Welcome Falls Prevention initiative Main title slide page Michele Streatfield, Lead Nurse

Situation Falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged 75 and older in the UK. People aged 65 and older have the highest risk of falling. Falls in hospitals are the most common patient safety incidents reported in hospital trusts in England. The National Patient Safety Agency’s (2011) report Essential care after an inpatient fall states that each year around 282,000 patient falls are reported to the NHS England's Patient Safety division from hospitals and mental health units.

Situation Sadly, the human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling can also affect the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs. With this in mind, it was widely acknowledged by the trust (local and senior teams) that an increased focus on falls prevention was required and reducing the number of falls was paramount.

Background Targets in previous years to reduce the number of falls resulting in moderate to severe harm by 20%. To work inline with NICE best practice falls prevention guidance and pathways

Benefits to the patient and staff More confident in self and staff Increased staff satisfaction Reduced mortality risk Competent Increased patient satisfaction Providing a better quality of care Reduced risk of injury and pain Reduced length of stay in hospital Increased independence Making a difference to patient outcome/reduction in falls injury risk Help reduce the cost to the wider health economy Patient Staff

Assessment - Falls Reduction in inpatient falls incidents AIM PRIMARY DRIVERS SECONDARY DRIVERS Understand local falls risk - where, when, time etc. Early identification and assessment of risk at first point of entry into care Identification of risk Patient falls risk assessment Falls hx/medication review – use of sedation Gait, balance, mobility, muscle weakness Osteoporosis risk Functional ability Visual and cognitive impairment Urinary incontinence Cardio vascular assessment Environmental Blood pressure/postural hypotension Reduction in inpatient falls incidents Multi-factorial risk assessment Multi-factorial interventions - Care plans/care pathway developed following on from patient specific risk assessments - Preparing the environment - Implement Intentional rounding/general observation or increased observation based on risk assessment Communication of falls risk and interventions Communicate risk (who needs to know) Falling star initiative Involvement of patient and family Integrate falls risks in ward handovers and safety briefings (mental health productive ward) Education for staff/service users/carer/relative Falls prevention training provided for staff and motivational interviewing

Measurement

Update This demonstrates that overall falls in our inpatient wards have reduced by 35% over this period. Moderate/severe harm has reduced by almost 25% (Sept 15 – Sept 16)

PDSA Testing Ramps for Falling star initiative DATA FEEDBACK TO FRONTLINE STAFF Cycle1E: Collate information review PDSA and roll out to other wards (blankets didn’t work and were withdrawn) Cycle 1D: Monitored falls incidents since start of initiative Falling star initiative discussed with staff and introduced safety huddles Cycle 1C: Meet Ward Managers to discuss falling star initiative and products ordered Cycle 1B: Cycle 1A: Identify wards to pilot the falling star initiative based on the number of falls identified by the Trust wide Falls Group 43

PDSA Testing Ramps for: Using MH Productive ward falls monitoring DATA FEEDBACK TO FRONTLINE STAFF 1E: Collate information review PDSA Cycle 1D: Review data and act/adapt accordingly Cycle 1C: Monitoring falls incidents via safety crosses and measles charts Cycle 1B: Meet with wards to discuss and support Cycle 1A: Communicate to ward managers re MH Productive Ward and falls recording 43

Recommendation Staff were initially sceptical about the falling star initiative, but the results spoke louder than words and encourage communication/safety huddles. Using the Productive Mental Health Ward to identify falls themes and trends was and can be challenging. Some wards were more enthusiastic than others, but with support teams were able to identify areas of improvement. Training the right staff, make it interesting and current and encourage patient/service user involvement. Keep the key messages focused on the positive human impact of falls reduction and lead enthusiastically, but encourage innovation and keep falls. Focus on what they CAN do, rather than what they feel can’t be achieved. Regular falls prevention meetings and falls incidents across the trust are monitored via the Quality Committee.

Key improvement message learnt