What was different about the FallSafe approach?1. It was evidence-based2. It prioritised the things we struggle with3. It was multidisciplinary4. The basic equipment they would need

was made available

What was different about the FallSafe approach?1. It was evidence-based2. It prioritised the things we struggle with3. It was multidisciplinary4. Basic equipment available5. The care bundle was implemented in stages

rather than all at once6. We measured delivery at least every month

Baseline Project end Six months later

1 Call Bell in reach 91% 98% 99%

2 Cognitive screen 50% 78% 63%

3 Asked about fear of falling 29% 68% 71%

4 History of falls taken 81% 89% 96%

5 Lying Standing BP 25% 50% 43%

6 Medication review 42% 84% 72%

7 Night sedation not given 82% 87% 90%

8 Safe footwear on feet 91% 97% 99%

9 Urine dip-test 63% 78% 82%

What was different about the FallSafe approach?

1. It was evidence-based2. It prioritised the things we struggle with3. It was multidisciplinary4. Basic equipment available5. The care bundle was implemented in stages6. We measured delivery at least every month7. We didn’t expect results to show overnight

What was different about the FallSafe approach?

1. It was evidence-based2. It prioritised the things we struggle with3. It was multidisciplinary4. Basic equipment available5. The care bundle was implemented in stages6. We measured delivery at least every month7. We didn’t expect results to show overnight8. We let patients be the judge

What was different about the FallSafe approach?

1. It was evidence-based2. It prioritised the things we struggle with3. It was multidisciplinary4. Basic equipment available5. The care bundle was implemented in stages6. We measured delivery at least every month7. We didn’t expect results to show overnight8. We let patients be the judge 9. We created a ‘safe space’

“It’s a safe environment to talk about it – no one is standing over you saying ‘why have you had ten falls?’ – so you can really think about what can prevent them”

“Where do you buy your slippersocks? ”

“If we can do it, surely you can!”

Peer support and challenge

Changing mindsets

“It used to be just one of those things you expected to happen; now it’s a big deal if a patient does fall and everyone will be thinking, ok, let’s try this or that – we know we can do something about it”

What was different about the FallSafe approach?

1. It was evidence-based2. It prioritised the things we struggle with3. It was multidisciplinary4. Basic equipment available5. The care bundle was implemented in stages6. We measured delivery at least every month7. We didn’t expect results to show overnight8. We let patients be the judge 9. We created a ‘safe space’ 10. We gave each FallSafe lead enough education and support to make them confident

and knowledgeable

FallSafe: training and support

eLearning focused on nurses’ role

“ Oh yes, the Occupational Therapists always do MMSE – they’ll be in the OT notes in their office somewhere”

“That’s a doctors’ job”

“We would do an AMTS when we notice that a patient’s confused…..”

19

Starting point for some FallSafe units

20

Delirium assessment?

Key thinking 1. Are they confused?

• using an objective assessment like AMTS2. Is the confusion new/different?

• talk to their family & friends • listen to the last shift each handover • notice changes since your days off

3. Think of apathetic delirium • Remember they can be delirious without being agitated

“Could this be delirium?”

Special observation

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Intentional rounding: if you do use

Don’t standardise, individualise

Minimise documentation

Remember:– Communication skills in dementia – An hour is a long time

Leadership commitment……

“I’d like to do FallSafe in my hospital, but we won’t be able to give staff for any training”

“ Two hours of eLearning is a bit much – can’t you do a version that covers everything in 15 minutes?”

Provision of walking aids at weekends

Royal College of Physicians 2012 Clinical Effectiveness and Evaluation Unit Report of the 2011 inpatient falls pilot audit www.rcplondon.ac.uk

Sometimes falls is not the priority

• 50 bed unit• No permanent unit manager in post• 30-40% temporary staff• Three FallSafe leads left in quick

succession

2001 censusPeople aged 75 years or more

3,704,945

Hospital admission statistics 2006People aged 75 years or more

admitted as inpatients3,174,676

You will meet most of your patients again…..

Separate to FallSafe but not to be forgotten

Last words

Questions and comment? frances.healey@nhs.net

@FrancesHealey