National Falls Programme Update. Julie Windsor Patient Safety Lead Older People and Falls. National Advice & Guidance Team

Transcription

1 National Falls Programme Update Julie Windsor Patient Safety Lead Older People and Falls. National Advice & Guidance Team May 21 st 2015

2 What I m going to cover. NRLS update and NHS England programme update National FFF audit programme Falls and Fracture Alliance update Public Health England FFF Programme update Sign up to Safety Campaign Patient Safety Collaboratives Vanguard Programme

3 Falls The facts Generally not accidental but result of complex interplay between Functional decline (normal aging process) Medical decline Social factors The environment

4 But not like this.

5 More like this

6 Falls.. The figures. Leading cause of death through injury for % of people age 65 and over will fall every year increasing to 50% of those age 80 and over 60% of those who fall once will fall again in the same year Incidence in Care Homes and hospital x 2-3 (dementia & delirium IP Hip fracture mortality = 3 in 10 Return to pre fracture independence = 1 in 10

7 There's no shortage of falls policies and guidance..! DoH Quality & Outcomes Framework, NHS, Adult Social Care, Public Health NICE GG 81 Hip# NICE Hip # QS 16 NICE 161 Falls NICE Falls QS 86 NICE TA s 204, 160,161 CQUIN # prevention. Dementia Comprehensive Spending Review NHS Operating Framework Best Practice Tariff Hip # Prevention Package Older People Musculoskeletal Services Framework Active for Life NSF Older People Commissioning Toolkit Falls & Fracture Prevention RCP National Falls & # Audit BGS/AGS Falls Guideline Blue Book ( hip#) Silver Book ( urgent Care) NPSA Slips, Trips & Falls in Hospital NPSA RRR post fall response NPSA Safer Practice Notice ( Bedrails) MHRA Use of Bedrails guidance NPSA How To Guide Reducing Harm from Falls RCN Lets Talk about Restraint

8 No wonder it seems daunting!

9 And so are the numbers.. Acute and Community Hospitals. England PD09 Degree of harm (severity) Total No Harm 170, , , , ,359 Low 64,121 64,669 61,484 57, ,258 Moderate 6,922 7,017 6,389 5,274 25,602 Severe 874 1,024 1,070 1,113 4,081 Death Total 242, , , , ,793

10 Mental Health Hospitals. England PD09 Degree of harm (severity) Total No Harm 18,370 17,241 17,093 16,120 68,824 Low 12,935 12,160 11,207 10,682 46,984 Moderate 1,425 1,368 1,431 1,292 5,516 Severe Death Total 32,835 30,886 29,872 28, ,805 10

11 Age of patients reported to have fallen in hospital % of all reported acute falls Breakdown by age of falls in acute clusters 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Age group

12 Scale of the problem: death & severe harm Over 8,000 reported fatal or severe harm incidents each year 5% 6% 6% 6% Suicide/severe self harm 9% Fall (hip #/sub-dural) 8% 19% 17% 14% Pressure ulcer grade 4 Treatment error or delay Obstetric-specific incident Operation/procedure related Clinical diagnostic error/delay Missed deterioration Medication incident Healthcare associated infection Pulmonary embolus Test results not acted on Transfer or discharge incident Other/unclear NRLS post clinical review (after clear reporting errors excluded) April 2013-March 2014 England data: 8,018 incidents

13 Types of moderate and severe falls harms

14 What does severe harm look like?

15 Hip fractures from falls during hospital care

16 Who should we assess? All patients aged 65 years or older Patients aged 50 to 64 years who are identified by a clinician as being at higher risk of falling e.g. o Sensory impairment o Dementia o Fall o Stroke o Syncope, o Delirium o Gait disturbances

17 NICE CG161 recommendations ₓ Do not use risk prediction tools esp those that assign a numerical score or hierarchy of risk. ₓ Do not offer one size fits all blanket interventions. Do use individual multifactorial assessment. Do use multifactorial intervention plans. Do provide relevant oral and written information about individual falls risk factors & bedrail use 17

18 Multifactorial assessment should include cognitive impairment esp delirium continence problems falls history (causes, consequences, & fear of falling) footwear that is unsuitable or missing health problems that affect falls risk medication review postural instability, mobility and/or balance problems syncope syndrome visual impairment

19 Staff Education

20 E-learning for nurses.

21 E-Learning for doctors Aimed at FY1 & 2 doctors Patient falls assessment skills including medication and cardiovascular causes environment post fall actions specifically suspected hip or spine fracture

22 National Inpatient Falls Audit Under way for 2015/ Acute Trusts taking part Organisational, clinical & bedside (observational) components.

23 F Falls and Fracture Programme A survey of 20 areas to establish the feasibility of gathering and making available information about their local FFF system. Conducted by Local Authority Public Health teams in partnership with clinicians Purpose: piloting a framework to support the assessment and comparison of local falls and fragility fracture systems. commissioning a review of falls screening tools (primary care) commissioning a review of falls risk factors to support a social marketing campaign to increase falls awareness.

24 Falls and Fracture Alliance Made up of reps from all key stakeholder groups professional and voluntary sector Consensus statement for all party parliamentary osteoporosis group in Oct 15 Equitable access to secondary fracture preventions (rehab) Bone health included in NHS Health Check Wrist fracture BPT

25 Patient Safety Collaboratives Borne out of Berwick report and funded by the NHS with 12 million a year for the next 5 years. Coordinated by NHS England and NHS IQ (improving Quality) 15 sites across England linked to local Academic Health Science Networks Local improvements to improve safety and quality locally developed and tested then shared nationally

26 New Care Models: Vanguard Sites First steps towards delivering 5 Year Forward View Backed by multi million pound NHS Transformation Fund Complete re-designs of current care models Many of the 29 sites are looking at falls services. Focus on: Integrated primary and acute care systems Multi- specialty community providers Enhanced health in care homes

27 Patient Safety Collaboratives Priority Matrix

28 Imperial College Health Partners Academic Health Science Network

29

30 Sign Up To Safety (SU2S) Webinars 08 June, : Reducing harm from falls in acute, mental health & community hospitals; what does & doesn t work Presented by Julie Windsor, Patient Safety Lead, Older People and Falls To register

31 In development: falls education game for care homes

32 HiP HoP Flooring study Large high quality RCT Follow up study to original pilot to test shock absorbing flooring in clinical areas. Run by Portsmouth University with many collaborating partners including Health & Safety Laboratory and NHS Estates Will run over 3 years currently recruiting - me if you're interested

33 Falls experts: regional/national network.

34 To conclude: What's the most important falls intervention?. YOU! Thanks for listening.any questions?