Falls Prevention & Promotion Deborah Birch Consultant Nurse for Frailty

Impact of falls A fall in hospital can result in an average increase in stay 1-2 days. Research has shown that multiple interventions performed by MDT & tailored to individual can reduce falls by 20-30%. Falls are estimated to cost the NHS more than £2.3 billion per year (NICE, 2013) and rising Research has shown that multiple interventions performed by MDT and tailored to individual can reduce falls by 20-30%

Falls related Anxiety cycle Fall or stumble Loss of confidence Fear of falling Reduced home or community duties Decreased body strength More unstable on feet Increased risk of falling

Lincolnshire

Lincolnshire Interesting facts Demographics Population of 743,400 1st policewoman - Edith Smith 1915 (Grantham) Population of 743,400 Large proportion of Rural, Retirement Proportion of people over 75yrs projected to increase by 95% bet 2014-2039. 4 x CCGs Home to one of only four surviving copies of the Magna Carta Invented the tank

Lincolnshire…… LCH = 500+ beds

Aims: Journey so far within ULHT NHS Improvement collaborative Ongoing initiatives

Reported falls per 1,000 OBD’s East Midlands Falls resulting in mod/severe harm or death per 1,000 OBD Falls per 1,000 OBD’s Chesterfield Royal 0.10 8.67 Derby Hosp 0.19 8.27 Northampton Gen 0.11 5.96 Nottingham Uni Hosp 0.31 9.99 Sherwood Forest Hosp 0.24 9.49 United Lincolnshire 0.56 6.60 University Hosp of Leicester 0.07 5.32 Organisations within the NHS vary in size and activity. Therefore, calculating reported falls per 1,000 OBDs can be used as a guide to benchmark with the reported rates from other NHS organisations The NPSA calculated the mean rate of falls per 1,000 OBD’s as 5.6 for acute hospitals

The Journey…… Deputy Chief Nurse with falls remit as part of safety remit - Reinvigorated Trust Falls Group - Monthly Falls Scrutiny Panels 1st Falls Summit to increase staff awareness Developed Falls Workbook

Trust Wide Falls Group Lead Jenny Hinchliffe (Interim Lead Nurse /Patient safety manager) Representation from across all sites Medics, OT, Physio, Nurses, Risk Management Monthly Forms part of Ward Accreditation W5 The ward has a Falls Ambassador for falls and attends a minimum of 6 falls steering group meetings. Yes/No Observe minutes of meetings, Resource Folder FS: 12.2c,18.1,19.1b KLOE: S1,S4,S6,E3,W1,W8 6C's: Competence, Communication, Commitment 10C's: C8,C9 NMC: 2,4

Falls Scrutiny Panels The ULHT Falls Scrutiny Panel is a sub-committee of the ULHT Falls Group. The panel forms part of the Trust’s overall assurance process relating to protecting patient’s safety. All patients who have sustained severe harm following a fall while in ULHT. Ward Sister presents timeline to panel Identifies areas of good practice and gaps in care. Helps to identify trends Action Plan W4 Ward attendance at falls scrutiny panel at 100% with action including Ward Improvement plan for falls greater than 2 severe harm. Yes/No Observe minutes of meetings, FS: 12.1,12.2b,17.2b,18.1 KLOE: S1,S5,S6,E1,W3,W1,W4,W8 6C's: Care, Courage, Communication, 10C's: C4 NMC: 3

Falls Summit

Falls Workbook W3 95% of staff have completed the Falls workbook and have gained competencies in lying and standing BP monitoring. Yes/No Observe records, Ask staff FS: 12.1,12.2b12.2c,17.2b,18.1,19.1b KLOE: S1,S4,S6,E3,W1,W8 6C's: Competence, Communication, Commitment 10C's: C8,C9 NMC: 2,3,4

NHS Improvement Falls Collaborative Programme 90 day improvement cycle aimed at improving the management of falls in the inpatient setting in 19 Trusts Re-energise the falls prevention improvement movement and ensure that providers have the information, skills and tools to reduce injurious inpatient falls and improve reporting and care Aimed to achieve a 5% reduction in falls rate PDSA cycles used to share improvements

Wards involved Ward 3B Trauma Orthopaedic Ward Ward 6B Complex Care of Older Males Ward

First Step: Falls Workbook role out 95% of staff have completed the Falls workbook and have gained competencies in lying and standing BP monitoring. Yes/No Observe records, Ask staff FS: 12.1,12.2b12.2c,17.2b,18.1,19.1b KLOE: S1,S4,S6,E3,W1,W8 6C's: Competence, Communication, Commitment 10C's: C8,C9 NMC: 2,3,4

PDSA a way of testing change

PDSA: Cycle One Medications Plan: To Improve the knowledge and awareness of the ‘Red Flag’ medications on each ward. Do: To place medication prompts of the top 10 risk medications in relation to falls on medication trolleys/ clinical rooms Study: Pre audit number of recognizable drugs know to staff. Then re-audit monthly Act: Role out

PDSA: Cycle Two Lying and Standing Blood Pressure Recording Plan: To improve the compliance of L&S BP by 75% Do: To apply stickers into patients notes as a prompt to undertaking the L&S BP Study: Monitor SQD results Act: Role out

PDSA: Cycle Three Fall Hot Spots Plan: To identify main areas where falls take place Do: Populate scatter graph onto a ward layout map Study: Monitor for ‘hot spot’ Act: ongoing

Falls incidents Wards 3B & 6B   No harm Low Harm Moderate Severe Death Total March 2016 2017 Ward 3B 7 3 1 8 4 Ward 6B 9 14 12 18 April 2 6 11 May June 5 3B – number of falls and falls with harm have reduced compared to the same period last year and since March – no moderate or severe harms compared to the same period last year. 6B – although the number of falls has not consistently reduced since last year, we are now seeing a downward trajectory. Falls with harm have reduced. Target is to reach 0.19 per 1000 OBD for falls with harm, in June Pilgrim exceeded this with 0.17 per 1000 OBD. Number of repeat falls on 6B. Further work is being done to understand how patients are managed between falls – 17 patients across the Trust had 3 or more falls since April.

Falls per 1000 bed days Ward 3B Downward trend

Falls per 1000 bed days Ward 6B Although we have seen an upward trend, we are now beginning to see a reduction in the number of falls. 18 falls in March, 14 no and 4 low harm 12 falls in June – 8 no harm, 4 low harm

What has the journey taught us so far…. The need for a whole system approach to change. The need to change the attitude and culture of falls That reducing falls needs to be multi faceted That education and knowledge is power Small changes lead to a big change

Next steps Need to consider ‘Multiple Falls’ and the role of safety huddles Development of e-learning training package to support workbook Role of L&S stickers across all sites Role out Medications prompts across all sites Develop falls ambassadors Falls as part of the metric for ward accreditation

Ultimately …We need to change the Culture to how we view a fall..