Falls in Care Homes NHS Bedfordshire
Background 2003 National Falls Collaborative Targeted work in a specific geographical area 2006/09 Local Area Agreement To reduce falls related emergency admissions
4.2.1 3 Falls service National CSPs CHOs Acute Does the falls service provide the following training to care homes: 4.2.1. Signposting of when to refer to primary care teams? Yes to all care homes 20% (64/321) 29% (27/92) 38% (25/66) 7% (12/163) Yes to some 30% (96/321) 45% (41/92) 33% (22/66) 20% (33/163) No 50% (161/321) 26% (24/92) 29% (19/66) 72%(118/163) 4.2.2. How to undertake critical incident analysis following a fall? Yes to all care homes 13% (41/321) 15% (14/92) 26% (17/66) 6% (10/163) Yes to some 20% (65/321) 35% (32/92) 17% (11/66) 13% (22/163) No 67% (215/321) 50% (46/92) 58% (38/66) 80%(131/163) 4.2.3. How to identify falls risks to minimise future incidents? Yes to all care homes 17% (55/321) 22% (20/92) 35% (23/66) 7% (12/163) Yes to some 34% (109/321) 53% (49/92) 35% (23/66) 23% (37/163) No 49% (157/321) 25% (23/92) 30% (20/66) 70%(114/163) 4.2.3. How to identify falls risks to minimise future incidents? Yes to all care homes 17% (55/321) 22% (20/92) 35% (23/66) 7% (12/163) Yes to some 34% (109/321) 53% (49/92) 35% (23/66) 23% (37/163) No 49% (157/321) 25% (23/92) 30% (20/66) 70%(114/163)
Falls Awareness Training Basic training template developed which can be adapted according to audience Primarily developed for care home staff Highlights the: importance of preventing falls role they can play in preventing falls causes of falls and potential interventions risk of osteoporosis value of falls risk assessments/checklists
Complex Care Team: Improving quality of life in care homes Initially a 6-month pilot (March-Sept 2010) Multi-disciplinary team Care Homes Lead Pharmacist Local GP Advanced Nurse Practitioner Provide support to selected nursing and residential homes with a history of high hospital admission rates
The Role of the Team Visited selected homes, one morning each week Identified high risk residents, which included those at high risk of falls Supported care staff to provide relevant and timely care for the resident Helped to improve communication through robust care plan recording
Falls Prevention Resident falling more frequently When was BP last checked? Has their medication changed? Do they have other symptoms? Is their fluid and food intake okay? Do they need a falls team assessment? Solutions Review medication Ensure they have their own walking aids Prescribe calcium and vitamin D to reduce risk of hip fracture Supporting decision making Support carers to recognise deterioration Support carers to access other services Support carers to reduce inappropriate 999 calls
Findings Dementia patients were often excluded from falls interventions High turnover of staff and high proportion of staff where English is not the first language Poor communication amongst care home staff Tendency for carers to contact the GP or call an ambulance in most instances Carers not aware of care home policy and tools available to give them confidence to deal with situations in-house, where appropriate
Outcomes As a result of the 6 month pilot: 25% reduction in A&E attendances 38% reduction in emergency admissions 50% reduction in GP OOH calls and visits Significant reduction in GP visits Reduction in number of medicines prescribed conservative estimate of 15,600 savings Full year estimate: Total gross saving = 203,016 p.a.
Additional Outcomes What the GPs said: Increased confidence to stop unnecessary medications Fewer phone calls to surgeries for visits What the residents/relatives said: 67% of responders felt more confident in medical support 56% residents felt more involved in their care 67% relatives felt more involved in decision making What the carers said: 100% expressed more confidence in dealing with minor ailments and injuries More empowered Shorter drug rounds
Complex Care Team Secured further funding The team informally discusses basic falls prevention with the member(s) of staff looking after the resident Falls Awareness Training Training is now provided on an ad hoc basis due to capacity issues Training is structured and suitable for all care home staff to attend
Next Steps Small multi-agency task and finish group set up including MH Trust, LINks and Local Authority Contracting colleagues Developing a comprehensive Falls Awareness Training and Information Pack which will include: Example of a falls policy and procedures document Examples of falls risk assessments / checklists Example of post falls assessments / checklists Role of a Falls Champion Leaflets and information, including a Making Your Home Safer booklet