1. An introduction to falls prevention Primary care Jo Davies - Bsc (Hons), RN Falls prevention Clinical Lead BCUHB Wrexham ,

2. North Wales Demographics
Locality
Number - over 65 years
Percentage
Welsh Ambulance call outs ( )
Wrexham
31,736
23.6%
2,686
Flintshire
32,530
21%
3,317
Denbighshire
23,850
25%
2,981
Conwy
36,250
27%
3,938
Anglesey
18,700
1,669
Gwynedd
30,380
3,128
Total
173,446
17,719

3. Under reported problem – understanding falls classifications
Explained vs Unexplained
Extrinsic vs Intrinsic
Injurious vs Non-injurious
Plus the behavioural risks
Ref : D Skelton

4. Consequences
At least 95% of hip fractures are due to falls, with osteoporosis playing a contributory factor, Lothian NHS, 2011.
Osteoporosis is considered a silent killer. According to the National Osteoporosis Society 1:3 women and 1:5 men over the age of 50 will suffer an osteoporotic fracture, rising to 1:2 women after the age of 70.

5. Referrals to community falls service
First phase
Primary care
WAST
Emergency department
SPOA
Mobile response teams
Second Phase
Community mental health teams
Third sectors
Voluntary organisations Re-ablement
Third Phase
Falls clinic
Fire service
Domiciliary care
Housing associations
Opticians

6. BCUHB community falls service – expanding referral rates
Falls prevention work has been duel focused: seeking opportunities to identify and secondly educating and working in partnership to employ evidenced based interventions

7. Case Study 93 year old gentleman
7 falls in 2 weeks. Diagnosed urinary tract infection, loss of appetite, reduced mobility, increased difficulty to maintain independence. Lives alone, no nuclear family.
Multiple medications
Side effects
Fear of falling
Reluctance to accept support
Environmental hazards & poor usage of sensory equipment

8. Intervention opportunities
General Medical Practitioner – medical and medicine review
Occupational Therapy – multiple home improvements and aids to improve safety
Physiotherapy – initial domiciliary input followed on by strength and balance
Optician and audiology – single lens glasses and referral to audiology for hearing aid
Social services –Discussed options of day care
Telecare – Discussed benefits of telecare in independent living. Falls pendant and multiple gem in brackets installed
Third sector – Be-friending service
Care home – shared communication of resource pack and community falls risk assessment
Shared communication with Community resource team in the event of hospital admission – in the event of emergency step up bed required

9. BCUHB Aims
Improving communication opportunities for falls prevention within each area

10. Impact within Care homes
Audit work carried out July (2016) identified number of residential homes utilising BCUHB falls resource pack
Audit undertaken August 2016
Pre June 2016
Dec Current
Residential care homes in Wrexham locality
Total number of people aged 65 in care in Wrexham : 1,211 29
Care homes utilising BCUHB falls pack 8
7 Partially completed 26
Care homes not utilising falls pack 21
3 (declined as not mandatory)

11. Reflective journey Reflect in practice Reflect on practice Educate
Understanding individuals’ physical, social, psychological and environmental needs, ability to pre-empt
Understanding who is at risk of falls and falls risk factors/ employ early interventions
Educate
Developing skills to equip competency – theoretical, reflective and interactive sessions
Training sessions around each of the subject domains
Reflect in practice
Falls Champions
Tailored plans of care
Continuous communication cycle with individual and stakeholders
Reflect on practice

12. Reviews

13. Post falls guidance

14. Working to BCUHB Vision
Reduce harm & fall rates
Effective service pathway
Support structure
Educate about importance of falls
Evidenced based practice
Continuous practice development
Empowerment
Working in partnership

15. Partnership