HSE Prevention of Falls A Joint Presentation by

HSE - Prevention of Falls A Joint Presentation by: Antoinette Malone, Clinical Placement Co-Ordinator Nursing Practice Development Department Connolly Hospital, Blanchardstown HSE Dublin North East & Isaac Bontha, Senior Physiotherapist, Physiotherapy Department Sacred Heart Hospital, Roscommon HSE West

Driver for Patient Safety for Both Projects • Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population 2008: – Economic burden estimated € 551 million: • Hospitalisation & healthcare provision. – Social cost: • Long term negative impact on quality of life and independent living. • High incidence of falls reported throughout both care settings: – Connolly Hospital: • 703 in 2008 • 649 in 2009 – Sacred Heart Hospital: • 135 in 2009

Connolly Hospital - Blanchardstown • Total Number of beds: 383 – Inpatient : 330 – Day Services : 53

Key Patient Safety Initiatives • Multidisciplinary team (MDT) Falls Prevention Committee 2009 - 2010. • Revisions to 2007 hospital guideline Falls Risk Assessment Scale for the Elderly (FRASE) >60 yrs. • Hospital wide introduction of: – Risk assessment tools. – Standardised nursing care plans. – MDT post fall flowchart, ward falls log. – Audit tool. • Subgroup established 2010: – Pilot changes on 32 bedded acute medical ward (2010 & 2011). – A new system of highlighting patients falls risk at ward level. • Falls prevention is everyone's business.

Look for the Star & Prevent the Fall “LOOK FOR THE STAR” STAR Symbol over patient bed: – RED – high falls risk – AMBER - medium falls risk – GREEN – low falls risk “PREVENT THE FALL” FALL by – Assisting the patient. – Call for assistance of nursing staff / healthcare assistant. – Ensure patient call bell is within reach.

Key Patient Safety Outcomes • Reduction in falls on pilot ward by 27%. • Falling stars a discreet way of highlighting patient falls risk. • Received positively by Patients/Relatives. • Increased compliance with guideline/audit. • Completion of incident form. • User friendly ward log. • Implemented on five general ward areas.

Sacred Heart Hospital - Roscommon • Care Facility for Elderly • Total no of beds = 95 – 80 long term – 15 rehabilitation / respite / palliative care

Focus on Patient Safety • An age group more vulnerable to slips / trips / falls. • Audit of falls conducted in 2009. • 42% reduction in incidence of falls since 2009.

Key Patient Safety Initiatives • Cultural change through education and training of all staff and residents. • Standardised assessments / care planning. • Standardised operating procedure in event of a fall / falls audit tool. • Medication review – impact of psychotropic drugs in relation to risk of falls. • Targeted exercise addressing gait and balance deficits. • Nurse-led Finometer Clinic to assess postural hypotension. • Equipment review - low profiling beds, crash mats, patient monitoring systems. • Awareness through falls calendar, posters and information booklet. • Trending of incidents to assist review and learning. • Creating a restraint free environment in parallel to falls prevention.

Governance Framework • Sacred Heart Hospital: – – Multi-disciplinary Committee. Monthly meetings. Review of incidents / trends. Minutes and trending graphs circulated to all staff. • Connolly Hospital – MDT Falls Prevention Committee. – Clinical Governance Quality Committee.

Shared Learning Across Both Projects The Challenges: The Benefits: • Implementing change. • Reduction in number of falls. • Proactive approach: • Monitoring effectiveness of intervention. • Promoting a “no-blame” culture. • Cross-organisational working. The Supports: • Leadership at management & ward level. • Multi-disciplinary / team-working. • Environmental assessments / modifications. • Piloting in one ward initially (Connolly). – Multifactoral assessments / interventions. – Standardised approach to falls prevention and post falls management. • Continual education and training. • Empowerment of staff / patients / residents / families. • Ongoing communication keeps patient safety on the agenda. • Continual improvement: – Connolly – plans to pilot falls risk precaution wrist band. – Roscommon - recent roll out to Daycare and collaborations with Primary Care Teams. • Links to National Primary Care Falls Prevention Programme 2012.