 Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures A resource to assist planning and development Will be available to view and download at:

8 Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures Places the different aspects of fall and fragility fracture prevention and management in the context of a journey of care Underpinned by explicit evidence, tacit and organisational knowledge and the older person s experience Based on the Future Model of Rehabilitation, Delivery Plan for Adult Rehabilitation in Scotland

9 The journey of care Stage 1 Stage 2 Stage 3 Stage 4 Supporting health improvement and self management to reduce the risk of falls and fragility fractures Identifying individuals at high risk of falls and/or fragility fractures Responding to an individual who has just fallen and requires immediate assistance Co-ordinated management including specialist assessment

10 Stage 1: Supporting health improvement and self management to reduce the risk of falls and fragility fractures Exercise provision for older people: the Vitality Programme Provided in partnership by Culture & Sport Glasgow and NHS Greater Glasgow and Clyde For people living with long term conditions, including those living with osteoporosis and older adults who have completed rehabilitation following a fall Highly trained instructors encourage individuals to participate in other suitable physical activities where appropriate Transport available Charge for class participation, which enables sustainability of the programme Contact: Deborah.Wylie@glasgow.gsx.gov.uk

11 Stage 2: Identifying individuals at high risk of falls and/or fragility fractures Identifying people at risk of osteoporosis and fragility fracture Fracture Liaison Services Assume responsibility for low trauma fracture case-finding Assess and perform diagnostic evaluations, and make specific treatment recommendations for the secondary prevention of osteoporotic fractures providing a one-stop clinic for all patients presenting with fragility fractures Contacts: Carol.Mcquillian@ggc.scot.nhs.uk (NHS GGC) Gina.delara@luht.scot.nhs.uk (NHS Lothian)

12 Stage 2: Identifying individuals at high risk of falls and/or fragility fractures Telecare services identifying recurrent fallers and linking with falls management and prevention services Joint NHS Forth Valley, Falkirk Council initiative, involving: the Mobile Emergency Care Service, Community Rehabilitation and Assessment Services and Day Hospital Two falls within a 6 month period - offer of referral to Falls Management Clinic GPs have agreed to direct referrals being made from MECS to Falls Management Clinic MECS service users sign a waiver to allow sharing of information between MECS and NHS Forth Valley Contact: linda.macpherson@falkirk.gov.uk

13 YEAR FALLS ATTENDED SERVICE USERS FALLS PER USER 2002 Projected 1768 * Projected 2003 Actual Actual 2004 Actual Actual 2005 Actual Actual 2006 Actual Actual 2007 Actual Actual 2008 Actual Actual # 2009 Actual Actual

14 Stage 3: Responding to an individual who has just fallen and requires immediate assistance A falls response service for older people who fall, are uninjured, but cannot get up Fife Falls Response Service (2006) Fife Council, NHS Fife, NHS 24, Ambulance, Fire and Police services Developed from Fife Council s pre-existing Mobile Emergency Care Service Two components: 1. Response: MECS team is dispatched to assist the person to rise from the floor 2. Referral for NHS follow-up/advice from existing teams for those over 65 to minimise the likelihood of future falls and fractures Contact: normahamilton-dyer@nhs.net

15 Contact: Stage 4: Co-ordinated management including specialist Assessment A community-based, integrated, multidisciplinary falls service: screening, triage and onward referral NHS Greater Glasgow and Clyde Community Falls Prevention Programme (CFPP) This service operates an open referral system to a central administration centre ie a single point of access Following referral, there is an initial telephone triage followed by a multifactorial risk screening in the older person s home, with onward referral to a variety of community and hospital services IT systems are in development to facilitate communication across the board-wide falls network The CFPP accepts approximately referrals per month Fallers are seen at home within 5 working days of telephone triage

16 Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures Will be available to view and download at:

17 Exchange knowledge, ideas, experience and good practice Find useful resources Access pre-programmed searches Find and contact colleagues Discuss topics of interest Keep up to date with news, events and Scottish initiatives Access secure shared spaces

18 Contact details: Ann Murray Falls Programme Manager NHS Quality Improvement Scotland Delta House 50 West Nile Street Glasgow G1 2NP Tel: Mobile: