NATIONAL FALLS INJURY PREVENTION PROGRAMME

Transcription

1 NATIONAL FALLS INJURY PREVENTION PROGRAMME SUMMARY A well attended initial meeting of the governance group was held in Wellington in a workshop format on 24 May 2012 to review: a draft Terms of Reference and broad priorities and parameters of the programme. MINUTES OF MEETING THURSDAY 24 MAY 2012 ATTENDANCE Jan Adams* Sandy Blake Gillian Bohm Frances Broatch Richard Hamblin Judith Johnson Shelley Jones Professor Ngaire Kerse Gina Langlands Karen Orsborn Carmela Petagna Helen Pocknall * Michael Rains Tania Simmons Ken Stewart Nicola Turner Dr Paul Watson Beryl Wilkinson Chair, National COO Group; COO, Waikato DHB (via teleconference) Director of Nursing, Patient Safety and Quality, Whanganui DHB Principal Advisor Quality Improvement, HQSC Programme Manager, Public Injury Insurance, ACC Director, Health Quality Evaluation, HQSC Clinical Advisor, NZ Aged Care Association Programme Coordinator, HQSC HOD, General Practice and Primary Health, School of Population Health, FMHS, Auckland University General Manager, Quality and Risk, BUPA Care Services General Manager, HQSC Senior Portfolio Manager, HQSC Chair, Lead DHB DONs *attending via teleconference attending from mid-morning leaving before value proposition session Principal Advisor, Hospital Quality and Productivity, DHB Shared Services Programme Manager, Hospital Quality and Productivity, DHB Shared Services Clinical Lead Falls Prevention (Primary, Secondary, Community and Aged Residential Care), Canterbury DHB; Occupational Health Physiotherapist, private practice. Manager, General Manager, Older People's Services with Presbyterian Support Services Central (Enliven), representing NZ Home Health Association Senior Adviser, MOH Chief Nurse Business Unit Consumer (Whangarei Age Concern) APOLOGIES Dr Shankar Sankaran MOH Chief Advisor, Older Person s Health; Clinical Head and Consultant Geriatrician, Community Geriatric Services, Adult Rehabilitation and Health of Older People, Counties Manukau DHB WELCOME AND INTRODUCTIONS Attendees introduced themselves, with Gillian Bohm speaking of Dr Shankar Sankaran s involvement in falls. A further round of introductions was undertaken as Beryl Wilkinson, Michael Rains and Jean-Pierre de Raad (observer/presenter) joined the group mid-morning. DRAFT: MINUTES OF MEETING THURSDAY 24 MAY 2012 page 1 of 5

2 A TERMS OF REFERENCE Document: DRAFT Terms of Reference Governance Group NATIONAL FALLS INJURY PREVENTION PROGRAMME Discussion Scope A wide-ranging discussion encompassed questions about Whether hospitals include those in the community (i.e. residential aged care providers) The Commission s relationship with primary health organisations Needing to spell out SAC 1 and 2 What filters should apply: Exclude children? Include only over 65? Include only falls in people receiving care - whether hospital inpatient, aged residential care or at home? Include adult falls at work? Considering different long term consequences of a fall in relation to filters Considering different risk factors for falls in different groups Considering value of preventing falling as an older person for people who are not yet older. Summary at this point: The programme has a broad scope across [public] hospitals, private sector and community; first phase to exclude children. Title of the programme In terms of outcomes, framing it as falls prevention leaves us not knowing whether the programme prevented falls or not, but we can determine an impact on reported injury rates. The strategies to reduce injuries are the same as those to prevent falls, and preventing harm. What is the practical difference between preventing injury and reducing harm? How important is branding? For the nurse in the ward? To distinguish this programme from others (such as ACC s national injury prevention strategy)? Would National Falls Harm Prevention Programme work? Would link to the Commission s emphasis on reducing harm. Accountability (1) Rests with the Commission. Purpose of the Governance Group (2) Whether the TOR provide sufficiently for the Governance Group to authorize new activities, and what funding is available to it? Tania Simmons s role is to put a case to DHBs for CEOs to sign off, they will elect how they fund it, costs of implementation will sit where implementation happens One perspective is that gains don t necessarily come from spending money, it s about awareness, empowering people and programmes; another is that e.g. in home health sector, people can t be supported at home without money; however, it may be as in Canterbury, that DHB expenditure transfers. Key Tasks (2.2) We may need to add coordination [with other programmes] to our key tasks The intent to deliver results (2.1) ensures that the Governance Group is more than a talkfest. Delivering results in residential care thought to require increased DHB funding and/or significant drop in falls injuries from awareness campaign Is it the Governance Group s role to advise on sector capability? TOR provides for evidence base (2.1). Composition of the group (3) Consumer perspective ideally we have two consumer representatives (bearing in mind that a consumer may speak of their mother or father s needs, and also that all GG members bring that perspective ourselves). We are looking for Maori perspective Recommendation that Otago Injury Prevention Unit (John Campbell) review our data as we progress. Connection to NZ Private Surgical Hospital s Association is provided for in an undertaking between DHB DONs Chair (Helen Pocknall) and Chair of NZPSHA DONs (Carey Campbell). Meetings (5), Attendance fees (7), Secretariat (8) The Chair suggested the Governance Group meet 2-3 monthly after July; fees and secretariat straightforward. Actions 1 Establish age range for children (note ACC definition is 0-19 years). 2 Sandy Blake, Carmela Petagna to take away common to ideas discussed is reducing bad effects of falls. 3 Explore how this programme relates to the national falls strategy launched in 2006 and the falls section in the ACC New Zealand Injury Prevention Strategy. 4 Governance map (to sit alongside TOR) to delineate the gap the Minister has asked us to address and the work of other agencies. 5 Explore linkage with Otago Injury Prevention Unit possibly through ACC 6 Look at scheduling our meetings in relation to other key meetings, and identify the people who link between this group and others 7 Identification of stakeholders, to be included in communications plan. 8 Bring TOR back to next meeting DRAFT: MINUTES OF MEETING THURSDAY 24 MAY 2012 page 2 of 5

3 B STARTING WITH THE END IN MIND: WHAT ARE WE TRYING TO ACHIEVE? What would you want to see as outcomes of a national falls injury prevention programme after a year? This exercise was proposed as a commitment to action, and facilitated by Sandy Blake (Project Lead, National Falls Injury Prevention and Pressure Injury Prevention Mapping Project). Whiteboard summary Stocktake of the good work Standardisation Integrated approach to service delivery Assessment linking to care planning Replicate identified best practice Shared resources e.g. equipment pool Clear value proposition Home OT for high risk people Strength and balance exercises Step towards screening for osteoporosis and treatment before leaving hospital Link between medications and risk of falling Sector capability building Awareness campaign (includes communications toolkit) story telling with data to support standardised education packages Productive ward (e.g. hourly rounding) Endorsement of linked projects Consumer can be involved at all times Put on clinical board agenda Vitamin D3/med chart review in ARC KPI Influence Councils Environment Mapping current activity across community. Discussion summary Are targets useful in all settings? Some DHBs had found setting stretch targets valuable (e.g. 10% year on year reduction in falls) and that it had driven commitment to falls prevention. However aged residential care (ARC) and home health services provide for people coming into care already at a high risk of falling (one home had seven people 100+; frequent fallers might fall four or five times a week). It was felt possible that aiming for a reduction in falls might drive poorer care on other measures (aims in ARC are to encourage activity, decrease use of medication and restraints). It was suggested that ARC and home service providers might be better evaluated on extent of risk assessment and implementation of mitigation activities. Because of so many confounding variables, it might be useful to benchmark against own data in ARC, and alongside that to be committed to awareness of falls injury prevention. What standardisation in falls injury prevention might mean: that the patient s experience (e.g. in being assessed, choosing interventions if at risk) would be consistent across care settings. an outcome such as a national policy, statement of commitment consensus statement a clinical standard. a framework for falls injury prevention could be organised around the Commission s New Zealand triple aim framework (improved quality, safety and experience of care; improved health and equity for all populations; best value for public health system resources) an exercise programme begun in hospital after admission for a fall would be the same as one delivered at home a tool kit of resources, including e-learning. screening for osteoporosis in primary care and Vit D treatment. after admission for falls injury, all patients would have strength and balance exercise training and a home OT assessment. Falls risk assessment is one thing appropriate and timely interventions another What difference does assessment for risk of falling make if the assessment is not then used? Intention that all assessment is via interrai but note Canterbury experience that interrai assessments made little difference but quality and safety awareness did. Even when older people are assessed as high or moderate risk, there may be no corresponding care plan paperwork should not pose a barrier. There is evidence for the efficacy of interventions to build muscle strength, balance etc but can ARC and home-based services afford for physio aides? An example an older person is provided home help to mitigate risk because the home OT assessment (needed to sign off DRAFT: MINUTES OF MEETING THURSDAY 24 MAY 2012 page 3 of 5

4 supply of a piece of equipment) is delayed. Integration We have already have an integrated approach in that ARC is within DHB funding Ensure integration across hospital departments, with other initiatives (such as The Productive Ward) and commonsense measures such as facilitating the presence of family with patients in hospital. Effective communications compelling arguments based on data No stories without data, no data without stories to get interest in the problem and commitment to solutions seek commitment first in decision-making forums such as clinical governance team. Consumer perspective From a consumer perspective, any policy should identify me, as an individual, assess me, allow me to make my own choices about what risks (e.g. medicating vs falling) are acceptable to me. Should also be attention to the environment not only in the home, also in the community (for instance local Council attention to the state of footpaths). Investment perspective what does it cost at the moment and what could we do differently? What difference does assessment for risk of falling make if the assessment is not then used? Cost of change vs current cost of inconsistent approaches Possibility that interventions in the community provide greatest possibility of reducing harm. Role of measurement in determining action. Stocktake Currently, all providers are required to have falls prevention programmes in place. What is being done and what is best practice, and how might it be replicated? C VALUE PROPOSITION Document: National Falls Prevention Programme: Scoping the value proposition, Jean-Pierre de Raad, NZIER Comments in discussion to assist completion of value proposition Slide 2: Value to whom? Add the public their trust and confidence in the integrity of healthcare system Impacts go beyond individual, include those in community, such as families, neighbours Consider costs of falls investigation Slide 4: Cost avoided We have to be sure that implementation of a programme doesn t cost more than dealing with harm from injury related to falls Suggestion to track all the costs for one person who fell at home - from GP presentation to possible outcomes. Look also at Otago exercise programme also Tai Chi. Slide 5: Volumes/values What is in/out of scope sports, work, all ages? Children and youth excluded, not sports or schools; ACC has data on children and work age adults. To be included in this programme are hospitals and ARC, those receiving health care. Are only serious and sentinel events to be considered? For instance harm from a fall may not look like much, but a skin tear might be the cause of death 3 months later. Divide community into those receiving services vs those who are not (e.g. the 75 year olds who fall off their motorbikes). Split those receiving dementia care in community and ARC. Slide 6: Pathways Add prevention. Consider adding costs to create some standardised packages (awareness, prevention, meds); look at a week s worth of #NOF occuring in DHB, ARC and community. Chris Ham s work (King s Fund), NMDS relevant. Follow up to assist JP Ken Stewart to forward relevant Cochrane and other studies (OEP) to Jean-Pierre de Raad. Tania Simmons has data for costs of falls investigation for some DHBs?Richard Hamblin to forward King s Fund work. DRAFT: MINUTES OF MEETING THURSDAY 24 MAY 2012 page 4 of 5

5 D CONCLUDING REMARKS The Chair summarised the presentations suggested for the next meeting Quality and Safety Markers (Richard Hamblin) Canterbury DHB initiatives and outcomes (Ken Stewart) Northern Region First do no harm initiatives ACC programmes Hip Fracture Registry Serious and Sentinel events reporting (Matthew Pitt) Evidence base (Professor Ngaire Kerse) Actions 9 Arrange presentations Meeting concluded at Next meeting: HQSC Wellington, Friday 13 July DRAFT: MINUTES OF MEETING THURSDAY 24 MAY 2012 page 5 of 5