What was different about the FallSafe approach?

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What was different about the FallSafe approach?

• It was evidence-based
• It prioritised the things we struggle with
• It was multidisciplinary
• The basic equipment they would need was made
  available

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What was different about the FallSafe approach?

• It was evidence-based
• It prioritised the things we struggle with
• It was multidisciplinary
• Basic equipment available
• The care bundle was implemented in stages rather
  than all at once
• We measured delivery at least every month

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Baseline Project end Six months later
1 Call Bell in reach 91 98 99
2 Cognitive screen 50 78 63
3 Asked about fear of falling 29 68 71
4 History of falls taken 81 89 96
5 Lying Standing BP 25 50 43
6 Medication review 42 84 72
7 Night sedation not given 82 87 90
8 Safe footwear on feet 91 97 99
9 Urine dip-test 63 78 82
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What was different about the FallSafe approach?

• It was evidence-based
• It prioritised the things we struggle with
• It was multidisciplinary
• Basic equipment available
• The care bundle was implemented in stages
• We measured delivery at least every month
• We didnt expect results to show overnight

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What was different about the FallSafe approach?

• It was evidence-based
• It prioritised the things we struggle with
• It was multidisciplinary
• Basic equipment available
• The care bundle was implemented in stages
• We measured delivery at least every month
• We didnt expect results to show overnight
• We let patients be the judge

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What was different about the FallSafe approach?

• It was evidence-based
• It prioritised the things we struggle with
• It was multidisciplinary
• Basic equipment available
• The care bundle was implemented in stages
• We measured delivery at least every month
• We didnt expect results to show overnight
• We let patients be the judge
• We created a safe space

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Peer support and challenge

• Its 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

Where do you buy your slippersocks?
If we can do it, surely you can!
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Changing mindsets

• It used to be just one of those things you
  expected to happen now its a big deal if a
  patient does fall and everyone will be thinking,
  ok, lets try this or that we know we can do
  something about it

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What was different about the FallSafe approach?

• It was evidence-based
• It prioritised the things we struggle with
• It was multidisciplinary
• Basic equipment available
• The care bundle was implemented in stages
• We measured delivery at least every month
• We didnt expect results to show overnight
• We let patients be the judge
• We created a safe space
• We gave each FallSafe lead enough education and
  support to make them confident and knowledgeable

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FallSafe training and support
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eLearning focused on nurses role
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Starting point for some FallSafe units

• Oh yes, the Occupational Therapists always do
  MMSE theyll be in the OT notes in their office
  somewhere
• Thats a doctors job
• We would do an AMTS when we notice that a
  patients confused..

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Delirium assessment?
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Key thinking

• Are they confused?
• using an objective assessment like AMTS
• Is the confusion new/different?
• talk to their family friends
• listen to the last shift each handover
• notice changes since your days off
• Think of apathetic delirium
• Remember they can be delirious without being
  agitated
• Could this be delirium?

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Special observation
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Intentional rounding if you do use

• Dont standardise, individualise
• Minimise documentation
• Remember
• Communication skills in dementia
• An hour is a long time

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Leadership commitment

• Id like to do FallSafe in my hospital, but we
  wont be able to give staff for any training
• Two hours of eLearning is a bit much cant
  you do a version that covers everything in 15
  minutes?

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Provision of walking aids at weekends
Royal College of Physicians 2012 Clinical
Effectiveness and Evaluation Unit Report of the
2011 inpatient falls pilot audit
www.rcplondon.ac.uk
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Sometimes falls is not the priority

• 50 bed unit
• No permanent unit manager in post
• 30-40 temporary staff
• Three FallSafe leads left in quick succession

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You will meet most of your patients again..
2001 census People aged 75 years or more 3,704,945
Hospital admission statistics 2006 People aged
75 years or more admitted as inpatients 3,174,676
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Separate to FallSafe but not to be forgotten
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Last words
Questions and comment?

• frances.healey_at_nhs.net

_at_FrancesHealey