Preventing falls in hospitals Where to start? Dr Frances Healey November 2013

Transcription

1 Preventing falls in hospitals Where to start? Dr Frances Healey November 2013

2 Semi-United Kingdom

3 Timeline of national initiatives

4 National Reporting & Learning System National Patient Safety Agency 2007 Slips trips and falls in hospital NPSA: London, UK

5 Degree of harm Acute hospitals Mental health Rehabilitation hospitals Total No Harm 143,591 19,470 24, ,675 Low 57,306 15,194 12,047 84,547 Moderate 6,596 1,687 1,785 10,068 Severe Death 68* 7* 8* 83* Total 208,338 36,482 38, ,438 Updated data Slips trips and falls in hospital data update NPSA: 2010 (England + Wales) death figures after apparent coding error corrected but before later mortality from injuries is known

6 Per cent of sample Per cent 25% 20% 15% 10% 5% 0% % 90% 80% 70% Age of patient (years) % of all reported acute falls Per cent of total bed days 6% 5% 4% 3% 2% 1% 0% Per cent of total falls 00 (12 01 AM (102 AM) -(203 AM) (304 AM) (405 AM) (506 AM) (607 AM) (708 AM) (809 AM) (9 10 AM) ( (12 AM) (11 PM AM) 13 - (1 Midday) 14 PM) (215 PM) (316 PM) (417 PM) (518 PM) (619 PM) (720 PM) (821 PM) (9 22 PM) (10 23 PM) (11 PM) Midnight) 35% Falls incidents by hour of occurrence, for acute clusters Hour 60% 50% 40% 30% 20% 10% 0% Acute hospitals Community hospitals Mental health units Location of incident Apparently unwitnessed by staff Witnessed by staff 30% 25% 20% 15% 10% 5% 0% Acute hospitals Community hospitals Mental health units

7 Falls from bed 35% 30% 25% 20% 15% 10% Whilst walking From beds Circumstances unclear From chairs From toilet or commode Other 5% 0% Acute hospitals Community hospitals Mental health units

8 Bedrail resources

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10 Quality Improvement guides

11 Research evidence Myakie-Lye et al Cameron et al DiBardio et al Spoelstra et al Oliver et al Oliver et al Inpatient Fall Prevention Programs as a Patient Safety Strategy: A Systematic Review Interventions for preventing falls in older people in care facilities and hospitals. Meta-analysis: multidisciplinary fall prevention strategies in the acute care inpatient population Falls prevention in hospitals: an integrative review Preventing falls and fall-related injuries in hospitals (narrative update of Oliver et al. 2007) Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. Coussement et al Interventions for preventing falls in acute- and chronic-care hospitals: a systematic review and metaanalysis.

12 Predicting patients risk of falling in hospital Do not use fall risk prediction tools to predict inpatients risk of falling in hospital Regard all inpatients aged 65 years or older as being at risk of falling in hospital + inpatients aged 50 to 64 years (if clinical judgement that underlying condition could cause falls) 12

13 Falls risk assessment falls risk prediction scores (numbers) modifiable risk factor checklists (prompts)

14 Multifactorial assessment may include: 14 cognitive impairment continence problems falls history (causes, consequences, & fear of falling) footwear that is unsuitable or missing health problems that affect falls risk medication postural instability, mobility and/or balance problems syncope syndrome visual impairment

15 Multifactorial intervention 15 Ensure that any multifactorial intervention: promptly addresses the patient s individual risk factors takes into account whether the risk factors can be treated, improved or managed during the patient s expected stay Do not offer falls prevention interventions that are not tailored to address the patient s individual risk factors for falling.

16 Attention to the environment 16 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

17 Information for patients and carers Provide relevant oral and written information and support for patients, and their family members and carers if the patient agrees. Take into account the patient s ability to understand and retain information. 17

18 Essential care after an inpatient fall Separate 2011 guidance based on safety reports rather than research: Have a post-fall protocol specifying: Checks for injury before moving Safe manual handling if fracture Neurological observations Timescales for medical review Provide: 18 Flat-lifting/immobilisation equipment Glasgow Coma Scale formats Fast track to CT/x-ray/theatre

19 19 NHS Presentation to [XXXX Company] [Type Date] So we know what we should do But how well were we doing it? How could we improve frontline care? How could we spread the learning? Dr Jonathan Treml Dr Adam Darowski Debbie Sutton Julie Windsor