4 site acute NHS FT Elective orthopaedic surgery Hot site Day case/ outpatient/rehab Town centre outpatients site Population c300,000; ~700 inpatient beds PROJECT AREA To reduce falls by 25% by December 2012 and to improve the patient experience post fall. 27 bedded acute medical ward specialising in gastroenterology. THE TEAM Falls champion Quality &Safety Matrons Sponsor Ward manager Matron AHP Alcohol liaison nurse Data analyst Head of Patient Engagement Advanced nurse practitioner THE TEAM Diane Lee Matron Emerging Leader Margaret Williams Sponsor Asst DON NWSHA

NHS Vanguard Programme The Vanguard Programme enabled me to ….. QUOTE -- “I have increased my knowledge and learned many skills in a supportive way, to enable me to develop and deliver improvements in patient care”

Cost savings – estimate savings £120,000 per year – direct / indirect. Improve quality of care / NICE guidance post fall. Improve patient experience Provide harm free care as defined by absence of harm from falls in 95% of patients Determine level of harm sustained Link with community services /re- admissions Analysis of data / visual falls map /PDSA cycles Incident reporting / incident completion Staff education / training Assessments / nursing metrics/ Falls champion Staffing review / shift pattern review Falls care bundle Post fall care Partnership working Patient questionnaire /staff questionnaire WHAT ? WHY ? HOW ? Trust WWL aim to reduce falls by 50% 2011/2013 1,110 in patient falls – 2010/2011 Estimated cost occurred £200,000 per year Number of falls per 7/1000 bed days --- higher than national average Ward Ward has highest number of falls (101) 2010 /2011 No reduction seen in 4 years Average 8.4 falls per month AIM Reduce falls on ward by 25% by Dec 2012 Improve patient experience post fall THE BUSINESS CRITICAL PROJECT QUIPP

THE IMPACT Post fall patient questionnaire implemented Patient comments – “staff were there within minutes” “My Zimmer frame falling onto the floor got the nurses attention” “The fall has knocked me off side” “It has knocked my confidence” “I will use my call bell all the time” “I didn’t want to trouble the nurses” Winning Hearts and Minds Call 2 Action Changes commenced 12/2011 Intentional rounding Falls champions Staff training MDT meetings Falls care bundle Post falls checklist Diagnostic PDSA PDSA Care bundle Visual falls map Patient stories SNCT Roster review / changes to shift patterns Low profiling bed trial Falls Data In depth analysis of falls in November 2011 Showed most falls no / low injury All occurred between hours of 21.00hrs and 07.30hrs Most occurred at bedside Majority of patients did not have nurse call bell Results Too early to see improvement Dec 11 falls – increase awareness and reporting Jan data 3 falls – normal variance SPC chart Patient questionnaires

Falls on Astley Ward & Trust CREATING CONTAGIOUS COMMITMENT TO CHANGE Call 2 Action Public narrative Lone nut video – Practising public narratives Harm free ward leads LEADING CHANGE Developed model for Large Scale Change Framing story Developed discovery model

Project Team HFC leaders Community MDT Harm Free Care Emergency Care Post Fall Care Community Team Specialist services NWAS Patient Opinion Patient Engagement Patient Stories PDSA Cycles SPC chart Data collection /analysis Sustainability Falls Scrutiny Quality Executive Champions Education Safety Express QUEST Transparency pilot E4E CQUINN ONWARD SPREAD OF THE LEARNING AND PROJECT Public Narratives Measurement for Improvement PDSA Cycles Sustainability tool Driver Diagram C2A Vanguard website Seminar recordings Publications Discovery Model