Falls prevention workshop

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Falls prevention workshop
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Falls prevention workshop

• AIM demonstrate how leaders can influence
  change
• Frances Healey national context and evidence
  base
• Kevin OHart local falls prevention initiatives
• Group discussion leadership challenges

• Kevin OHart
• Practice Development Nurse
• Essex Rivers Healthcare NHS Trust
• Kevin.OHart_at_essexrivers.nhs.uk

• Frances Healey
• Patient Safety Manager
• National Patient Safety Agency
• frances.healey_at_npsa.nhs.uk

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Slips, trips and falls in hospital

• Summary of the evidence base for falls
• prevention (including 7 systematic reviews)
• 14 practical examples of implementing
• the evidence
• Model care plan
• Calculate your own benchmark
• Improve local learning from reports of falls
• Signposts 60 key guidance and resources
• Download Slips, trips and falls in hospital from
  www.npsa.nhs.uk/pso

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Recommendations

• Each patient at risk of falling should receive
  multifaceted clinical and environmental
  interventions. To achieve this
• make sure that the circumstances of falls are
  described completely and meaningfully on local
  incident forms
• analyse and use reports of falls to learn about
  contributing factors, from ward to board level
• create a falls prevention group with the right
  members to act on both clinical and environmental
  risk factors
• base falls prevention policies on the evidence
  described in this report
• if using a falls risk score, understand to what
  degree it under- or over-predicts the chances of
  a patient falling
• have appropriate guidance for staff on how to
  observe, investigate, care for and treat patients
  who have fallen.

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Headlines 2005/06
98 of NHS trusts in England and Wales
12 months 2005/06
206,323 falls
972 fractures (530 NOF)
26 deaths
15,000,000
at time of reporting given known mortality
post NOF, likely to be subsequent deaths
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• Preventing patients from falling is a particular
  challenge in hospital settings because patients
  safety has to be balanced against their right to
  make their own decisions about the risks they are
  prepared to take, and their dignity and privacy.
  
• Rehabilitation always involves risks, and a
  patient who is not permitted to walk without
  staff may become a patient who is unable to walk
  without staff.
• NPSA Slips trips and falls 2007

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Any magic bullets?

• Risk assessment tools problematic
• Increasingly weak evidence on hip protectors
• Movement alarms and ultra-low beds may benefit
  only a small number of patients but may
  re-energise attitudes

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Who falls? Age
Relative risk highest 85 years

• bed days
• falls

0 years
100 years
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Why?
69 patient factors
5 environmental

• ..the patient stood up from her chair at the
  bedside and fellwearing inappropriate footwear,
  diabetic, has hypotension, was admitted following
  fall at home, normally uses nurse call bell but
  when checked after fall had low blood sugar, this
  probably made her momentarily forgetful.

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Complex interplay between individuals and
environment

• For example
• Confusion (cant recall advice)
• Illness (faints as falls)
• Incontinence (slip hazards)
• Poor eyesight (miss hazards)
• Age/frailty (increased likelihood of injury in
  minor fall)
• Individual attitudes to risk, compliance, privacy
• Dont mention the F word!

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Falls have multiple individual causes.

• . and need multiple individual interventions
  from multi-disciplinary teams
• Culprit medication/unnecessary polypharmacy
• Eyesight
• Footwear
• Unsafe mobility balance, advice, aids
• Medical cardiac, postural hypotension,
  delirium, UTI
• Detect and treat osteoporosis
• Oliver et al BMJ 334 82-7 2007

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and attention to the environment

• Flooring surface, underlay, cleaning methods,
  pattern
• Lighting including light gradients, sensor
  lights
• Furniture beds, chairs, tables, stability
• Call bells intercoms, brass bells
• Toilets compromises
• Spaces/journeys/grab points e.g. door hinge
  side
• Trip hazards including medical equipment

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Advising or intervening?

• Recent systematic review of RCTs in community
  settings Interventions that actively provide
  treatments may be more effective than those that
  provide only advice or recommendations
• Equally true of hospital policies? advise
  patient/relatives on safe footwear
• Has to be the real McCoy (six weeks movement to
  music exercise class not equivalent to sixteen
  weeks of intensive physio-led strength and
  balance training !)
• Gates et al. BMJ 2008 336 130-3

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National clinical audit of care and secondary
prevention after fracture

• unacceptable variations in care. most were
  nowhere near meeting NICE guidelines and NSF
  standards it is up to local commissioners,
  managers and clinicians to work together
• Annual admissions 75 1/3 population 75
• Start in hospital benefit in the community
• (e.g. osteoporosis treatment)
• Start in the community benefit in hospital
• (e.g. eyesight)
  www.rcplondon.ac.uk

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Using bedrails safely and effectively

• Helping organisations strike a balance
• Model policy
• Literature review
• Audit tool
• Safe systems to embed MHRA guidance (dimensions)
• Awareness raising posters

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Take home messages

• Falls prevention is a long term effort not a
  one-off
• Falls prevention is not just a nursing problem
• create a falls prevention group with the right
  membership to act on both clinical and
  environmental risk factors.
• First things first (cautionary tales of shoes,
  hip protectors, and walking frames)
• A little bit of resource breaks down
  powerlessness/apathy
• Dont ask the impossible or the unreasonable
  (cautionary tales of one-to-one observation and
  measuring bedrails)

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Thank you for listening

• Any questions before the group exercise?

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Coroners case

• For discussion
• How can Directors and Champions ensure this
  patients story is used positively to improve the
  future safety of patients?
• How would they respond to the coroners statement
  that privacy and dignity are less important than
  safety?