Transcript Falls Awareness Training: Housing Support Advisors

Falls in Bristol’s residential
and nursing care
Rob Benington
Injury Prevention Manager
Bristol Public Health
Today’s presentation
1.
2.
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6.
Falls in Bristol
NICE guidance
Falls in Bristol’s care homes
Bristol’s service specification
Examples of falls reduction projects
from local providers
Building external links (postural
stability, diet, nutrition, hydration)
Falls are the leading
external cause of death for
the over-75s
1. Falls in Bristol
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Every year between 33% and 50% of people
over the age of 65 suffer a fall, (estimates
from Help the Aged)
20% of fallers will need medical help and just
under 10% will sustain a fracture
Fractured hips cost the NHS £1.8 billion every
year: All smoking £5bn, (2009).
All obesity £4.2bn, (2007).
Emergency admissions Bristol residents aged 65+
due to falls in 2012/13
All Bristol (65+) residents
390
Hip fractures
1215
Other fall related injury
4.4
2.8%
Admissions every day
% of all 65+ Bristol residents admitted
following a fall (57,200 2012 ONS MYE)
1. Falls In Bristol
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Emergency admissions per day (over 65’s)
2008/9
2009/10
2010/11
2011/12
2012/13
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3.9
4.4
4.0
4.3
4.4
In 2012/13, 390 people over 65 were admitted to
hospital with hip fracture, of which 15-30% die within 1
year, (60-121 deaths).
39% of Bristol’s 65+ admissions are from 7,082 beds
2. NICE Guidance
Assessment and prevention of
falls in older people
Issued: June 2013
NICE clinical guideline 161
guidance.nice.org.uk/cg161
Identification of vulnerable people
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Older people in contact with healthcare professionals should
be asked routinely whether they have fallen in the past year
and asked about the frequency, context and characteristics of
the fall/s.
Older people who present for medical attention because of a
fall, or report recurrent falls in the past year, or demonstrate
abnormalities of gait and/or balance should be offered a
multifactorial falls risk assessment.
The multifactorial fall risk assessment should be performed by
a clinician (or clinicians) with appropriate skills and training.
Biggest risk factor?
Having had a fall in the last 12 months.
“If you’re 65 or older, your health professional or
practitioner should regularly ask whether you’ve had a fall in
the past year. And if you’ve had a couple of falls, you should
see your doctor anyway, even if you feel okay.
This is because someone who has already had a fall is more
likely to fall in the future. But there are ways of helping a
person avoid having a fall so they can feel more confident in
their daily lives, and perhaps live independently for longer”.
NICE Clinical Guideline 21, 2004.
Fear of falling 'boosts elderly's fall risk'
Worry about falling
Increasing
unsteadiness /
loss of
balance
Restricted
activity
Fall
Functional
decline
Most relevant guidance…
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1.1.3 Multifactorial interventions
All older people with recurrent falls or assessed as being at increased
risk of falling should be considered for an individualised multifactorial
intervention.
1.1.4 Strength and balance training
Strength and balance training is recommended.
1.1.5 Exercise in extended care settings
Multifactorial interventions with an exercise component are
recommended for older people in extended care settings who are at
risk of falling.
1.1.7 Psychotropic medications
Older people on psychotropic medications should have their medication
reviewed, with specialist input if appropriate, and discontinued if
possible to reduce their risk of falling.
1.1.8 Cardiac pacing
Cardiac pacing should be considered for older people with
cardioinhibitory carotid sinus hypersensitivity who have experienced
unexplained falls.
Multifactoral interventions
In successful multifactorial intervention programmes
the following specific components are common
(against a background of the general diagnosis and
management of causes and recognised risk factors):
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strength and balance training
home hazard assessment and intervention
vision assessment and referral
medication review with modification/withdrawal.
3.
Falls in Bristol’s care homes
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Public Health Outcome Indicators
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Admissions, postcodes
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Occupancy and rates
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Confidentiality
Falls admissions from ECH, Care Homes, CH with Nursing,
sheltered accommodation (2011/12)
Extra Care Housing
54
Care Homes with Nursing
129
Residential care homes
107
Supported housing
91
Total
381
8.4% (One in 12)
% of 65+ care home residents admitted
39%
Of all Bristol’s 65+ falls admissions are
from 7,082 beds
Falls by accommodation type
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Residential on average smaller than
nursing homes (33 beds vs 57 beds)
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Older building / conversions
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Risk = hazard x exposure
Variation of falls admission rates (residential
and nursing homes) by home
Of 15 with sig higher than city av ad rates, 12 are residential homes
Variation by type
(Nursing Homes)
Variation by type
(Residential care)
Dementia
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4 year admission rate CHwNursing
= 6.7%
4 year average rate residential care
=12.2%
Average admission rate from homes for
people with dementia
=15.7%
4.
Joint service specification
Falls risk management
The Provider ensures that Service Users are assessed for risk of falls
within 24 hours of admission and the outcome recorded in their Care
and Support Plan. Those Service Users who are vulnerable to falls are
actively supported by their key worker or equivalent member of care /
nursing staff to reduce / prevent the risk of a fall occurring and thereby
supporting a reduction in unnecessary emergency admissions related to
falls.
The Provider maintains a falls register recording such information as the
causes of fall (injurious or otherwise) and this register is regularly
audited to ensure that necessary actions are taken to reduce falls within
the home.
4.
Joint service specification
Medicines management
Reducing polypharmacy
and
proactively seeking 6-monthly medicines reviews by GP.
Hydration/nutrition
Provides access to training on the identification of dehydration.
General
Users registered with General Practitioner within 7 days of admission.
Initial Care and Support Plan drawn up on the first day of admission.
Person centred care (and reviews)
Care and Support plans are kept and maintained
It is likely that meeting outcomes will require addressing falls risk factors
Wellbeing needs
Support to attend appointments
Footcare
Ensure footcare needs are assessed by an appropriately trained person (podiatrist
where appropriate)
Moving on
Service Users are involved in assessing risk for them or others if they move.
Management and leadership
…effective leadership…
Working with the local community
The Provider will be knowledgeable of the services available in the local
community and where identified in the SDS Support plan / CHC Care plan will
ensure the Service User is enabled to access these services.
The environment of the care home (various)
Leadership
Management
of health and
wellbeing
Medicines
management
Falls
admissions
are indicators
of…
Housing type
and client
group
Record
keeping and
care planning
Contact with
GP and other
services
Summary: Factors affecting
variation in falls rates
Housing type
Client group (frailty, co-morbidities)
Relationship with and quality of local services?
Staff turnover? (Correlated with decreases in nursing care,
Castle and Engberg, 2005).
Management practices?
FALLS PROJECT
2012
Falls Auditing
 Falls audits in the care homes had traditionally focused upon the number
of falls per month – was a paper exercise with no visible positive
outcomes
 Merely looking at the number of falls does not enable you to establish
any trend or cause behind the number
 Falls audits in their old format were time consuming, duplicated
information already held and were of no value to the staff or residents
 Staff understanding and ownership of falls management was limited with
a perception that ‘falls happen’ and without preventing residents from
mobilizing they would continue to fall
Plotting the Location
Plotting the Time
Number of falls – in context
Robinson Falls 2012
70
60
Number of falls
50
40
30
20
10
0
Jan
Feb
Mar
Apr
May
Jun
July
Month
Aug
Sept
Oct
Nov
Dec
What have we learnt?
The key to success has been involving the staff as they are the ones
who will make the difference on the floor.
Staff really understand the plotting and the concept of days between
falls. The information is visual, has an immediate impact and does
not have to be computer generated.
Looking at a number of different factors enables you to gather a true
picture of what the actual issues are – a number on its own merely
provides a snapshot that can be misleading – you may put the
wrong corrective or preventative measure in place if you do not have
the full information.
Falls happen for a reason and a pattern can almost always be
established for those residents who repeatedly fall.
The patterns and trends you uncover can be surprising!
Auditing in this way adds real value and makes a positive difference
for residents
Sandra Payne
Head of Clinical Excellence
Brunelcare
email – [email protected]
Mob – 0778 6706227
Falls in Bristol’s residential
and nursing care
Rob Benington
Injury Prevention Manager
Bristol Public Health
[email protected]