www.shropscommunityhealth.nhs.uk current situation for shropshire falls services/ pathway sandy...

www.shropscommunityhealth.nhs.uk

Current Situation for Shropshire

Falls Services/ Pathway

Sandy LockwoodSCHT Falls Prevention Service Team Lead

Whole System Approach to Falls Prevention Workshop2nd Sept 2014


History of Specialist Falls Service

• Pre 2005 ad hoc falls prevention work around County

• 2005 Falls prevention Pilot in South Shropshire

• 2007 Draft care pathway and service spec for delivering a Falls Prevention Service within Shropshire County

• 2009 Team Lead appointed to FPS


Specialist Falls Service

What is it?

• MDT – 4.8 x wte covering whole of Shropshire• SPR• Accept referrals from anyone including self referrals• Standardized screening, Ax, documentation, treatment• Falls prevention programmes across Shropshire County• Exercise delivery (PSI and Otago) • Facilitate discussion group to make lifestyle changes, peer support• Outcome data collection• Specialist Falls Prevention Resource for County, • Patient information leaflets, website• Mandatory falls training for SCHT• Falls awareness training for other organisations / older people groups• LHE wide Falls Champion Forum / Falls Task Finish Group


We need helpPreventing Falls is everyone’s responsibility

• What is the basic aim?

• To be proactive – Make every contact count

• To reduce the number of falls - community, hospitals, care homes

• To reduce the number of fractures

• To reduce the consequences of falls and fractures

• To use strategies researched to save lives and be cost effective

• To implement a coordinated approach across Shropshire


Coordinated Approach

• What do we have now that follows best evidence based practice?

• Can we optimize what we have ?

• Can we do things differently ?

• Can we identify gaps that we have in achieving best evidence based practice?

• Do we know how big the problem is in Shropshire?


Best evidence to prevent falls

What should we be doing?

Identify patients over 65 who have fallen / at risk of falling

What are we doing ? Who’s doing it

Level 1: Falls risk screening and referral form - Community Level 1: Falls pathwayFalls and injury risk screening and management plan - Hospitals Care Homes – no standardised screening




Identify patients requiring focussed medical assessment


Level 1 identifies patient and shows pathway to: DAARTs in Shrewsbury, Oswestry, BridgnorthLocality GPs where no DAART available Consultant in specialist services as appropriate




Assess falls risk factors in patients who have fallen / at risk of falling including physio led gait and balance assessment using validated outcome measures


Level 2: standardised mutifactorial falls and fracture risk assessment (MFFRA) SCHT nurse/ therapists in IDTs, DAARTs, FPSFalls and injury risk screening and management plan - Hospitals Care Homes – no standardised Ax SCSWIS package available on SPIC website




Assess risk of fragility fracture in those who have fallen / at risk of falling

What are we doing ? Who’s doing itFRAX ( Fracture Risk Assessment Tool) included in Level 2 MFFRAPhysiosGeriatriciansGPs QOF register for those with fragility fractureTrauma nurse PRH reviews bone health of hip fracture patientsRJAH dexa scans, Bone Health dept / consultantNOS




Action interventions identified to reduce individuals falls risk factors


Community, Hospitals – health related with onward referrals to appropriate services memory service, dementia support workers, podiatry, vision, hearing services, continence, voluntary agencies, social services, handy person groups, fire services etc. Opportunistic low level interventions by individuals in contact with older people

Hospitals / Care homes – action interventions to keep safe in that setting


Interventions proven to reduce risk


Home environment assessment in those that have fallen in previous year- OT led


Home environment checks done by wide range of agencies including OTsFCF – OT members developed locally validated Home Safety Check booklet – available for use by all (SCHT website)




Falls specific Medication review for those patients on 4 or meds


Falls Medication review completed by clinical pharmacist on all hospital admissionsPractice based clinical pharmacist / GP review those highlighted as high risk of falls in communityCare Home – variable frequency?




Deliver evidence based postural stability falls prevention exercise programmes

Prevent “long lie” scenarios by training how to get up or by alarm technology


FPS deliver 9x evidence based 13 week postural stability falls prevention programmes in 7 localities across Shropshire / 1:1 at home where appropriate

Transport offered for those unable to access independently – NSL service

IDT therapy deliver 1:1 Otago for very frail



• What should we be doing?

Provide ongoing exercise by suitably trained instructors

Falls exercise pathway

• What are we doing ? Who’s doing it

Variety of private community exercise classes available Extend,

( supported by Community Council Shropshire) , some Otago trained,

Walking for Health, leisure centres, exercise on prescription, Active 4Health

but only one PSI instructor to maintain/ build on benefits gained from FPS




Provide training for clinical staff involved in assessing / delivering falls strategies / interventions to older people at risk of falling in community, hospital, care home teams

What are we doing ? Who’s doing itFPS deliver training to SCHT clinicians

RCP e- learning Preventing falls in Hospital SCHT, SaTH, RJAH, SSSFT FPS delivered training to Care homes 2011/12 in partnership with SPIC. Care Home clinical educator to take up post Sept 2014 to link with FPSFalls prevention info, including Social Care Social Work Improvement Scotland (SCSWIS ) managing falls in care homes, identified and added to SPIC website as part of Safecare Shropshire work


• What should we be doing?

Falls awareness Training for care agencies/ Social services/ voluntary agencies

Raise awareness : patient info leaflets, distribution / availablity

Falls awareness events

• What are we doing ? Who’s doing it

FPS delivered Falls awareness training past year to :

AgeUK home support workers, NOS, GP education event

Public / carers in partnership with Community Council Shropshire Senior Safety Days

Dementia Patient self care programme Shropshire CCG

Day Centres/ private groups

Memory Service SSSFT

FPS - SCHT website

Shropshire Falls Awareness week Sept 1-5



Sharing best practice/ cascading information

Raising quality and standards


Falls Champion Forum hosted by FPS

Safecare Shropshire Falls Task and Finish Group

GP education events


How can we add years to life and life to years

• How can we maximise resources we have?

• What can we do better ?

• Where are the gaps ?

• What are our opportunities ?

• What are our challenges ?


Some thoughts

• What can we do better? What are the gaps? Poor / non existent data on falls in Shropshire

• What are the opportunities? To develop Public Health intelligence for feedback to Primary Care team, CCG and Health and Wellbeing Board

Use patient level linked data to understand how costs are distributed across

Shropshire’s hospital, community and social care system for falls patients

• What are the challenges? What data do we need How do we get it


Some thoughts

• What can we do better? What are the gaps? Better screening of over 65’s at risk of falls

• What are the opportunites?

Develop/ Strengthen engagement with Primary care teams– Level 1?

NHS health checks for 50-74 yr olds to include falls ? Bone health ?

• What are the challenges?

Increased screening leads to increased demand on already stretched

resources


Some thoughts• What can we do better? What are the gaps?

Identify number of WMAS call outs for falls in Shropshire

Community dwelling, Pendant alarm holders ,Repeat fallers ,Care Homes

No single point of referral for WMAS to request MFFRA reduce risk of

further fall

• What are the opportunities? Triage 999 request for fall – medical/ non medical need Consider alternative organisation to pick patient up from floor Work with pendant alarm providers / housing associations Work with manual handling training for carers- Manga Elk, etc?


Numbers?

Need for adequate SPR provision

Continuity of safety / Suitable training

Demand on existing services


Some thoughts

• What can we do better? What are the gaps? Strengthen pathway from orthopaedics and fracture clinics to FPS Offer follow up Falls Assessment on fallers attending A/E but not requiring hospital admission to prevent future admissions

• What are the opportunities?

Create easy link between A/E and DAARTs to instigate MFFRA and

onward referrals

Home safety check


Increased demand on community/ voluntary organisations?


Some thoughts

• What can we do better? What are the gaps? Raise awareness of falls pathway to all organisations in contact with older people Empower staff in those organisations to MECC to reduce risk factors Expand falls awareness training via coordinated approach with standard info


Promote standardised training package for older people – train the trainer –

use in Day centres/ Senior’s events

Promote standardised training package for staff/ volunteers involved with

individual older people.

Refocus where falls awareness training is delivered in 2014-15 and by who

• What are the challenges? Standardisation Quality Content continually updated to reflect best practice


• What can we do better? What are the gaps? Improve bone health to reduce fractures

No full fracture liaison service

• What are the opportunities? Fracture liaison service spanning primary and secondary care Identify fragility fractures, those at risk of fragility fractures Refer for scan, offer treatment based on NICE guidance Link with RJAH, FPS for MFFRA, exercise pathway to improve balance


Some thoughts


• What can we do better? What are the gaps? Improve exercise continuum to prevent entry to and strengthen exit strategy from FPS Increase numbers of PSI trained exercise instructors in community Develop coordinated approach to exercise


Right exercise for different ages, health conditions delivered by

appropriately trained instructors

Public Health Healthy Shropshire Leisure centres - outreach Exercise on prescription Voluntary agencies - falls buddies ?

• What are the challenges? Patient adopting behaviour change and adherence to long term activity Transport / suitable venues

Some thoughts


SummaryOutcomes from assessing needs, strategic planning and commissioning should be 3 fold

•To reduce the number of fall - better health and wellbeing

- improve an individuals balance by exercise

- individual Ax of people who fall for underlying

medical causes with a treatment plan to reduce risk

- provide safer environment

•To reduce the number of fractures- better bones for all

- after the first fracture, act to prevent the second

- Improve balance and treating the bones

•To reduce the consequences After a fall – rehabilitate and get active again

After a hip fracture – ensure high quality care to save lives and money

Prevent “long lie” scenarios by training how to get up or by alarm technology


Non-hip fragility fracture patients

The work starts here today!

Individuals at high risk of 1st fragility fracture or other injurious falls

Older people

How are we going to do it?

www.shropscommunityhealth.nhs.uk current situation for shropshire falls services/ pathway sandy...

Documents

fps falls

number of falls

consequences of falls

falls prevention service

falls prevention pilot

falls prevention work

falls risk factors

shropshire slide