The National Falls Programme

Orthopaedic Clinical Services Managers

6.08.12

Ann Murray

National Falls Programme Manager

ann.murray3@nhs.net

http://www.knowledge.scot.nhs.uk/fallsandbonehealth

The National Falls Programme Why falls and fragility fractures in the over 65s?

Consequences for older people and their carers: • Physical and psychological consequences leading to loss of function in

activities of daily living, loss of independence, social isolation, loss of quality of life.

Consequences for NHSScotland (2011/12): • 38, 825 SAS call outs • 50, 340 A&E attendances • 390, 500 occupied bed days

Consequences for social care: • 40% care home admissions

Evidence base: • 20% to 35% reduction falls • 0.43 relative risk reduction fractures

Growing older population: • Increase by around two thirds in next twenty years.

The National Falls Programme Background

• HDL 2007; NHSQIS Falls Programme 2007-2009.

• Jacqui Lunday, Chief Health Professions Officer and Scottish Government Policy Lead for Falls.

• Part of the Rehabilitation Framework Programme since 2009.

• Focus on falls and fracture prevention in older people in the community.

• To support the development and improvement of local integrated falls and fragility fracture care pathways for older people in the community.

• Programme Manager works in partnership with CHP Falls Leads and other key stakeholders.

The National Falls Programme Pathways for the prevention and management of falls and fragility fractures; the ‘Up and About’ Pathway

http://fallspathway.nhshealthquality.org

Multifactorial assessment Tailored intervention incl: - Strength & balance exercise - Medication review/modification - Mitigate home hazards - ADL retraining -Vision correction - Address foot problems - Management of postural hypotension, heart rate or rhythm abnormalities - Management of osteoporosis

The National Falls Programme Main work streams 2010-2012 (Community)

• Falls and Fractures in Care Homes (with Care Inspectorate): • Self assessment resource pack • Implementation support • Evaluation

• Pathway development: • Telecare services (with JIT, National Telecare Learning

Network) • Scottish Ambulance Service (with SAS, JIT, Perth &

Kinross, Borders, Edinburgh)

• Education: • Learning framework (NES, Care Inspectorate, SQA) • Access to online learning programmes for health and

social care staff (with NES, SSSC)

• Access to information on falls and fracture prevention for general public (with NHS 24)

Is there a recognised local pathway for falls and fracture prevention and management in your CHP?

The National Falls Programme 2011 Mapping Exercise

The National Falls Programme 2011 Mapping Report

The National Falls Programme On-going challenges…

• Embedding local co-ordinated care pathways involving all key services and organisations.

• Systematically reaching the target population including those older people at highest risk of further falls and emergency admission to hospital.

• Reliable delivery of evidence-based practice.

• Use of measurement to demonstrate impact and improve quality of services.

5/08/2012 8 AHPs as Agents of Change

Up and About (NHSQIS 2010)

• Care bundles plus PDSA cycles plus balance set of measures.

• Test sites in Fife and Grampian.

• Cost consequence analysis:

– Resources, costs and benefits associated with implementing care bundles.

– CHP, NHS board and Scotland level.

– Costing template.

The National Falls Programme Falls care bundles

Trigger bundle

Assessment bundle

Intervention bundle

Monitoring bundle

Adapted from 1000 Lives Plus Campaign, Wales

The National Falls Programme What would success look like?

Key Performance Indicators

A falls event is recorded and initial screening completed within 24 hours of the fall being reported in 95% of falls presentations.

Basic multifactorial risk assessment is completed within 7 days in 95% of all falls referrals.

An agreed multifactorial plan of assessment and intervention is initiated within a maximum of six weeks in 95% of all falls referrals.

Progress against the plan is monitored within six months in 95% of patients who have a falls plan.

The National Falls Programme What would success look like?

Key Performance Indicators Present ↓ 5% ↓ 10% ↓ 20%

Reduced number of SAS call-outs 38,825 36,884 34,942 31,060

Reduced number of A&E attendances as a result of a fall.

50,340 47,823 45,306 40,272

Reduced number of emergency admissions as a result of a fall.

17,795 16,905 16,015 14,236

Reduced number of hip fractures.

5,468 2% 5,358

3% 5,303

5% 5,194

The National Falls Programme Reducing falls in hospitals

• Learning event 1 June 2012; all NHS boards represented.

• Working with Leading Better Care, Improving Care for Older People in Acute Care and Scottish Patient Safety Programme.

• National improvement programme to support NHS boards to test and implement care bundles, learning from the findings of the RCP’s FallSafe project.

• Developing pathways into prevention services.

• November 2012 - May 2014.

5/08/2012 12 AHPs as Agents of Change

Thank you for listening Ann Murray

Falls Programme Manager

Framework for Adult Rehabilitation

48 Lister Street

Crosshouse Hospital

Kilmarnock KA2 0BE

Mobile: 07833 095399

Ann.murray3@nhs.net

http://www.knowledge.scot.nhs.uk/fallsandbonehealth