1. Turning national guidance into local reality
Julie Windsor
Patient Safety Clinical Lead – Medical Specialties/ Older People
13th October 2016
Title slide with embedded images

2. What I’m going to cover.
Links between national audit data and other drivers to enhance improvement work
Engaging with patients to ensure data improves services important to them
Linking data with CQC inspection
NHS Improvement Falls Collaborative

3. In-patient falls audit
Most commonly reported patient safety event in hospital
Over 600 reported per day in England and Wales (>200,000 a year)
Not all result in injury but affects confidence and increases anxiety
>2500 hip fractures occur in hospital (4.2%)
£15 million per year

4. How do we prevent falls in hospital?
No easy answer
Multiple interventions performed by MDT reduces falls by 20-30%
Patients with dementia and delirium at particular risk
NICE CG161 and NPSA guidance
Audited all hospitals in England and Wales (and Northern Ireland)

5. Audit Design Organisational Audit Clinical Audit
Section 1- organisational details including data for falls/1000 OBD
Section 2- policies and protocols
Section 3- leadership and service provision
Participation 96% trusts and LHB’s
Clinical Audit
Section 1- evidence of assessment and intervention by case note review
Section 2- bedside assessment
Participation 90% trusts and LHB’s

6. Organisational results
Everyone has a Falls Prevention Policy- no relation between this and what actually happens
85.3% have a falls steering group, multi-disciplinary working group or sub group
73.1% use a falls risk prediction tool- NOT advised!
50.7% audit their bedrail use

7. Key recommendations for Trusts and LHB’s
Falls steering group –board-level falls steering group that has representation from and reports to the board. Review trends in falls/1000 OBD’s
Falls multidisciplinary working group –that meets regularly, and that they reviews the activities of the falls service. This group should monitor interventions to improve prevention of falls in hospital and use proven methods to embed these changes.

8. Key recommendations for Trusts and LHB’s
Do NOT use a fall risk prediction tool –
This is a tool identifying high/low risk
None are predictive of falls
Assess:
a ALL patients aged 65 years or older
b patients aged 50–64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition.

9. Key recommendations for Trusts and LHB’s
Audit bed rail use –regularly audit the use of bed rails against their policy and embed changes to ensure appropriate use.
Review multifactorial falls risk assessments (MFRAs) –review their MFRA and associated interventions to include all the domains in this audit.

10. Key clinical data national results

11. Or put another way… 6/7 patients didn’t have a l and s BP
Half didn’t have a clear medication review
2/3 didn’t have a delirium assessment
Half didn’t have a vision assessment
1/3 couldn’t reach their mobility aid
1/5 couldn’t reach their call bell
So there is a lot of room for improvement!

12. Key indicator recommendations
Dementia and delirium –review their dementia and delirium policies to embed the use of standardised tools and documented relevant care plans.
Falls teams should work closely with dementia and delirium teams (if present) to ensure team working for these high-risk patients.

13. Key indicator recommendations
7 Blood pressure –all patients aged over 65 years should have a lying and standing blood pressure performed as soon as practicable, and that actions are taken if there is a substantial drop in blood pressure on standing.

14. Key indicator recommendations
8 Medication review – We recommend that all patients aged over 65 years have a medication review, looking particularly for medications that are likely to increase risks of falling.

15. Key indicator recommendations
9 Visual impairment – all patients aged over 65 years are assessed for visual impairment and, if present, that their care plan takes this into account.

16. Key indicator recommendations
Walking aids –
A- all trusts have a system in place to ensure patients get the appropriate walking aid on admission
B- Regular audits should be undertaken to assess whether the policy is working and whether mobility aids are within the patient’s reach, if they are needed.

17. Key indicator recommendations
11 Continence care plan –all patients aged over 65 years have a continence care plan developed if there are continence issues, and that the care plan takes into account and mitigates against the risks of falling.

18. Key indicator recommendations
12 Call bells – We recommend that all trusts and health boards regularly audit whether the call bell is within reach of the patient and embed change in practice if needed.

20. CQC Inspection – a driver for improvement

21. Anywhere Hospital National Audit of Inpatient Falls
Metric
CQC Key Question
2015² Report
National Aggregate
(England)
National Aspirational Standard
Audit’s rating
53 cases
Case Ascertainment
All patients
Well led
Not reported for this audit
n/a
Does the trust have a multi-disciplinary working group specifically for falls prevention where data on falls and falls resulting in harm, severe harm and death per 1,000 OBDS is discussed at most or all the meetings.?
Effective
Yes
yes
Proportion of patients who had a vision assessment
Safe
53.3%
48.3%
100%
Between 50 and 79%
Proportion of patients who had a lying and standing blood pressure assessment
22.4%
16.1%
Less than 50%
Proportion of patients assessed for the presence or absence of delirium
85.6%
35.6%
100%*
More than 80%
Proportion of patients with appropriate mobility aid in reach
Responsive
83.7%
68%
Anticipated date of next update is mm/yy
1 Xxx 1x- Xxx 1x
2 May 15
* NICE Clinical Guideline

22. NHS Improvement – support for improvement

23. Who are NHS Improvement?
Patient Safety function from NHS England (including National Learning & Reporting System)

24. Strong regional presence to support 238 NHS and Foundation Trusts.
Support improvement (national and local)
Work alongside providers
Support local systems in agreeing longer term solutions and delivering them
Provide balance between support and regulation
Work closely and collaboratively with other national bodies, especially NHS England and CQC
Provide leadership support,

25. Key role to share best practice and reduce variation
Develop a national approach to improvement that supports local capability, aspiration and energy.
Ensure focus is on the quality of patient care.
Create a culture of continuous improvement.
Current nurse led improvement programmes include:
Pressure Ulcers
1:1 Nurse care
Infection, Prevention & Control Collaborative
Falls Collaborative launches on 19th October.

26. NHSI Falls Collaborative
Based on national audit indicators
Main purpose to:
Reduce incidence of falls and harm
Encourage increase in quality of reporting to support learning
Increase quality of interventions
Reduce variance in adherence to evidence based approaches

27. Other influencing opportunities

28. Summing up
National audit extremely well taken up
Provided high quality data
Focussed provider and national body attention
Provided a ‘road map’ for improvement
Thanks for listening …Any questions?