1. Being a FallSafe lead: Jo Gambril & Hayley Hall Rowan ward, Petersfield Hospital & Parklands Hospital, Basingstoke

2. FallSafe: What is it? It is a Quality Improvement Project It is not: –A research project –A randomised controlled trial in falls prevention Run by Clinical Effectiveness Unit at the Royal College of Physicians Funded by the Health Foundation

3. FallSafe question “Can a nurse influence others on the ward to embed falls prevention into regular ward practice using a quality improvement approach?”

4. Components within successful v. unsuccessful multifactorial trials Oliver D, Healey F, Haines T (2010) Preventing falls and falls related injuries in hospital Clinics in Geriatric Medicine (26 4 645-692)

5. FallSafe: The Project 16 sites across South Central Region Variety of hospital and settings –Acute Medicine –Consultant Led Rehabiliation –GP Led Rehabilitation –Psychiatry of Old Age –Trauma –Acute Geriatrics –Cold Surgery

6. FallSafe: The Project 16 sites across South Central Region Variety of hospitals –Isle of Wight –Portsmouth –Southampton –Reading –Oxford –Banbury –Basingstoke –Petersfield

7. FallSafe: Training Initial 3 day training in falls prevention, quality improvement and project goals Further 8 training days over the duration of the project Support from a fulltime project manager Telephone support from project leaders Ward visits from project team Peer support at training and via website

8. 1) Getting ready for the care bundle: changes on the ward Early provision of frames by nurses –Training of nurses in provision of frames –Acceptance that this can be their responsibility –Finding somewhere to store frames to make them available 24/7 Changing admission documentation –To include questions on a history of falls and fear of falling

9. FallSafe: The care bundle 2) Frailer and more vulnerable patients Cognitive assessment (AMTS or MMSE) on all admissions >70yrs age * Test for delirium using Confusion Assessment Method (CAM) as per NICE guidelines in vulnerable patients Visual assessment: recognising objects from end of bed Lying and standing blood pressure using manual sphygmomanometer * Nurse to request medication review by medical staff according to agreed guidelines * Toileting assessment and plan

10. FallSafe: The care bundle 3) Bundle for after a fall Assessment of injury before moving patient, medical review if needed Neuro obs in unwitnessed falls or when patient has hit head Review of falls prevention for that patient Incident report Root cause analysis

11. FallSafe Care Bundle: Introduction One item of care bundle introduced every 4-6 weeks For selected elements, baseline measurements of that item on the ward, followed by measurements after introduction of the care bundle, and repeated measurements every month. Full care bundle active only after 9 months

12. First monthLast month 1 Call Bell91%98% 2 Cognitive screen50%78% 3 Fear of falling29%68% 4 History of falls81%89% 5 Lying Standing BP25%50% 6 Medication review42%84% 7 Night sedation not given78%87% 8 Safe footwear91%97% 9 Urine dip-test63%78%

13. Adjusting for reporting changes Staff asked about last fall At baseline After Total who remembered a recent fall 85%72% Total who were certain it was reported 56%85% Total who thought it had probably been reported 18%8% Total who doubted if it got reported at all 26%7%

14. Adjustments for under-reporting In period one (before), the reported falls rate on the FallSafe wards was 9.98 falls per 1000 bed days. Given at that time, staff were confident that only 56% of falls were being reported, the actual falls rate was likely to be around 17.82. In period three (after), the reported falls rate on the FallSafe wards was 11.57 falls per 1000 bed days. Given at that time, staff were confident that 85% of falls were being reported, the actual falls rate was likely to be around 13.61. This suggests actual falls may have reduced by around 25%

16. Believing you can make a difference “It used to be just one of those things you expected to happen; now it’s a big deal if a patient does fall and everyone will be thinking, ok, let’s try this or that – we know we can do something about it”

17. Peer support “It’s a safe environment to talk about it – no one is standing over you saying ‘why have you had ten falls?’ – so you can really think about what can prevent them”

18. Impact of this project on patients Reduced anxiety by knowing staff are pro- active in reducing falls. Happy to discuss concerns with staff as know staff will be understanding Like being given safe slippers!

20. Impact of FallSafe on staff Greater understanding of reasons for falls. Empowerment to discuss with other agencies. Satisfaction at knowing you are making a difference. On FallSafe Lead : to know we have made a difference, confidence in own abilities.

21. Key lessons Prepare staff Keep them informed Carrots and not sticks Changes need to be ‘fluid’ Some falls cant be prevented!

22. Thank you for listening. Any questions?