Falls: A Review of the Data

Transcription

1 RJAH - Oswestry October 27,

2 Sources April 2013 to April Datix EPR Operation Notes EPR Medicines Reconciliation EPR Immediate Discharge summaries

3 Data Quality Missing Present No harm Low harm Molderate harm 0 24 Table: Datix Reports With No RJAH Number by Severity

4 Adult Falls: Year Severity + Type 13/14 14/15 15/16 75 Number of Patients Fall_Type Assisted slide to floor Not applicable Other Unwitnessed fall Witnessed fall 0 NO HARM LOW HARM MODERATE NO HARM LOW HARM Severity MODERATE NO HARM LOW HARM MODERATE

5 Inpatient Activity NO HARM LOW HARM MODERATE 13/ / / Table: Inpatient Activity - Numbers

6 Outpatient Activity NO HARM LOW HARM MODERATE 13/ / / Table: Outpatient Activity - Numbers

7 Assisted Falls Aided Unaided Harmed 0 10 Unharmed Table: Relationship between Aid Present and Fall Severity Chi Sq p = 1.

8 Severity of Incident Age 60 Severity NO HARM LOW HARM MODERATE count 100 Severity NO HARM LOW HARM MODERATE /14 14/15 15/16 Year 20 13/14 14/15 15/16 Year

9 Falls Map

10 Falls Map

11 Falls Map

12 Reconciliation 150 Number of Patients Medicine Reviews None /14 14/15 15/16 Year

13 count /14 14/15 15/ Number of s

14 Hypotensives and Sedatives Number of Hypotensive Agents 13/14 14/15 15/16 Number of Sedative Agents 13/14 14/15 15/ Severity Severity count 20 MODERATE LOW HARM NO HARM count 20 MODERATE LOW HARM NO HARM Hypotensives Sedatives

15 Combinations of Sedatives and Hypotensives Number of Hypotensives /14 14/15 15/ Number of Sedatives n

16 Polypharmacy as a Driver of Falls

17 Multi-Morbidity Adapting clinical guidelines to take account of multimorbidity Percentage of patients with this condition who also have this condition CHD Hypertension Heart failure Stroke Atrial fibrilation Diabetes COPD Painful condition Depression Dementia No other condition Coronary heart disease Hypertension Heart failure Stroke/transient Iscaemic attack Atrial fibrilation Diabetes Chronic obstructive pulmoary disease Painful condition Depression Dementia

18 30 Number of patients Year 13/14 14/15 15/ Number of Falls

19 13/14 14/15 15/ Table: Number of falls in multiple fallers by year

20 of Serial Falls Number of Falls Med&Rehab - GLADSTONE Med&Rehab - MCSI DEPARTMENT Med&Rehab - SHELDON Med&Rehab - WREKIN Surgery - ALICE Surgery - CLWYD Surgery - KENYON Surgery - LUDLOW Surgery - POWYS Table: Where multiple fallers are cared for

21 13/14 14/15 15/16 RevTHR RevTKR Spine THR TKR Table: Main Categories of Procedure Associated with Falls

22 13/14 14/15 15/16 RevTHR RevTKR Spine THR TKR Table: Main Categories of Procedure Associated with Falls

23 Number TypeOp RevTHR RevTKR Spine THR TKR Day of Fall After Operation

24 Age of 13/14 14/15 15/16 80 Age Spine RevTHR THR RevTKR TKR TKR RevTKR THR RevTHR Spine Spine RevTHR THR RevTKR TKR Type of Operation

25 Severity by Operation Type /14 14/15 15/16 Number Severity MODERATE LOW HARM NO HARM 0 Spine RevTHR THR RevTKR TKR Spine RevTHR THR RevTKR TKR Spine RevTHR THR RevTKR TKR Type of Operation

26 Falls in TKR Patients 13/14 14/15 15/16 Non Faller Faller Table: Falls in Patients

27 Falls After TKR - Drivers All knee arthroplasty patients used RandomForest statistical analysis Factors that explain and predict falls identified Shows areas for further examination

28 Items of importance Predictors of Falling in TKR Patients Anaesthetist Age Consultant AvgDrugs Year Sex Operation_Type MeanDecreaseGini

29 The Anaesthetic Effect Percentage of Cases Falling Rates of Falls in TKR Patients By Anaesthetist Anaesthetist Cases Anaesthetised

30 The Surgeon Effect Percentage of Cases Falling Rates of Falls in TKR Patients By Consultant Cases Treated Consultant

31 The Effect of Anaestheic Technique Freedom from pain Motor Blockade Reduced Proprioception Post operative sedation BUT... No data to allow evaluation

32 Age and Age t-test p = mean age non-fallers = mean age fallers = 72.7 Drugs t-test p = mean medications non-fallers 5.86 mean medications fallers 7.512

33 Falls in Children count Specialty Orthopaedics Paediatric Rehabilitation Paediatric Surgery Physiotherapy 13/14 14/15 15/16 Year

34 of Paediatric Falls count Alice Ward Bath/Shower Facilities Alice Ward Bay 1 Alice Ward Bay 2 Alice Ward Corridor Alice Ward Dayroom Alice Ward Other Alice Ward Physiotherapy Room Alice Ward Toilets Children's Outpatients Waiting Area Physiotherapy Hydrotherapy Area 13/14 14/15 15/16 Year

35 Outcome Severity in Childrens Falls count 5.0 Severity NO HARM LOW HARM /14 14/15 15/16 Year

36 Changes in reporting overwhelm trends Polypharmacy needs addressing (STOPP/START Protocol) Variation in anaesthetics needs understanding (Dept Anaesthetics) Frailty needs recording (Pre-op Assessment)! Focus on Multimorbidity

37 A Cut-Off for Frailty Assessment 1.00 Culmulative Age of Proportion of % Age