What was different about the FallSafe approach?

1. 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

3. 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

7. 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 didn’t expect results to show overnight

9. 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 didn’t expect results to show overnight • We let patients be the judge

11. 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 didn’t expect results to show overnight • We let patients be the judge • We created a ‘safe space’

12. Peer support and challenge • “It’s 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!”

13. Changing mindsets • “It used to be just one of those things you expected to happen; now it’s a big deal if a patient does fall and everyone will be thinking, ok, let’s try this or that – we know we can do something about it”

14. 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 didn’t 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

15. FallSafe: training and support

16. eLearning focused on nurses’ role

19. Starting point for some FallSafe units • “ Oh yes, the Occupational Therapists always do MMSE – they’ll be in the OT notes in their office somewhere” • “That’s a doctors’ job” • “We would do an AMTS when we notice that a patient’s confused…..”

21. Delirium assessment?

22. 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?”

24. Special observation

25. Intentional rounding: if you do use • Don’t standardise, individualise • Minimise documentation • Remember: • Communication skills in dementia • An hour is a long time

26. Leadership commitment…… • “I’d like to do FallSafe in my hospital, but we won’t be able to give staff for any training” • “ Two hours of eLearning is a bit much – can’t you do a version that covers everything in 15 minutes?”

27. 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

28. 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

29. 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

30. Separate to FallSafe but not to be forgotten

31. Last words • frances.healey@nhs.net Questions and comment? @FrancesHealey