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Wednesday 23rd September 2009
HEAT TARGETS: NETWORK EVENT Fall and fracture prevention
Ann Murray Falls Programme Manager Practice Development Unit
NHS Quality Improvement Scotland
Prevalence of falls and fractures
Based on a local authority and PCT population of 300,000, which may include 45,000 people over 65.
Of these:
• 35% (15,500) will fall each year• 15% (6,700) will fall twice or more• 15% (2,200) of fallers will attend an A&E department• 15% (2,200) of fallers will call the ambulance service• 7% (1,100) will sustain a fracture, 2% (360) to the hip
From: Falls and fractures: effective interventions in health and social care (DoH 2009)
Older people who fall: A&E attendance
• Falls are under-reported: the consequence of the fall, namely the injury or fracture, becomes the diagnosis and subsequent ‘code’ for the episode of care
• Over one third of falls go unreported in computerised A&E records
• In practice this results in the wider use of falls preventions becoming overlooked
From: Urgent Care Pathways of Older People with Complex Needs, Best Practice Guidance, DoH 2007
Hip fracture
• Over 6,000 hip fractures in Scotland each year
• Costing on average £12,163 per admission (excl cost post discharge)
• Estimated cost to NHS Scotland £73 million
From: SIGN 111 management of hip fracture in older people (2009)
Falls are not an inevitable consequence of old age;
• Falls are nearly always due to one of more underlying risk factors
• Recognising and modifying these risk actors is crucial in preventing falls and injuries
• Multifactorial targeted interventions, based on risk assessment, can reduce falls by up to 30%up to 30%
From: Falls and fractures: developing a local joint strategic needs assessment. (DoH 2009)
• In people with osteoporosis, the risk of further fracture can the risk of further fracture can be halved be halved by anti-resorptive drug therapy
From: The care of patients with fragility fracture (British Orthopaedic Association, 2007)
The National Picture
• Rehabilitation and Falls HDL 2007 (13)
– CHPs need to appoint a falls prevention falls prevention lead or colead or co--ordinatorordinator to work along side the rehab coordinators rehab coordinators
• NHS QIS Falls Programme
– Two year programme
– Working with identified CH(C)P Falls Leads
– Work programme identified by key stakeholders
Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures
• A resource to assist planning and development
Will be available to view and download at:www.fallspathway.nhshealthquality.org
Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures
• Places the different aspects of fall and fragility fracture prevention and management in the context of a journey of care
• Underpinned by explicit evidence, tacit and organisational knowledge and the older person’s experience
• Based on the Future Model of Rehabilitation, Delivery Plan for Adult Rehabilitation in Scotland
The journey of care…
• Stage 1 Supporting health improvement and self management to reduce the risk of falls and fragility fractures
• Stage 2 Identifying individuals at high risk of falls and/or fragility fractures
• Stage 3 Responding to an individual who has just fallen and requires immediate assistance
• Stage 4 Co-ordinated management including specialist assessment
Exercise provision for older people: the ‘Vitality’ Programme
• Provided in partnership by Culture & Sport Glasgow and NHS Greater Glasgow and Clyde
• For people living with long term conditions, including those living with osteoporosis and older adults who have completed rehabilitation following a fall
• Highly trained instructors encourage individuals to participate in other suitable physical activities where appropriate
• Transport available
• Charge for class participation, which enables sustainability of the programme
Contact: [email protected]
Stage 1: Supporting health improvement and self management to reduce the risk of falls and fragility fractures
Identifying people at risk of osteoporosis and fragility fracture
• Fracture Liaison Services
• Assume responsibility for low trauma fracture case-finding
• Assess and perform diagnostic evaluations , and make specific treatment recommendations for the secondary prevention of osteoporotic fractures
• providing a one-stop clinic for all patients presenting with fragility fractures
Contacts: [email protected] (NHS GGC)[email protected] (NHS Lothian)
Stage 2: Identifying individuals at high risk of fallsand/or fragility fractures
Telecare services identifying recurrent fallers and linking with falls management and prevention services
• Joint NHS Forth Valley, Falkirk Council initiative, involving:– the Mobile Emergency Care Service, Community Rehabilitation and
Assessment Services and Day Hospital
• Two falls within a 6 month period - offer of referral to Falls Management Clinic
• GPs have agreed to direct referrals being made from MECS to Falls Management Clinic
• MECS service users sign a waiver to allow sharing of information between MECS and NHS Forth Valley
Contact: [email protected]
Stage 2: Identifying individuals at high risk of fallsand/or fragility fractures
YEAR FALLS
ATTENDEDSERVICE USERS FALLS PER
USER
2002 Projected
1768 * 4213 0.42 Projected
2003 Actual 1429 4600 0.31 Actual
2004 Actual 1409 4904 0.28 Actual
2005 Actual 1487 5600 0.26 Actual
2006 Actual 1524 5598 0.27 Actual
2007 Actual 1291 5939 0.22 Actual
2008 Actual 1964 6014 0.33 Actual #
2009 Actual 1172 6131 0.32 Actual
A falls response service for older people who fall, are uninjured, but cannot get up
• Fife Falls Response Service (2006)
• Fife Council, NHS Fife, NHS 24, Ambulance, Fire and Police services
• Developed from Fife Council’s pre-existing Mobile Emergency Care Service
Two components:1. Response: MECS team is dispatched to assist the person to rise
from the floor
2. Referral for NHS follow-up/advice from existing teams for those over 65 to minimise the likelihood of future falls and fractures
Contact: [email protected]
Stage 3: Responding to an individual who has justfallen and requires immediate assistance
A community-based, integrated, multidisciplinary falls service: screening, triage and onward referral
• NHS Greater Glasgow and Clyde Community Falls Prevention Programme (CFPP)
• This service operates an open referral system to a central administration centre ie a single point of access
• Following referral, there is an initial telephone triage followed by a multifactorial risk screening in the older person’s home, with onward referral to a variety of community and hospital services
• IT systems are in development to facilitate communication across the board-wide falls network
• The CFPP accepts approximately 250-300 referrals per month
• Fallers are seen at home within 5 working days of telephone triage
Contact: [email protected]
Stage 4: Co-ordinated management including specialistAssessment
Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures
Will be available to view and download at:www.fallspathway.nhshealthquality.org
www.fallscommunity.scot.nhs.uk
– Exchange knowledge, ideas, experience and good practice
– Find useful resources
– Access pre-programmed searches
– Find and contact colleagues
– Discuss topics of interest
– Keep up to date with news, events and Scottish initiatives
– Access secure ‘shared spaces’
Contact details:
Ann MurrayFalls Programme Manager
NHS Quality Improvement ScotlandDelta House
50 West Nile StreetGlasgow G1 2NP
Tel: 0141 225 6987Mobile: 07970 [email protected]
