1. Up and About in Care Homes The Management of Falls and Fractures in Care Homes for Older People Improvement Project 11 th September 2014 Lianne McInally National Project Lead Lianne.mcinally1@nhs.net

2. The National Falls Programme in Scotland (2010-present) Aims To reduce the personal, system and societal costs associated with falls and harm from falls in Scotland. For every health and social care partnership area in Scotland (32 partnerships) to have a local integrated falls prevention and management and fracture prevention pathway for older people in operation by the end of 2014. Contributes to Reshaping Care for Older People Programme for Change 2 Falls Leads Network

3. The Prevention and Management of Falls in the Community Current work streams Framework for Action for Scotland 2014-15 Unscheduled care pathways Falls Care Bundles Materials to support self management Learning resources for health and social care staff Repository of new and emerging practices Up and About in Care Homes 3

4. Evidence of significantly higher falls rates, hip fracture rates and emergency admissions in care homes (costing £22m +). Managing Falls and Fractures in Care Homes for Older People issued to all care homes for older people in 2011. 2012 evaluation: effective when used as intended but underutilised across Scotland. Falls in care homes: background

5. Falls prevention and the NDPDP

6. Phase One: Test out a ‘prototype’ approach Based on IHI Breakthrough Series Collaborative methodology –Everybody teaches, everybody learns –Share generously (transparency) –Steal shamelessly –Acknowledge graciously Using the Model for Improvement: –measurement for improvement –small tests of change (involving all staff) Test change package and measurement plan The learning from this period of testing will inform Phase Two Our approach

7. In summary… … provide focused support to care home managers and staff to: utilise the Care Inspectorate/NHSScotland good practice resource and self-assessment tool to best effect, gather and analyse data to understand and address the local causes and patterns of falls, provide training, facilitate integrated working with the local health and social care team and At learning sessions, bring together participating care home ‘improvement teams’ and members of the wider MDT, to help foster a support and learning network.

8. Aim and Goals Improvement aim: To reduce falls in participating care homes by 50% by 2015. Goals: For care home managers (and staff) to gather and analyse data to understand and address the causes and patterns of falls within the care home. To improve the reliability of safe, effective and person centred care to prevent falls and fractures in care homes. To improve reliability of safe and effective care and intervention following a fall. To deliver resident and family centred care to reduce falls and fracture risk and increase physical activity. To work towards embedding an infrastructure and culture that promotes high quality, person centred care.

9. Up and About Collaborative Measures OUTCOME MEASURES 1. Number of falls in care home or days between falls. 2. Percentage of residents who have had a fall/falls. 3. Number of Emergency Department attendances secondary to a fall. 4. Number of Scottish Ambulance Service attendances secondary to a fall. 5. Number of emergency admissions secondary to a fall. 6. Resident/carer experience (Quality of life) PROCESS MEASURES 7. Percentage of residents with completed falls risk assessment on admission. 8. Percentage of residents with completed falls risk assessment following a fall or change in medical status 9. Percentage of residents with an up-to-date documented fall/injury reduction plan

10. Project Team

11. Learning Session 1 ‘Top 11’ Project Started Pre LS support (self assessment) Action phase Improvement Charter Data collection PDSAs Reporting Action Phase Data collection PDSAs Reporting Leaflets Training pack VC sourcing Learning Session 2 Active resident care Data dashboard Action Phase continues/testing Spreadsheet development Care About Swimming

12. Learning Session 1: ‘Top 11’

13. Learning Session 1 ‘Top 11’ Project Started Pre LS support (self assessment) Action phase Improvement Charter Data collection PDSAs Reporting Action Phase Data collection PDSAs Reporting Leaflets Training pack VC sourcing Learning Session 2 Active resident care Data dashboard Action Phase continues/testing Spreadsheet development Care About Swimming

14. Sharing Success

15. Action Phase continues/testing Collation and review of impact data Action Phase continues/testing E learning development Roll out of education and leaflets Final Report Phase 1

17. Measurement for improvement: data spreadsheet

18. Phase One: The 38 care homes have completed a self assessment. 151 people attended six learning sessions. Systems are in place for recording and analysis of falls activity. Outcome data is encouraging Increased (1) staff knowledge and understanding, (2) implementation of good practice, and (3) knowledge of areas for improvement and how to approach this. Improved community networks. Evidence of spread. National collaboration Impact

21. Learning from Up and About in Care Homes Leadership has been essential Care homes require implementation and improvement support to adopt and sustain good practice. Care home staff report competing pressures in response to legislation, regulation, commissioning and good-practice but now recognise importance of integrating falls prevention into everyday practice. Regular and ongoing support from local Falls Leads to initiate, identify and implement improvements has been essential. Data collection and post falls analysis has been challenging. Innovations and examples of good practice exist but are not routinely shared, e.g. exercise provision and ‘Active Resident Care’ Care home staff want to link with external agencies but pathways to access these are unclear. “We need further support in accessing agencies including recognition of how we still need physio, OT input” Unscheduled care pathways for resident s who have just fallen and need urgent assistance are unclear and inconsistent. Delays in reporting of urine test results and subsequent treatment has been highlighted as resulting in further falls/admissions.

22. Communication strategy Falls and Bone Health Community http://www.knowledge.scot.nhs.uk/fallsandbonehealth.aspx

23. THANK YOU FOR LISTENING For more information please contact: Lianne McInally National Project Lead Lianne.mcinally1@nhs.net National Falls Programme Ann Murray National Falls Programme Manager Ann.murray3@nhs.net