1. Welcome Falls Prevention initiative Main title slide page
Michele Streatfield, Lead Nurse

2. Situation
Falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged 75 and older in the UK. People aged 65 and older have the highest risk of falling.
Falls in hospitals are the most common patient safety incidents reported in hospital trusts in England. The National Patient Safety Agency’s (2011) report Essential care after an inpatient fall states that each year around 282,000 patient falls are reported to the NHS England's Patient Safety division from hospitals and mental health units.

3. Situation
Sadly, the human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling can also affect the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs.
With this in mind, it was widely acknowledged by the trust (local and senior teams) that an increased focus on falls prevention was required and reducing the number of falls was paramount.

4. Background
Targets in previous years to reduce the number of falls resulting in moderate to severe harm by 20%.
To work inline with NICE best practice falls prevention guidance and pathways

5. Benefits to the patient and staff
More confident in self and staff
Increased staff satisfaction
Reduced mortality risk
Competent
Increased patient satisfaction
Providing a better quality of care
Reduced risk of injury and pain
Reduced length of stay in hospital
Increased independence
Making a difference to patient outcome/reduction in falls injury risk
Help reduce the cost to the wider health economy
Patient
Staff

6. Assessment - Falls Reduction in inpatient falls incidents
AIM PRIMARY DRIVERS SECONDARY DRIVERS
Understand local falls risk - where, when, time etc.
Early identification and assessment of risk at first point of entry into care
Identification of risk
Patient falls risk assessment
Falls hx/medication review – use of sedation
Gait, balance, mobility, muscle weakness
Osteoporosis risk
Functional ability
Visual and cognitive impairment
Urinary incontinence
Cardio vascular assessment
Environmental
Blood pressure/postural hypotension
Reduction in inpatient falls incidents
Multi-factorial risk assessment
Multi-factorial interventions
- Care plans/care pathway developed following on from patient specific risk assessments
- Preparing the environment
- Implement Intentional rounding/general observation or increased observation based on risk assessment
Communication of falls risk and interventions
Communicate risk (who needs to know)
Falling star initiative
Involvement of patient and family
Integrate falls risks in ward handovers and safety briefings (mental health productive ward)
Education for staff/service users/carer/relative
Falls prevention training provided for staff and motivational interviewing

7. Measurement

8. Update
This demonstrates that overall falls in our inpatient wards have reduced by 35% over this period.
Moderate/severe harm has reduced by almost 25% (Sept 15 – Sept 16)

9. PDSA Testing Ramps for Falling star initiative
DATA FEEDBACK TO FRONTLINE STAFF
Cycle1E: Collate information review PDSA and roll out to other wards (blankets didn’t work and were withdrawn)
Cycle 1D:
Monitored falls incidents since start of initiative
Falling star initiative discussed with staff and introduced safety huddles
Cycle 1C:
Meet Ward Managers to discuss falling star initiative and products ordered
Cycle 1B:
Cycle 1A:
Identify wards to pilot the falling star initiative based on the number of falls identified by the Trust wide Falls Group 43

10. PDSA Testing Ramps for: Using MH Productive ward falls monitoring
DATA FEEDBACK TO FRONTLINE STAFF
1E: Collate information review PDSA
Cycle 1D: Review data and act/adapt accordingly
Cycle 1C: Monitoring falls incidents via safety crosses and measles charts
Cycle 1B: Meet with wards to discuss and support
Cycle 1A: Communicate to ward managers re MH Productive Ward and falls recording 43

11. Recommendation
Staff were initially sceptical about the falling star initiative, but the results spoke louder than words and encourage communication/safety huddles.
Using the Productive Mental Health Ward to identify falls themes and trends was and can be challenging. Some wards were more enthusiastic than others, but with support teams were able to identify areas of improvement.
Training the right staff, make it interesting and current and encourage patient/service user involvement.
Keep the key messages focused on the positive human impact of falls reduction and lead enthusiastically, but encourage innovation and keep falls. Focus on what they CAN do, rather than what they feel can’t be achieved.
Regular falls prevention meetings and falls incidents across the trust are monitored via the Quality Committee.

12. Key improvement message learnt