NORTHWEST PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDIT

Transcription

1 PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDIT

2 AINTREE UNIVERSITY HOSPITALS NHS FT AUDIT RESULTS

3 Summary Aintree University Hospital Foundation Trust Acute healthcare Urban population of 330,000 North Merseyside and surrounding areas Provides some tertiary services for a wider area > 73,000 episodes of inpatient and day case care each year Goals Ensure initial assessments are done in a timely fashion Assess modifiable risk factors Actions taken since 2009 Changes in documentation AINTREE UNIVERSITY HOSPITALS NHS FT

4 SWOT analysis Strengths Assessment on day 1 or 2 of admission: Falls risk 67% 85% Hxof previous falls 29% 91% Gait 75% 85% Cognition 62% 86% Weaknesses Review of anxiety of falls: 0% 7% Medication review: 95% 15% Assessment for bedrails: 15% 29% Eyesight checked: 33% 17% Postural blood pressure: 11% 8% Opportunities Link objectives to other trust targets eg dementia strategy New electronic documentation may improve things Threats Ever increasing work load on staff due to competing demands on time eg VTE assessment AINTREE UNIVERSITY HOSPITALS NHS FT

5 EAST LANCASHIRE HOSPITALS NHS TRUST AUDIT RESULTS

6 SWOT ANALYSIS Strengths High level support in the Trust The Trust has a non stratified screening tool and evidence based policy 68% patients had their cognitive / mental state reviewed on admission 55% had their gait reviewed Transforming community services Safety Express Harm Free Care Opportunities Awaiting commissioner intervention: RE: support of a falls prevention programme in the community RE: support of a fracture liaison service Falls champions sharing information Strengthening of inter disciplining ways Dementia pathway and CQIN Orthogeriatrics Weaknesses Medication review Need to improve compliance with Trust policy Cohesive bundle for medical interventions for fallers On-going monitoring of cognition needs to be strengthened Threats Communication and engagement Resistance to change Small falls team not a fully cohesive service across pathways (but improving) EAST LANCASHIRE HOSPITALS NHS TRUST

7 LANCASHIRE TEACHING HOSPITALS NHS FT AUDIT RESULTS

8 Summary Population covered is 340,000 Central Lancashire Goals for 2011 audit: Complete Falls Assessment Tool with Moving and Handling and Bed/Trolley rail assessment Lying and Standing Blood pressure Communication with patient is documented Improve the Falls Referral on Discharge for continuity of care Rolled out the Falls Assessment tool throughout the Trust Supported staff in understanding the important of Lying and Standing Blood Pressure Several audits in the trust identify Falls Assessment tool is completed Blood Pressure is not being completed -- Criteria now in place for age 65 and over to improve figures Audit Results: 80% Falls Assessment was completed on admission 98% Moving and Handling Plan 0% Lying and standing Blood pressure 32% had a urinalysis checked Hearing and vision very low % 23% Anxiety about falling LANCASHIRE TEACHING HOSPITALS NHS FT

9 Action Plan Outcomes: 1 All patients identified at risk of falls have appropriate plan of care 2 Encourage urinalysis on admission and assessment of vision and hearing 3 RCA to be encouraged on all injuries following a fall Outcome Indicators: Documentation Audit reduction on in-patient falls and severity of injuries Ward audits and ECAP audit Data on injuries and RCA collected on Datix 4 Improve education and training for all staff Training records, e-learning 5 Documentation Ward Performance audits, NHSLA and ECAP LANCASHIRE TEACHING HOSPITALS NHS FT

10 EAST CHESHIRE NHS TRUST AUDIT RESULTS

11 Summary East Cheshire NHS Trust has 306 acute beds and serves a population of approximately 450,000. There is a high proportion of elderly patients in this area approximately 80% of the inpatient population are over the age of 75 Aims for the 2011 audit were to improve assessment processes and care planning. This was achieved in the majority of cases with marked improvement from 2009 in the majority of areas. There is still work to do around: The number of ward transfers Patients experience Pharmacy reviews Reduction the actual number of falls per 1000 bed days EAST CHESHIRE NHS TRUST

12 SWOT analysis Strengths Strong clinical leadership Designated Falls Lead identified Regular monthly MDT meetings Assessment documentation reviewed and fit for purpose (falls and bed rails) Regular documentation audits via patient metrics Operational staff engaged in falls prevention agenda Falls improvement initiatives in place Equipment available Osteoporosis and Bone Protection Weaknesses Training Pharmacy input and medication reviews Continence care Change in incident reporting system? Inconsistent information Opportunities Integration with Community Business Unit Exec engagement and focus on falls prevention Participation in Safety Thermometer Opportunity to dovetail with other projects eg dementia strategy, development of acute elderly care unit Introduction of Datix incident reporting system Threats Access targets influencing number of ward moves Period of change within organisation change in personnel etc Limited resource available Patient Information EAST CHESHIRE NHS TRUST

13 MID CHESHIRE HOSPITALS NHS FT AUDIT RESULTS

14 Summary MCHFT beds serving population of 400,000. N West audit - 60:40 Female:Male 53% Gen Med. 23% Surgical 23% Orthopaedic Average age 80 yrs. Average length of stay 15 days Goals from 2009 Improve Bedrail Screening Lying/Standing BP (increase in recording) Medication Review particularly psychotropic's. Documentation of Interventions MID CHESHIRE HOSPITALS NHS FT

15 Summary What have you done to meet those goals? Reviewed and amended FRASE documentation to include bone health assessment and Lying/Standing BP. Dissemination of instructions to wards for recording L/S BP. Online falls summary to include medication review. What has or has not worked? New documentation not implemented until July 11 so audit completed using old documentation. Ward-based pharmacists to review all medication, particularly following falls. Assessment of bedrails much improved. MID CHESHIRE HOSPITALS NHS FT

16 SWOT analysis Strengths Identified during 2009 audit what needed to change. Improved documentation. FaB Newsletter Falls Leads and Cascade training. Monthly ward projections. Regular falls group meetings (now with executive representation) Weaknesses Time taken to implement change therefore not reflected in 2011 audit. Lack of Falls Lead/admin assistance. Medical engagement No prevention training in Non ward areas. Lack of continence strategy Opportunities FallSafeProject Online falls reporting Development fracture clinic Physiotherapy re falls prevention classes within trust. Non-hip fracture nurse. Threats Process to implement change i.e. Governance channels. Different challenges for time within trust and changing working practices. Economic climate (funding issues for new posts) MID CHESHIRE HOSPITALS NHS FT

17 ST HELENS & KNOWSLEY HOSPITALS NHS TRUST AUDIT RESULTS

18 Summary Population : Elderly, chronically ill, low socio-economic group Goals for 2011 audit: Evaluate progress since 09 How goals were met: What has worked? Detailed service review, revised falls service provision (inc. policies, assessment tools, care plans, training) increased liaison with primary care / emergency care colleagues Almost everything! What hasn't worked? Time frame for implementation. Main issue = changing existing culture takes longer to reach full implementation ST HELENS & KNOWSLEY HOSPITALS NHS TRUST

19 SWOT analysis Strengths: Committed staff: Nomination for most improved service provision in Trust Falls leads, regular falls group meetings, new reporting mechanisms, multidisciplinary approach, internal audit programme + resources ALL = improved clinical practice Weaknesses: Pervasive 'negative' culture, limited staff (clinical & audit) + financial resources Opportunities: Audit (local, regional, national) National projects eg. FallSafe, Patient Safety Express, Offsite visits to explore gold standard practice elsewhere Networking through Steering Group / Audit Meetings & Workshops etc Threats: Large, complex, time consuming project Prospect of reduced financial / staff resources in future ST HELENS & KNOWSLEY HOSPITALS NHS TRUST

20 STOCKPORT NHS FT AUDIT RESULTS

21 Summary What is your population like? Population 264,000, 800 bed hospital, recently taken on two community settings Tameside (inc 2 in-patient areas) and Stockport PCT, Total 5,300 staff. Number of admissions 18 and over April 2011-March ,707. Number of Falls Including Near Misses April 2011 March What were your goals for the 2011 audit? To check improvement since the 2009 audit. To re-focus work regarding falls at the Trust, taking into account North West Falls Audit recommendations. What have you done to meet those goals? Bed Rails Policy updated and re-launched. Falls Risk Assessments updated and easily accessible, Lying & Standing BP including in Falls Risk Assessments and Training. FRAX tool in use. What has or has not worked? Found in practice that some issues implemented still don t work despite training! More work required Cognitive/Mental States. STOCKPORT NHS FT

22 SWOT analysis Strengths Multi-Disciplinary Falls Group Executive Director Led/Board of Directors & Governors commitment Falls Risk Assessments done early on admission quickest and improved Falls Training Mandatory Multi-disciplinary initiatives to help reduce falls Opportunities New Harm Free Care Committee Thermometer Survey Falls Collaborative in place on high risk wards. More Focus Work modifiable factors Corporate Objective to reduce numbers/harm rates Weaknesses So What Theory and Practice Gap Review mental status STOCKPORT NHS FT Threats Motivation in current climate increase quality, reduced costs. Just another thing! Measurement Number of patient transfers

23 UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT AUDIT RESULTS

24 Summary UHSM is an acute teaching hospital NHS Trust providing services for adults and children at Wythenshawe Hospital, Withington Community Hospital and in the Community. The Trust has around 920 inpatient beds with a total of approx 89,000 admissions per year. In relation to Incident Reporting, we reported 8448 incident reports in , of which 1608 were inpatient falls of these 29 were moderate / major harm. UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

25 Goals for 2011 Audit To compare our progress against the previous audit results. Has the introduction of the Trust Fall Falls Intervention Tool improved compliance with the assessment of Inpatient Falls Risk? To understand whether we have improved our compliance with Risk Benefit Medication reviews. To identify if the recording of Lying / Standing blood pressure has improved. UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

26 What have you done to meet those goals? The Falls Intervention Tool was introduced across the Trust over the last 2 years to all inpatient areas. The recording of lying and standing blood pressure is reinforced during teaching sessions on how to use the tool. There have been a number of initiatives piloted to formalise the Risk Benefit review of Medications. UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

27 What has or has not worked? The Inpatient Falls Intervention Tool has improved the risk assessment compliance, and also vision and hearing assessment. The recording of Lying and Standing Blood Pressure has not improved as expected need to include this in training programmes. The Risk Benefit review of medications has deteriorated as there is no formalised process for this review. All medications are reviewed by a pharmacist on admission and this may be why the original audit in 2009 recorded 91% compliance. UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

28 SWOT analysis Strengths Full-time Falls Service Facilitator. Quarterly falls group meetings. We assess patient s risk in line with our policy 95% of the time (within 24 hours). Combined Falls, M&H and Bed rails assessment. Weaknesses Identification of Risk Benefit review of Medication. Recording of Lying and Standing BP. Audit sample was an equal cross section across all areas of the Trust previously focused on Unscheduled Care. Opportunities Full-time Falls Service facilitator. Introduction of Ward based Falls Champions Fallsafe. E-learning package -RCP Falls Training Package. Threats Resources at ward and department level. Setting of unrealistic targets for compliance suggest stretch targets for improvement. Nature of audit is in some places subjective and open to interpretation. The purpose of some questions is not clear medications for example. UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

29 TAMESIDE HOSPITAL NHS FT AUDIT RESULTS

30 Summary What is your population like? - The audit population ranged from yrs, mixture of male and female. What were your goals for the 2011 audit? - The goals were to benchmark the Trust with last year results to mark our own improvement and how it compared with the rest of the region. What have you done to meet those goals? - A focus group was established. An action plan was developed. New falls documentation was developed out of the results of last audit and implemented. A Trust wide patient safety falls programme was implemented. RCA investigations and audits of falls documentation. What has or has not worked? RCA, falls audits and implementation of action plans have been a great success for the Trust and Patient Safety TAMESIDE. HOSPITAL NHS FT

31 Action Plan Outcomes: 1 Improve documentation to support the patient from falling during their in patient stay 2 To increase the number of falls risk assessments complete from 79% to 95% 3 To increase the number of vision risk assessments from 16% to a minimum of 50% 4 To increase the number of cognitive assessment from 70% to a minimum of 95% 5 To increase the number of hearing assessments 28% to a minimum of 50% Outcome Indicators: The Trust patient safety programme was launched in May Monthly audits show encouraging results. Falls documentation was revised and Launched in November 2011 Falls documentation is audited monthly and non compliance managed Admission documentation has been fully revised and will be launched July 2012 Admission documentation has been fully revised and will be launched July Eyesight test feature in the audit to be completed within 12 hours As above point 4 TAMESIDE HOSPITAL NHS FT

32 WRIGHTINGTON, WIGAN & LEIGH NHS FT AUDIT RESULTS

33 Summary IMPROVED EARLY FALLS RISK ASSESMENT RELIABLE RISK STRATIFICATION URINE ANALYSIS ASSESMENTS : - CONTINENCE - ALTERNATIVE BEDS -BED RAILS - OSTEOPOROSIS NOT MUCH CHANGE : AVERAGE AGE SEX DISTRIBUTION BASE LINE MOBILTY WARD DISTRIBUTION & LOS EARLY FIRST REVIEWS MEDICINE USAGE REVIEW WRIGHTINGTON, WIGAN AND LEIGH NHS FT

34 Action Plan ACTIONS: IMPROVE ASSESSMENTS IMPROVE BED MANAGEMENT (DECREASE WARD TRANSFERS) IMPROVE TRAINING AND EDUCATION ADDRESS BONE HEALTH ESTABLISHED INITIATIVES : FALLS REPORTING ON DATIX QSMs (reported falls - moderate to severe harm) FALLS SCRUTINY COMMITTEE RCAs FALLS RAPID RESPONSE TEAM ( POST FALLS) WRIGHTINGTON, WIGAN AND LEIGH NHS FT

35 PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDIT

36 NEXT BREAK FOR TEA & COFFEE RETURN FOR FALLSAFE PRESENTATION & THE NEW NATIONAL IN-PATIENT AUDIT CLOSING REMARKS RECEPTION