Falls

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 Falls Service • 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

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): 999 calls for falls Falls assessments 2006 2007 2008 2009 2010 2011

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 Standards outlined in strategy

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: Fiona.Shaw@newcastle-pct.nhs.uk Fiona.Shaw@nuth.nhs.uk www.phine.org.uk