1. Falls
Safer Care North East Falls Task Group and Regional Implementation Group
hosted by County Durham and Darlington NHS Foundation Trust
Dr. Fiona Shaw (Chair)
Newcastle Upon Tyne Hospitals NHS FT

2. The problem ….

3. Falls and fractures: BIG cause of HARM
PCT / LA (pop 300,000, 45,000 age > 65) each year:
15,000 fallers age > 65, 2,200 A&E attendances
1,100 fractures including 360 hip fractures
25% of those admitted to hospital IP > 1 month
4x increased chance of admission to Care Home
Loss of confidence, social isolation
Recurrent falls – double mortality
Cost = £2.5 million per annum

4. Falls and fractures are PREVENTABLE
Multi-factorial intervention reduces falls in community dwellers, hospital patients and care home residents by about 30%
Targeted exercise reduces falls in selected community dwellers by about 30%
Osteoporosis treatment would prevent 105 fractures, including 55 hip fractures per PCT / LA area in 5 years
Money saved = estimated £750,000 per year

5. Safer Care Falls Task Group
‘Do something’ to reduce falls and fractures
Across region
Doctors, nurses, falls co-ordinators, physiotherapists, OT’s, pharmacist, NEAS, osteoporosis specialists, third sector, commissioners
Link individuals and services to:
Share good practice
‘Collective voice’ to argue for change
Support change needed for wider implementation of good practice

6. OGIM (2009)
To reduce the number of hip fractures and other adverse outcomes following a fall
To reduce the number of falls in hospitals / in-patient facilities
To reduce the number of falls in care homes
To promote use of multi-factorial falls assessment and intervention, including diagnosis and treatment of osteoporosis
To improve the quality of falls data collection and reporting of falls
To achieve a whole system approach to falls prevention by collaborative working across primary and secondary health care, independent care providers, social services and the voluntary sector

7. Implementation …
North East Regional Falls and Fracture Prevention Strategy
Safer Care North East: Falls Task Group and Regional Implementation Group
2012 – 2015
North East Regional Falls and Fracture Prevention Strategy
Safer Care North East: Falls Task Group and Regional Implementation Group
2012 – 2015

8. Consensus recommendations for falls and fracture prevention
Organisational issues
Services delivered
In-patient / hospital falls
Care homes
Training
Information
Quality metrics
Services mapped themselves against recommendations

9. Service mapping Individual issues addressed:
Funding for Osteoporosis Specialist Nurse
Development of Falls Training
Recurrent themes identified across region:
Lack of robust pathways of referral from A&E to falls services
Assessment and treatment of osteoporosis

10. Regionally suggested Falls (and fractures) CQUIN 2011/2012 and 2012/2013
Capture of falls information in A&E
Evidence of timely referral to falls service for patients who present to A&E with:
A fall
A blackout
A fracture relating to a fall
Evidence of timely and appropriate assessment by falls service including:
Initial falls assessment
Screening for osteoporosis
Falls Service

11. Pilot (service) data from Wansbeck General Hospital (15 months)
Monthly referrals
to falls services
x2.25 increase in
referrals

13. Across the region: SOTW (Sunderland, South Tyneside, QE Gateshead):
2011/2012: shadowing of CQUIN
2012/2013: working to CQUIN
North of Tyne – individual good practice working:
Since 2011 Wansbeck working to standards
Feb & March 2012 Newcastle pilot of working to standards (x 2 increase in referrals) …. hopeful of extending into usual practice
North Tees and Hartlepool – team in A&E to identify fallers
South Tees – referral system under review

14. Joint work with North East Ambulance Service
New referral pathway established Jan 2007 (Newcastle) and now in place across whole of North East region
Direct referrals from ambulance crews to Falls Services
And also link to local Community Care Alarm providers

15. Impact on 999 calls for falls (Newcastle):
Falls assessments

16. Regional audit of compliance with NPSA standards for hospital inpatients ‘Reducing Harm from Falls’
Trusts performed well
Consistent gaps:
Root cause analysis
Peer support
Measurement of implementation
Exercise programmes
Communication of risk at discharge
Appropriate footwear

17. Care Homes: Sharing of Good Practice
Quality Standards: Sunderland
Similar process in progress in MRCPCT and Newcastle
Middlesbrough, Redcar and Cleveland
Primary Care Trust

18. Regional outcome measures
Work with NEQOS (North East Quality Observatory System) to use routine data as regional outcome measures
Admissions with fractures
In hospital mortality for
patients admitted with a
fracture
Split into fragility fracture
and fracture neck of femur

19. Information sharing website: www.phine.org.uk
Policies, protocols, assessment tools, training documents, patient information, group documents
Share with professionals – regionally and nationally
Live March 2012

20. North East Regional Falls and Fracture Prevention Strategy 2012 – 2015
Safer Care North East: Falls Task Group and Regional Implementation Group
Set of prioritised falls and bone health objectives, mapped to Department of Health priorities
Regionally agreed plan for use in service development discussions with commissioners and trusts
Auditable performance targets
Local good practice examples
Due to arrive with CEO’s soon …..

21. Priority 1: Improve patient outcomes and improve efficiency of care after hip fracture through compliance with core standards
All patients with fracture neck of femur to receive care in line with Best Practice Tariff standards
Target at least 80%

22. Priority 2: Respond to the first fracture and prevent the second
All patients attending A&E with a fracture to be asked about falls / blackouts and referred for assessment / treatment as appropriate, including for osteoporosis / fracture risk
Work to 2012/2013 CQUIN Targets
All patients presenting to hospital services (A&E, X-ray, inpatients, other) with a fracture to have appropriate assessment and treatment as above
BPT, CQUIN, pathways with X-ray

23. Priority 3: Early intervention to restore independence – through falls care pathways, linking acute and urgent care services to secondary prevention of further falls and injuries
All patients attending A&E with a fall or blackout to be asked about falls / blackouts and referred for assessment / treatment as appropriate, including for osteoporosis / fracture risk
Work to 2012/2013 CQUIN Targets
Systems and services in each locality to work together across boundaries and in keeping with nationally and regionally agreed best practice
Regional Good Practice Recommendations – Re-audit 2012

24. Priority 3 cont: Early intervention to restore independence – through falls care pathways, linking acute and urgent care services to secondary prevention of further falls and injuries
Agreed referral pathway from front-line ambulance crews (NEAS) and local community care alarms providers to local falls service
Pathway in place NEAS → falls services all localities except 1
Target 50% of non-conveyed patients referred where pathway in place
Falls and falls risk in hospital inpatients to be managed according to NPSA / SafeCare QIPP standards
10% reduction in falls and 10% reduction in falls resulting in ‘serious harm’

25. Priority 3 cont: Early intervention to restore independence – through falls care pathways, linking acute and urgent care services to secondary prevention of further falls and injuries
Falls and falls risk in care homes to be managed according to regionally agreed best practice
Standards outlined in strategy
Joint responsibility – care homes, falls services, commissioners
Safeguarding Adults Network Quality Assessment Tool
Falls and falls risk in mental health trusts to be managed according to regionally agreed best practice

26. Priority 4: Prevent frailty, promote bone health and reduce accidents – through encouraging physical activity and healthy lifestyle, and reducing unnecessary environmental hazards
Evidence-based community exercise programmes working collaboratively with falls services available in sufficient numbers to meet demand
Systems operating to standards to be outlined in expected (summer 2012) NICE Guidance: Osteoporosis: assessing the risk of fragility fracture

27. Current situation …
Continue to meet (quarterly) as Regional Falls Task Group
Involvement of SHA being discussed
Work locally with trusts and commissioners to implement Regional Falls and Bone Health Strategy
Work locally to implement A&E CQUIN either ‘for real’ or as good practice working
Peer support for implementation of Regional Strategy / A&E CQUIN / good practice working
Re-audit against regionally agreed Good Practice Recommendations planned 2012
Respond to national falls alerts / initiatives – RCP e-learning / FallsSafe Project
Continue to share good practice / provide peer support …..

28. Contacts: