northwest inpatient falls

NORTHWEST

INPATIENT FALLSPREVENTION & MANAGEMENT OF

AUDIT

AINTREE UNIVERSITY HOSPITALS NHS FT

AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST

PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST

• Acute healthcare

• Urban population of 330,000

• North Merseyside and surrounding areas

• Provides some tertiary services for a wider area

• > 73,000 episodes of inpatient and day case care each year

Summary


Goals

• Ensure initial assessments are done in a timely fashion

• Assess modifiable risk factors

Actions taken since 2009

• Changes in documentation

Aintree University Hospital Foundation Trust



SWOT analysis

Strengths

Assessment on day 1 or 2 of admission:

Falls risk 67% �� 85%

Hx of previous falls 29% �� 91%

Gait 75% �� 85%

Cognition 62% �� 86%

Opportunities

Link objectives to other trust targets

eg dementia strategy

New electronic documentation may

improve things

Weaknesses

Review of anxiety of falls: 0% �� 7%

Medication review: 95% �� 15%

Assessment for bedrails: 15% �� 29%

Eyesight checked: 33% �� 17%

Postural blood pressure: 11% �� 8%

Threats

Ever increasing work load on staff due

to competing demands on time

eg VTE assessment

EAST LANCASHIRE HOSPITALS NHS TRUST


SWOT ANALYSISStrengths

• High level support in the Trust

• The Trust has a non stratified screening

tool and evidence based policy

• 68% patients had their cognitive /

mental state reviewed on admission

• 55% had their gait reviewed

• Transforming community services

• Safety Express – Harm Free Care

Opportunities• Awaiting commissioner intervention:

• RE: support of a falls prevention programme in the community

• RE: support of a fracture liaison service

• Falls champions sharing information

• Strengthening of inter disciplining ways

• Dementia pathway and CQIN

• Orthogeriatrics

Weaknesses• Medication review• Need to improve compliance with

Trust policy• Cohesive bundle for medical

interventions for fallers• On-going monitoring of cognition

needs to be strengthened

Threats

• Communication and engagement

• Resistance to change

• Small falls “team” not a fully cohesive

service across pathways (but improving)


EAST LANCASHIRE HOSPITALS NHS TRUST

LANCASHIRE TEACHING HOSPITALS NHS FT



Goals for 2011 audit:

• Complete Falls Assessment Tool with Moving and

Handling and Bed/Trolley rail assessment

• Lying and Standing Blood pressure

• Communication with patient is documented

• Improve the Falls Referral on Discharge for continuity

of care

Rolled out the Falls Assessment tool throughout the Trust

Supported staff in understanding the important of Lying

and Standing Blood Pressure

Several audits in the trust identify Falls Assessment tool is

completed

Blood Pressure is not being completed -- Criteria now in

place for age 65 and over to improve figures.

Summary


2011 Audit Results:

80% Falls Assessment was

completed on admission

98% Moving and Handling Plan

0% Lying and standing Blood

pressure

32% had a urinalysis checked

Hearing and vision very low %

23% Anxiety about falling

Population covered is 340,000 Central Lancashire


Outcomes:

1 All patients identified at risk of falls have

appropriate plan of care

Documentation Audit – reduction on

in-patient falls and severity of injuries

2 Encourage urinalysis on admission and

assessment of vision and hearing

Ward audits and ECAP audit

3 RCA to be encouraged on all injuries

following a fall

Data on injuries and RCA collected on

Datix

4 Improve education and training for all staff Training records, e-learning

5 Documentation Ward Performance audits, NHSLA and

ECAP

Outcome Indicators:

Action Plan


EAST CHESHIRE NHS TRUST



Aims for the 2011 audit were

to improve assessment

processes and care planning.

This was achieved in the majority of

cases with marked improvement

from 2009 in the majority of areas.

Summary


East Cheshire NHS Trust has 306 acute beds and serves a population of

approximately 450,000.

There is a high proportion of elderly patients in this area –

approximately 80% of the inpatient population are over the age of 75

There is still work to do around:

• The number of ward transfers

• Patients’ experience

• Pharmacy reviews

• Reduction the actual number of falls

per 1000 bed days



SWOT analysis Strengths

Strong clinical leadership

Designated Falls Lead identified

Regular monthly MDT meetings

Assessment documentation reviewed and fit for

purpose (falls and bed rails)

Regular documentation audits via patient metrics

Operational staff engaged in falls prevention agenda

Falls improvement initiatives in place

Equipment available

Osteoporosis and Bone Protection

Opportunities

Integration with Community Business Unit

Exec engagement and focus on falls prevention

Participation in ‘Safety Thermometer’

Opportunity to dovetail with other projects eg

dementia strategy, development of acute elderly care

unit

Introduction of ‘Datix’ incident reporting system

Weaknesses

Training

Pharmacy input and medication reviews

Continence care

Change in incident reporting system ? Inconsistent

information

Patient Information

Threats

Access targets influencing number of ward moves

Period of change within organisation – change in

personnel etc

Limited resource available

MID CHESHIRE HOSPITALS NHS FT



MCHFT - 560 beds serving population of 400,000.

N West audit - 60:40 Female:Male

53% Gen Med. 23% Surgical 23% Orthopaedic

Average age 80 yrs. Average length of stay 15 days

Goals from 2009

Improve Bedrail Screening

Lying/Standing BP (increase in recording)

Medication Review particularly psychotropic's.

Documentation of Interventions

Summary



What have you done to meet those goals?

Reviewed and amended FRASE documentation to include bone health assessment and Lying/Standing BP.

Dissemination of instructions to wards for recording L/S BP.

Online falls summary to include medication review.

What has or has not worked?

New documentation not implemented until July ‘11 so audit completed using old documentation.

Ward-based pharmacists to review all medication, particularly following falls.

Assessment of bedrails much improved.

Summary




SWOT analysisStrengths

Identified during 2009 audit what needed

to change.

Improved documentation.

FaB Newsletter

Falls Leads and Cascade training.

Monthly ward projections.

Regular falls group meetings (now with

executive representation)

Opportunities

FallSafe Project

Online falls reporting

Development fracture clinic

Physiotherapy re falls prevention classes

within trust.

Non-hip fracture nurse.

Weaknesses

Time taken to implement change therefore

not reflected in 2011 audit.

Lack of Falls Lead/admin assistance.

Medical engagement

No prevention training in Non ward areas.

Lack of continence strategy

Threats

Process to implement change

i.e. Governance channels.

Different challenges for time within trust and

changing working practices.

Economic climate (funding issues for new posts)

ST HELENS & KNOWSLEY HOSPITALS NHS TRUST



Population : Elderly, chronically ill, low socio-economic group

Goals for 2011 audit: Evaluate progress since 09

How goals were met: Detailed service review, revised falls service provision (inc. policies, assessment tools, care plans, training) increased liaison with primary care / emergency care colleagues

What has worked? Almost everything!

What hasn't worked? Time frame for implementation

Main issue = changing existing culture ∴∴∴∴ takes longer to reach full implementation

.

Summary




SWOT analysisStrengths:

Committed staff: Nomination for

most improved service provision in

Trust

Falls leads, regular falls group

meetings, new reporting

mechanisms, multidisciplinary

approach, internal audit programme

+ resources

ALL = improved clinical practice

Opportunities:

Audit (local, regional, national)

National projects eg. FallSafe, Patient

Safety Express,

Offsite visits to explore gold standard

practice elsewhere

Networking through Steering Group /

Audit Meetings & Workshops etc

Weaknesses:

Pervasive 'negative' culture,

limited staff (clinical & audit) +

financial resources

Threats:

Large, complex , time consuming project

Prospect of reduced financial / staff

resources in future

STOCKPORT NHS FT



What is your population like?

Population– 264,000, 800 bed hospital, recently taken on two community settings –Tameside (inc 2 in-patient areas) and Stockport PCT, Total 5,300 staff.

Number of admissions 18 and over April 2011-March 2012 – 72,707. Number of Falls Including Near Misses April 2011–March 2012 - 1579

What were your goals for the 2011 audit?

To check improvement since the 2009 audit. To re-focus work regarding falls at the Trust, taking into account North West Falls Audit recommendations.


Bed Rails – Policy updated and re-launched. Falls Risk Assessments updated and easily accessible, Lying & Standing BP including in Falls Risk Assessments and Training. FRAX tool in use.

What has or has not worked?

Found in practice that some issues implemented still don’t work despite training! More work required – Cognitive/Mental States.

Summary

STOCKPORT NHS FT

Strengths

Multi-Disciplinary Falls Group

Executive Director Led/Board of

Directors & Governors commitment

Falls Risk Assessments done early on

admission – quickest and improved

Falls Training – Mandatory

Multi-disciplinary initiatives to help

reduce falls

Opportunities

New Harm Free Care Committee

Thermometer Survey

Falls Collaborative in place on high risk

wards.

More Focus Work – modifiable factors

Corporate Objective to reduce

numbers/harm rates

Weaknesses

“So What” – Theory and Practice Gap

Review mental status

Threats

Motivation in current climate – increase

quality, reduced costs.

Just another thing!

Measurement

Number of patient transfers


STOCKPORT NHS FT

SWOT analysis

UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

AUDIT RESULTS



UHSM is an acute teaching hospital NHS Trust providing services for adults and children at Wythenshawe Hospital, Withington Community Hospital and in the Community.

The Trust has around 920 inpatient beds with a total of approx89,000 admissions per year.

In relation to Incident Reporting, we reported 8448 incident reports in 2011-12, of which 1608 were inpatient falls of these 29 were moderate / major harm.


Summary

Goals for 2011 Audit

• To compare our progress against the previous audit

results.

• Has the introduction of the Trust Fall Falls Intervention Tool improved compliance with the assessment of Inpatient Falls Risk?

• To understand whether we have improved our compliance with Risk Benefit Medication reviews.

• To identify if the recording of Lying / Standing blood pressure has improved.




• The Falls Intervention Tool was introduced across the Trust

over the last 2 years to all inpatient areas.

• The recording of lying and standing blood pressure is

reinforced during teaching sessions on how to use the tool.

• There have been a number of initiatives piloted to formalise

the Risk Benefit review of Medications.



What has or has not worked?• The Inpatient Falls Intervention Tool has improved the risk

assessment compliance, and also vision and hearing

assessment.

• The recording of Lying and Standing Blood Pressure has not

improved as expected – need to include this in training

programmes.

• The Risk Benefit review of medications has deteriorated as

there is no formalised process for this review. All

medications are reviewed by a pharmacist on admission

and this may be why the original audit in 2009 recorded

91% compliance.



Strengths

Full-time Falls Service Facilitator.

Quarterly falls group meetings.

We assess patient’s risk in line with our

policy 95% of the time (within 24 hours).

Combined Falls, M&H and Bed rails

assessment.

Opportunities

Full-time Falls Service facilitator .

Introduction of Ward based “Falls

Champions – Fallsafe.”

E-learning package - RCP Falls Training

Package.

Weaknesses

Identification of Risk Benefit review of

Medication.

Recording of Lying and Standing BP.

Audit sample was an equal cross section

across all areas of the Trust – previously

focused on Unscheduled Care.

Threats

Resources at ward and department level.

Setting of unrealistic targets for compliance

– suggest stretch targets for improvement.

Nature of audit is in some places subjective

and open to interpretation.

The purpose of some questions is not clear

– medications for example.



SWOT analysis

TAMESIDE HOSPITAL NHS FT



What is your population like? - The audit population ranged from 65 –92 yrs, mixture of male and female.

What were your goals for the 2011 audit? - The goals were to benchmark the Trust with last year results to mark our own improvement and how it compared with the rest of the region.

What have you done to meet those goals? - A focus group was established. An action plan was developed. New falls documentation was developed out of the results of last audit and implemented. A Trust wide patient safety falls programme was implemented. RCA investigations and audits of falls documentation.

What has or has not worked? – RCA, falls audits and implementation of action plans have been a great success for the Trust and Patient Safety

.

Summary



Outcomes:

1 Improve documentation to support the

patient from falling during their in patient stay

The Trust patient safety programme was

launched in May 2011. Monthly audits

show encouraging results. Falls

documentation was revised and

Launched in November 2011

2 To increase the number of falls risk

assessments complete from 79% to 95%

Falls documentation is audited monthly

and non compliance managed

3 To increase the number of vision risk

assessments from 16% to a minimum of 50%

Admission documentation has been fully

revised and will be launched July 2012

4 To increase the number of cognitive

assessment from 70% to a minimum of 95%

Admission documentation has been fully

revised and will be launched July 2012.

Eyesight test feature in the audit to be

completed within 12 hours

5 To increase the number of hearing

assessments 28% to a minimum of 50%

As above point 4

Outcome Indicators:

Action Plan


WRIGHTINGTON, WIGAN & LEIGH NHS FT



IMPROVED ☺☺☺☺

EARLY FALLS RISK ASSESMENT

RELIABLE RISK STRATIFICATION

URINE ANALYSIS

ASSESMENTS :

- CONTINENCE

- ALTERNATIVE BEDS

- BED RAILS

- OSTEOPOROSIS

Summary

WRIGHTINGTON, WIGAN AND LEIGH NHS FT

NOT MUCH CHANGE :

AVERAGE AGE

SEX DISTRIBUTION

BASE LINE MOBILTY

WARD DISTRIBUTION & LOS

EARLY FIRST REVIEWS

MEDICINE USAGE REVIEW


Action Plan

WRIGHTINGTON, WIGAN AND LEIGH NHS FT

ACTIONS:

IMPROVE ASSESSMENTS

IMPROVE BED MANAGEMENT (DECREASE WARD TRANSFERS)

IMPROVE TRAINING AND EDUCATION

ADDRESS BONE HEALTH

ESTABLISHED INITIATIVES ☺☺☺☺ :

FALLS REPORTING ON DATIX

QSMs (reported falls - moderate to severe harm)

FALLS SCRUTINY COMMITTEE

RCAs

FALLS RAPID RESPONSE TEAM ( POST – FALLS)

NORTHWEST

INPATIENT FALLSPREVENTION & MANAGEMENT OF

AUDIT

NEXT


BREAK FOR TEA & COFFEE

RETURN FOR FALLSAFE PRESENTATION &

THE NEW NATIONAL IN-PATIENT AUDIT

RECEPTION

CLOSING REMARKS

northwest inpatient falls

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