1. Reducing harm from falls our story.
Colin Baker, Lead Nurse
Presented by Sally Ashton,
Clinical Continuous improvement lead
2011 – NHS south west quality and patient safety improvement programme
Instigated by NHS south of england and institute for health improvement
Several workstreams one of which was falls – I was appointed lead

2. Original target – reduce harm from falls
Context : 48 bedded acute assessment hospital for people with psychiatric illness and physical frailty
Note harm from falls not numbers of falls
Several falls resulting in fracture nof and some deaths as a result.
Falls risk was identified but passed to MDT
No formal strategy was in place

3. Using the driver diagram: Examples
Ideas tested
Secondary drivers
Ward floor mapping
Falls pathway and post falls pathway
Need for handrails
Night light plug-ins
Re-test and re-invent!
Safety crosses
Falls alert magnets on Patient Status whiteboards.
Understand the local falls risk
Preparing the environment
Planning Patient specific care
Diagnosis/assessment
Staff skills/knowledge
Created drivers and thought about how we could tackle each one using PDSA cycles
Just some examples here which I will explain in more detail in a moment

4. Simple approach to encourage ownership, involvement and interest
The motto was “what can I do by next Tuesday ?”
No approval needed , no delay , simple steps to create momentum
PDSA Cycle

5. Falls cross One of the first examples
Simple, memorable and easy to introduce
Staff could see patterns they would ordinarily miss
I will come back to these later as with all these initiatives there is a timescale involved

6. Falls alert magnets
How many times do you look at the white board in a day and what do you consider when you do?
Now falls risk is prompted on each occasion
Easy, simple and memorable

7. Falls mapping
Bit more scientific and intended to add a bit of interest
Results showed those at risk tended to fall everywhere, no obvious hot spots to address although those not previously identified as being at risk tended to fall in their rooms

8. Pants! We developed a falls risk assessment involving all of the MDT
Those identified at risk were automatically provided with pants
A supply on the ward for out of hours admissions or staff concerns which suddenly arose
Obvious benefit to use – cheap in comparison to fractured nof
NHFD 2012 – 60,000 admissions for #nof each year
Cost to NHS around £2 billion each year
1 in 10 chance of dying within one month half do regain their previous mobility this is dropping currently about 8%

10. Handover +falls cross
Each handover staff report on any falls and update the cross.
If one has occurred and have a brief discussion about what happened.
Need to keep ideas new and re invigorate old ones , one way is to add a touch of detail and more involvement

11. Data – what does it tell us over time?
The number of falls has been reduced by 50% at times, but has risen during due to increased acuity of mental and physical health problems experienced by the patient group, on admission. This has also been reported in other mental health and general hospital settings.
When the number of falls fluctuates, the level of harm remains consistently reported as no/low harm – around 78% of reported falls.
Severe harm from falls has reduced by 50% since 2012 and been sustained.
Death as a result of a fall is a rare event.

12. Visual “at risk”  indicators Visual prompts for mobility aids
Falls Prevention training in Gloucestershire 
Visual “at risk”  indicators
Falls prevention training in Herefordshire 
Falls pathway and post falls pathway
Revised falls assessment
Visual prompts for mobility aids
Safety cross
Hip protectors 
Falls risk included in handovers
Post falls pathway embedded.
Hip protectors used.
Falls pathway revised.
Last death reported 

13. What have we learnt?
Safety Crosses/implementations have a shelf life and may need re-energising.
Customize your interventions and think out side the box.
Ideas can be brought across disciplines and adapted to be even more effective.
Data tells part of the story – use it to focus next steps and celebrate milestones to reinforce implementation.
Some areas may benefit from more formal study.

14. Ferrari Frames! (another PDSA). Dementia = impaired perception
Walking frames are grey
Grey is boring and blends in with the back ground
Paint them bright red!
Dementia – yellow last colour to go but red is the most attractive to people generally – not just talking about patients but also staff here

15. Learning from red frames:
Successful in raising both staff and patients awareness of the need to use a walking aid.
Patients will more readily recognise the red frame over a silver frame and staff have also been observed to be more aware of who uses a red frame.
Vigilance is heightened and falls have occurred less for those who use them. One gentleman’s falls reduced by 30%.
Time has been spent trying to source a supplier of red walking frames .
This idea has spread to other areas.

16. Proposed Study
The proposed study involves establishing a study group of those at risk due to noncompliance with their frame, exchanging this for a red one and then measuring for any improvement. This will also be re assessed at intervals to establish lasting changes if present.
If proven effective in improving compliance the plan would be to introduce red frames as a “norm” within this client group. We are hoping to work in partnership with the Hospitals Trust to improve the validity of the data and cover a wider scope of environments.
Assessment for compliance , stigma ?

17. Falls used to be something for the Physio/pharmacist/medic to sort out
The key element?
Falls used to be something for the Physio/pharmacist/medic to sort out
Now all staff know they have a part to play and in playing that part they can actively reduce the number of falls and the harm caused by them.
Attitude and belief

18. Thank you