1. Preventing Falls The South Tees Journey Mrs Glynis Peat – Spinal Services Lead, Trauma Mrs Kathryn Hodgson – Clinical Lead Falls Team

2. Most common cause of death from injury on the over 65s Between 10-25% of falls in hospitals and care homes result in fracture Inpatient Falls 26% of all national patient safety incidents reported 84055030

3. YearCatastrophicMajorModerate Insignificant / Minor Total 08/09023 24572503 09/102142321302169 10/112131421132142 11/121201820342073 12/133243124692527 Number and Severity

4. 2012 - 2013

5. 08/0909/1010/1111/12 12/13 Fractured Neck of Femur24141118 27 Other Fractures2019151618 Total4433263445 Fractures

6. Themes From RCAs

7. 10/1111/1212/13 Risk Assessment completed91%97%95% Fall within 24 hours12%13%15% First fall80%81%75% Fall from bed – bed rails in use17%16% Confused at time of fall37%41%35% Fall witnessed18%19% Observations recorded97%95% Reporting

8. What is FallSafe A quality improvement project led by the Health Foundation aimed at “closing the gap” between the evidence base for effective care and the care that patients actually receive. Involves educating, inspiring and supporting Registered Nurses (FallSafe leads) to lead ward based MDTs in reliably delivering assessments and interventions through a care bundle approach

9. What is a Care Bundle? A list of actions (called elements) that need to be applied consistently to patients for whom they are appropriate. The actions are selected because they have been shown to be effective through research.

10. Care Bundle - All Patients History of falls and fear of falling Urinalysis Avoidance of night sedation Call bell in reach Appropriate footwear Assessment and provision of walking aids

11. Care Bundles - Older Patients Cognitive assessment Delirium screening for those at risk Bed rails - risk vs benefit Visual assessment Lying and standing blood pressure Medication review Tailored toileting plan

12. Post fall checklist – Assessments and neurological examination Post fall review to prevent further fall Incident report RCA for severe harm falls Care Bundles – After a Fall

13. Hospital wide falls leaders Lead Nurse for Trauma Clinical Lead for Falls Elderly care consultant Executive board Overall monitoring Hospital falls strategy group Clinical Matrons AHP lead Clinical leads Patient and carer representative FallSafe leads working group FallSafe lead and deputies from each ward from each ward FallSafe Lead on their ward Hospital Falls Strategy Overall monitoring Planning, monitoring and feedback to executive board Policy Action planning Problem solving Promotion trust wide Assurance Review RCA Promotion at ward level Training at ward level Share learning Point of contact Learning Updates Communication Audits Action planning Share learning

14. Build a ward based MDT improvement team Share your knowledge Promote project and e-learning tool Understand your reported falls Undertake measurement of under reporting Measure care bundle compliance Fallsafe Leads Priorities

15. FallSafe Project Reducing Falls for all patients South Tees Hospitals NHS Foundation Trust are implementing the FallSafe project across all inpatient areas. There are three key elements: Reviewed in line with the new evidence A section for all patients admitted to hospital Further assessment for those at increased risk Includes bed rails risk assessment and new Dementia assessment New Falls Risk assessment tool and care plan (Care Bundle) Mandatory for all staff completing inpatient assessment tools Available via NMLS Username and password available via training link Preventing Falls in hospitals e-learning programme Identified for each ward to support role out of project Your FallSafe lead is: _______________________________________ FallSafe lead for each ward

16. They personally reported the last patient fall on this ward that they are aware of (how certain %). 53 (100%) They believe someone else reported the last fall on this ward that they are aware of (how certain %). 82 (96%) Under Reporting Audit

17. Bell in sight and reach? 91% Safe footwear on feet? 98% Asked about history of falls? 97% Asked about fear of falling? 89% Urinalysis performed? 60% Avoided night sedation last night? (‘Yes’ = not given, ‘No’ = given) 85% Cognitive screen? 57% Lying and standing BP recorded? 71% Full medication review requested? 71% Received all relevant bundle elements? 24% Care Bundles Audit

18. Or are they any of the below:  Have high heels  Backless  Novelty slippers which may be a tripping hazard  Unsupportive If you have ticked one of the above you would benefit from a different pair of slippers Do they:  Fit well: not loose and baggy or too tight?  Have fastenings such as laces, buckle or velcro to help keep your feet inside  Have non-slip, lightly padded soles  Have soft supple uppers This would be a “safe” pair of slippers The Slipper Challenge How safe are your slippers? If you feel your slippers are “unsafe” please ask a visitor to bring you in a different pair. Ask a member of staff for further advice

19. Results of slipper audit 63% patients wearing SAFE SLIPPERS

20. Bell in sight and reach? 91%99% Safe footwear on feet? 63%90% Asked about history of falls? 90%92% Asked about fear of falling? 87% Urinalysis performed? 60%70% Avoided new night sedation last night? 85%96% Cognitive screen? 57%98% Bed rails risk Assessment 96% Lying and standing BP recorded? 40%50% Full medication review requested? 71%86% Received all relevant bundle elements? 24%44% Care Bundles Audit

21. Achievements 2013/14 19.3% reduction in number of falls 20% reduction in the number of patients who sustained a fracture (58% reduction hip fractures)

22. Falls per 1,000BD

23. What is Quest? NHS QUEST is the first member-convened network for Foundation Trusts who wish to focus relentlessly on improving quality and safety. The NHS QUEST membership is currently made up of 16 Foundation Trusts from across England. Falls collaborative has been set up to work together to address the complex issue of reducing falls in inpatient setting.

24. Synplex Influence Map

25. AIM To reduce harm from falls by 50% by June 2015 Culture & behaviour – falls prevention Reliable falls care processes Environmental factors Leadership Primary Drivers Secondary Drivers Multi media falls prevention strategy Human factors Staff and patient education Engagement of patients and staff in falls prevention strategies Dynamic, individualised risk assessment Dynamic communication plan Individualised plan of care to manage at risk patients Management of confused patients Assessment of environment Visual management of risk Patient placement on ward No night-time transfers Management of the patient at night Toileting Rapid review for every patient post-fall Safe staffing in the management of falls Falls measurement Reliability with falls bundle interventions Driver diagram

26. CHANGE TESTED “DO” DATE PREDICTION & RESULTSNEXT STEPS SWARMOngoingAll actions identified within falls risk assessment will not have been completed. RESULTS - footwear - alcohol - confused patients Footwear trial Review care of confused patients PDSAs

27. CHANGE TESTED “DO” DATE PREDICTION & RESULTSNEXT STEPS PATIENT EDUCATION 22/09/14The use of information leaflets will increase patient awareness of falls risks and actions they can take to minimise their risk. Observation and patient interviews.

28. PDSAs CHANGE TESTED “DO” DATE PREDICTION & RESULTSNEXT STEPS ENHANCED OBSERVATION 10/11/14The policy will not have been implemented fully. Implementation will reduce falls for confused patients. Raise staff awareness at ward meeting. Improve Implementation of documentation and processes. Levels and Interventions Level 0 General observation. No behavioural concerns. Staff are expected to be aware of the whereabouts of the patient in their care Level 1 Regular behavioural observations. Record triggers and plan therapeutic interventions to prevent escalation. Level 2 Patient(s) within sight at all times and observed at a minimum frequency of every 15 minutes. Level 3 The patient is within arm’s reach (security to be informed of the need for possible rapid response).

29. PDSAs CHANGE TESTED “DO” DATE PREDICTION & RESULTSNEXT STEPS FOOTWEAR01/11/14Patients will not have appropriate footwear on admission. Providing footwear will reduce falls. To roll out.

30. CHANGE TESTED “DO” DATE PREDICTION & RESULTSNEXT STEPS RAISING STAFF AWARENESS 10/11/14Staff will have an increased awareness of the QUEST falls project and be more proactive. Distribute posters and newsletters. PDSAs

31. CHANGE TO BE TESTED WHEN?PREDICTION NURSING DOCUMENTATION NovemberNursing time will be freed up. This will positively influence ability to improve implementation of enhanced guidance

32. CHANGE TO BE TESTED WHEN?PREDICTION STAFF EDUCATIONDecemberIncreased knowledge will assist in reducing patient risk. PDSAs

33. CHANGE TO BE TESTED WHEN?PREDICTION WALKING AID SIGNSFebruaryUsage will improve patient compliance with instructions provided PDSAs

34. Falls per 1,000 BD

35. Next Challenge? Improve (sustaining is a challenge in itself) Share and Spread Documentation RCP Audit AHSN

36. Life is a journey, not a destination Aerosmith