1. HSE - Prevention of Falls A Joint Presentation by: Antoinette Malone, Clinical Placement Co-Ordinator Nursing Practice Development Department Connolly Hospital, Blanchardstown HSE Dublin North East& Isaac Bontha, Senior Physiotherapist, Physiotherapy Department Sacred Heart Hospital, Roscommon HSE West

2. Driver for Patient Safety for Both Projects Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population - 2008 : – Economic burden estimated €551 million: Hospitalisation & healthcare provision. – Social cost: Long term negative impact on quality of life and independent living. High incidence of falls reported throughout both care settings: – Connolly Hospital: 703 in 2008 649 in 2009 – Sacred Heart Hospital: 135 in 2009

3. Connolly Hospital - Blanchardstown Total Number of beds: 383 – Inpatient : 330 – Day Services : 53

4. Key Patient Safety Initiatives Multidisciplinary team (MDT) Falls Prevention Committee 2009 - 2010. Revisions to 2007 hospital guideline Falls Risk Assessment Scale for the Elderly (FRASE) >60 yrs. Hospital wide introduction of: – Risk assessment tools. – Standardised nursing care plans. – MDT post fall flowchart, ward falls log. – Audit tool. Subgroup established 2010: – Pilot changes on 32 bedded acute medical ward (2010 & 2011). – A new system of highlighting patients falls risk at ward level. Falls prevention is everyone's business.

5. “ LOOK FOR THE STAR “LOOK FOR THE STAR” Symbol over patient bed: – RED – high falls risk – AMBER - medium falls risk – GREEN – low falls risk PREVENT THE FALL “PREVENT THE FALL” by – Assisting the patient. – Call for assistance of nursing staff / healthcare assistant. – Ensure patient call bell is within reach. Look for the Star & Prevent the Fall

6. Key Patient Safety Outcomes Reduction in falls on pilot ward by 27%. Falling stars a discreet way of highlighting patient falls risk. Received positively by Patients/Relatives. Increased compliance with guideline/audit. Completion of incident form. User friendly ward log. Implemented on five general ward areas.

7. Sacred Heart Hospital - Roscommon Care Facility for Elderly Total no of beds = 95 – 80 long term – 15 rehabilitation / respite / palliative care

8. Focus on Patient Safety An age group more vulnerable to slips / trips / falls. Audit of falls conducted in 2009. 42% reduction in incidence of falls since 2009.

9. Key Patient Safety Initiatives Cultural change through education and training of all staff and residents. Standardised assessments / care planning. Standardised operating procedure in event of a fall / falls audit tool. Medication review – impact of psychotropic drugs in relation to risk of falls. Targeted exercise addressing gait and balance deficits. Nurse-led Finometer Clinic to assess postural hypotension. Equipment review - low profiling beds, crash mats, patient monitoring systems. Awareness through falls calendar, posters and information booklet. Trending of incidents to assist review and learning. Creating a restraint free environment in parallel to falls prevention.

10. Governance Framework Sacred Heart Hospital: Sacred Heart Hospital: – Multi-disciplinary Committee. – Monthly meetings. – Review of incidents / trends. – Minutes and trending graphs circulated to all staff. Connolly Hospital Connolly Hospital – MDT Falls Prevention Committee. – Clinical Governance Quality Committee.

11. Shared Learning Across Both Projects The Challenges: Implementing change. Monitoring effectiveness of intervention. Promoting a “no-blame” culture. Cross-organisational working. The Benefits: Reduction in number of falls. Proactive approach: – Multifactoral assessments / interventions. – Standardised approach to falls prevention and post falls management. Continual education and training. Empowerment of staff / patients / residents / families. Ongoing communication keeps patient safety on the agenda. Continual improvement: –Connolly – plans to pilot falls risk precaution wrist band. –Roscommon - recent roll out to Daycare and collaborations with Primary Care Teams. Links to National Primary Care Falls Prevention Programme 2012. The Supports: Leadership at management & ward level. Multi-disciplinary / team-working. Environmental assessments / modifications. Piloting in one ward initially (Connolly).