1. Halving fractured hips in New Zealand Hospitals.
Sandy Blake – National Falls Clinical Lead
Carmela Petagna – Manager – Quality Improvement

2. The approach is … individualised care

3. The aim of individualised care
Understand the risks and plan to prevent falls
Reduce harm improve care outcomes
Especially for our older people
Both in hospital, residential care, or in their own home

4. We have made a difference

5. Harm reduced/cost savings July 2013-2016
76 # NOF
NZ$3.5 million
# hips per week:

6. But it’s even bigger than that
On average an avoided broken hip gives an extra 1.6 years of healthy life
This adds up to an additional 125 years of healthy life*, worth NZ$22.6 million

7. *Healthy life There are two ways to measure value and costs saved.
Spending health care dollars more effectively
People living longer, healthier lives.
Value of a life  $4 million
Value for a year of life in good health  estimated at $180,000

8. Prevent falls and reduce harm from falls in older people
Goals/aims
Prevent falls and reduce harm from falls in older people

9. Preventing falls and reducing harm from falls in older people
Hospital settings
Outcome measures:
Nationally a reduction in fall-related hip fractures (10-30%) in hospital settings by 30 June 2015
Reduced fall-related additional occupied bed days and associated costs
Process measures:
90% of older in-patients receive a risk assessment and individualised care plan addressing identified risks
Prevent falls and reduce harm from falls in hospital acute care settings
Reduce harm from falls and promote safe mobilising in aged residential care settings
Promote falls prevention strategies in home based care settings and in the community (includes population health approach)
Promote evidence-based best practice to build capacity & capability for Improvement and system change

10. What we did: Reducing harm from falls framework
Enabled by: Capability and leadership, measurement for improvement, partners in care

11. Quarterly reporting to the Commission of older persons receiving risk assessment
Move away from predictive risk assessments
The level of risk is not important, but the actual risk is

12. Think about how to mitigate the risk you have identified
Document the individualised strategies
Note when a patient’s condition changes and reassess/rethink

13. Strategies are essential for all older persons regardless of risk
Listed to save repetitive documentation
But
Must be audited to check they are implemented

14. Quarterly reporting to the Commission of older person deemed at risk and who has a care plan
Individualised care must be linked to identified individualised risk factor
If patient condition changes, reassess and then re-plan

15. Acknowledge the patient and family/whānau will know the problem of falling, therefore ask and listen
Partner in care planning
Partner in discharge planning and further community options

16. Check with family/whānau about what works to keep their loved ones safe
Close care is not ‘watching’, it is caring, understanding and partnering with families/whānau
Care for cognitively impaired should be the norm, not the exception

17. Falls 10 topics
Having the discussion:
expert visits
webinars
clinical lead visits
Showcasing:
what works
seminars
Releasing time to care module adapted for New Zealand

18. Recap: Reducing harm from falls framework
Enabled by: Capability and leadership, measurement for improvement, partners in care

19. The Commission’s ongoing focus
Leadership and guidance
Clinical leadership and networks
Cross-agency collaboration (Commission, ACC, Ministry of Health)

20. The Commission’s ongoing focus (cont.)
Adaptive/flexible
Measurement – stimulates improvement, evaluation, judgement of overall quality, prompt important questions
Ongoing measurement for improvement

21. The Commission’s ongoing focus (cont.)
Resources
Evidence-based
System approach to ‘falls, fractures fragility, frailty’

22. Our journey at a glance: Evaluation

24. Thank you
Questions?