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  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

    1

    CONTENTS

    Page1 Executive Summary 22 Project Board 43 Background 54 Aims and Objectives 75 Developing the Audit and Data Collection Strategy 86 Standards 97 Data Collection and Methodology 148 Results 199 Summary/Conclusions 4110 References 4611 Contact Details 4812 Acknowledgements 49

    APPENDICESAppendix 1 List of Charts and Tables 50Appendix 2 Hospital wards type and number of beds 51Appendix 3 Hospital Falls Services 53Appendix 4 Feedback Seminar Attendees 56Appendix 5 Proforma 57

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

    2

    1. EXECUTIVE SUMMARY

    The purpose of this report is to inform Trust Management/Executive Teams, PCTs,

    Strategic Health Authorities and the Greater Manchester Clinical Audit Group of the

    outcome of the recent Greater Manchester and Wirral Falls Risk Assessment Audit.

    The principal aim is to audit current Falls Management and Prevention in a group of

    Hospitals across Greater Manchester within the context of the National Service

    Framework for Older People.

    The main results of the audit concentrate on assessments and documentation, risk

    factors, mobility assessments, interventions and prevention measures, and the

    possible impact of falls risk assessment tools (FRA) in preventing falls in hospital.

    Patients in the sample were predominantly the very elderly, those aged 80 years or

    more comprised almost 58% of the sample. This proportion varied by Trust from,

    45% in MRI to 73% at the Wirral.

    Approximately 30% of patients in the sample were admitted with a fall.

    Between 85 - 95% of patients in 4 of the hospitals were assessed. The other 6

    hospitals all fell below the mean value, which was less than 53%.

    Overall 34% of patients who had a risk assessment were reviewed.

    Some form of action to prevent falls was taken in 61% of patients who had a risk

    assessment form in the 5 hospitals that used Falls Risk Assessment forms.

    Patients were more likely to have mobility and/or transfer assessments done than

    other assessments such as Lying & Standing BP and Medication reviews.

    The most likely interventions included referral to a physiotherapist and/or an OT,

    the patient was placed under close observation, and a call bell was at hand.

    Patients having a FRA completed were significantly more likely to have certain

    prevention measures.

    Fewer patients fell in the group that had a FRA completed.

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

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    The main conclusions from the audit are: using a FRA may have a protective effect;

    the patients are more likely to have prevention measures targeted at them; in-patient

    falls were less likely in hospitals using a FRA and patients with risk factors are not

    necessarily being documented as being at risk of falling.

    Following the feedback seminar a Falls Working Group will be set up to look at

    multidisciplinary core skills in relation to an inpatient falls action plan and to explore

    standardising falls risk assessment and intervention across Greater Manchester.

    Funding for the audit was provided by the Greater Manchester Clinical Audit Leads

    Group.

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

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    2. PROJECT BOARD

    Members Title Organisation

    Mrs J Barnes Physiotherapist Tameside & Glossop AcuteServices NHS Trust

    Dr D BourneConsultant in GeneralMedicine and ElderlyCare

    Central Manchester & ManchesterChildrens University HospitalsNHS Trust *

    Dr G Cook ConsultantEpidemiologist Stockport NHS Foundation Trust

    Mrs J Gray Falls Co-ordinator South Manchester UniversityHospitals NHS Trust

    Mrs S Gunnion Lead Falls NurseCentral Manchester & ManchesterChildrens University HospitalsNHS Trust **

    Dr M Hanley Consultant in ElderlyMedicine Stockport NHS Foundation Trust

    Mrs J Powell Falls Prevention Officer Pennine Acute Hospitals NHSTrustDr M Pritchard-Howarth

    ConsultantOrthogeriatrician Wirral Hospital NHS Trust

    Ms J Rodgers Audit Co-ordinator Stockport NHS Foundation Trust

    Jacquie Ruddick Clinical Governance Co-ordinator Wirral Hospital NHS Trust

    Mrs G Wakefield Clinical GovernanceFacilitator Trafford Healthcare NHS Trust

    * Now employed by South Manchester University Hospitals NHS Trust** Now employed by Stockport PCT

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

    5

    3. BACKGROUND

    Injury is a leading contribution to the burden of disease in the world. In 1998 injury

    from falls was the 14th leading contributor for all age groups (Myers, 2003). Falls are a

    major cause of disability and the leading cause of mortality due to injury in people

    aged over 75 in the UK. Up to 14,000 people a year die in the UK as a result of an

    osteoporotic hip fracture (DoH, 2001). Falls prevention is a priority area for research

    and interventions. Identification of high risk patients is an important component of falls

    prevention measures (Myers, 2003).

    NSF for Older People

    The National Service Framework (NSF) for Older People, recognises the importance

    of prevention (DoH, 2001). The NSF sets out the aims in standard six, to reduce the

    number of falls which result in serious injury and to ensure effective treatment and

    rehabilitation for those who have fallen. The NSF promotes the establishment of

    specialist falls services within specialist multidisciplinary and multi-agency services for

    older people including health and social care staff that target, especially, older people

    who are at high risk of falling.

    As part of the Service Model, the NSF states that staff in hospitals should be trained to

    recognise when older people are at risk of falling and be able to refer them to the falls

    service for assessment. Assessments should identify the risk factors for falls and

    osteoporosis and offer appropriate interventions. Current practice should be examined.

    New procedures should be agreed by a range of professionals involved in the falls

    service. Finally, prior to discharge, the needs of the patient and their carers for care

    and support at home should be identified. This includes making sure that patients are

    advised about how they can reduce their risk of falling and therefore prevent further

    falls or fractures. (DoH, 2001)

    This audit aimed to assess whether or not such services were established in the

    hospitals involved. Preventing falls in older people depends on identifying those most

    at risk of falling and co-ordinating appropriate preventative action. The audit would

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

    6

    examine how hospitals identify those at risk and whether this is routinely done and

    what preventative measures are then put into place. The audit would examine current

    practice and whether the standards developed within and through the NSF had been

    met.

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

    7

    4. AIMS & OBJECTIVES

    AIM

    To audit current falls management and prevention in a group of hospitals across

    Greater Manchester in support of the National Service Framework for Older People.

    OBJECTIVES

    I. To conduct a multidisciplinary audit of the use of risk assessment tools for falls

    prevention on Care of the Elderly and Trauma and Orthopaedics wards

    II. To develop further the multidisciplinary clinical network between Care of the

    Elderly, Trauma and Orthopaedics and Anaesthetics

    III. To develop further links with the local collaborative initiatives around

    orthopaedics and care of the elderly

    IV. To establish a baseline of current services within each hospital setting

  • GREATER MANCHESTER & WIRRAL FALLS RISK ASSESSMENT AUDIT

    Greater Manchester & Wirral Falls Risk Assessment Audit Group, 2004Clinical Effectiveness Unit, Stockport NHS Foundation Trust

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    5. DEVELOPING THE AUDIT AND DATA COLLECTIONSTRATEGY

    5.1 Trusts participating in the audit

    Six trusts from Greater Manchester and one from Wirral were recruited to the audit.

    The trusts were Central Manchester & Manchester Childrens University Hospitals

    NHS Trust, Pennine Acute Hospitals NHS Trust (across 4 hospital sites), South

    Manchester University Hospitals NHS Trust, Stockport NHS Foundation Trust,

    Tameside & Glossop Acute Services NHS Trust, Trafford Healthcare NHS Trust and

    Wirral Hospital NHS Trust. In total 10 hospitals participated.