Halving fractured hips in New Zealand Hospitals. Sandy Blake – National Falls Clinical Lead Carmela Petagna – Manager – Quality Improvement

The approach is … individualised care

The aim of individualised care Understand the risks and plan to prevent falls Reduce harm improve care outcomes Especially for our older people Both in hospital, residential care, or in their own home

We have made a difference

Harm reduced/cost savings July 2013-2016 76 # NOF NZ$3.5 million # hips per week: - 2 2015 - 1.3 2016 -1.2

But it’s even bigger than that On average an avoided broken hip gives an extra 1.6 years of healthy life This adds up to an additional 125 years of healthy life*, worth NZ$22.6 million

*Healthy life There are two ways to measure value and costs saved. Spending health care dollars more effectively People living longer, healthier lives. Value of a life  $4 million Value for a year of life in good health  estimated at $180,000

Prevent falls and reduce harm from falls in older people Goals/aims Prevent falls and reduce harm from falls in older people

Preventing falls and reducing harm from falls in older people Hospital settings Outcome measures: Nationally a reduction in fall-related hip fractures (10-30%) in hospital settings by 30 June 2015 Reduced fall-related additional occupied bed days and associated costs Process measures: 90% of older in-patients receive a risk assessment and individualised care plan addressing identified risks Prevent falls and reduce harm from falls in hospital acute care settings Reduce harm from falls and promote safe mobilising in aged residential care settings Promote falls prevention strategies in home based care settings and in the community (includes population health approach) Promote evidence-based best practice to build capacity & capability for Improvement and system change

What we did: Reducing harm from falls framework Enabled by: Capability and leadership, measurement for improvement, partners in care

Quarterly reporting to the Commission of older persons receiving risk assessment Move away from predictive risk assessments The level of risk is not important, but the actual risk is

Think about how to mitigate the risk you have identified Document the individualised strategies Note when a patient’s condition changes and reassess/rethink

Strategies are essential for all older persons regardless of risk Listed to save repetitive documentation But Must be audited to check they are implemented

Quarterly reporting to the Commission of older person deemed at risk and who has a care plan Individualised care must be linked to identified individualised risk factor If patient condition changes, reassess and then re-plan

Acknowledge the patient and family/whānau will know the problem of falling, therefore ask and listen Partner in care planning Partner in discharge planning and further community options

Check with family/whānau about what works to keep their loved ones safe Close care is not ‘watching’, it is caring, understanding and partnering with families/whānau Care for cognitively impaired should be the norm, not the exception

Falls 10 topics Having the discussion: expert visits webinars clinical lead visits Showcasing: what works seminars Releasing time to care module adapted for New Zealand

Recap: Reducing harm from falls framework Enabled by: Capability and leadership, measurement for improvement, partners in care

The Commission’s ongoing focus Leadership and guidance Clinical leadership and networks Cross-agency collaboration (Commission, ACC, Ministry of Health)

The Commission’s ongoing focus (cont.) Adaptive/flexible Measurement – stimulates improvement, evaluation, judgement of overall quality, prompt important questions Ongoing measurement for improvement

The Commission’s ongoing focus (cont.) Resources Evidence-based System approach to ‘falls, fractures fragility, frailty’

Our journey at a glance: Evaluation

www.hqsc.govt.nz/our-programmes/reducing-harm-from-falls/publications-and-resources/publication/2595/

Thank you Questions?