Introduction to the Falls Pathway

1. Introduction to the Falls Pathway Julie Windsor Clinical Nurse Specialist (Falls and Bone Health)

2. Definition • Unexpected event in which a person comes to the ground or other lower level with or without loss of consciousness” (World Health Organisation / Lamb 2005)

3. Epidemiology • 30% of people age 65 and over will fall every year increasing to 50% of those age 85 and over • 60% of those who fall once will fall again in the same year

4. Falls are more common in hospital • Even more likely due to frailer population (40 ED attendances a day, 650 fallers admitted to PHT every month) • Acute illness increases risk factors (may be temporary) • PHT averages 200 reported falls a month 2275last year (300 less than year before BUT still highest risk in the Trust).

5. Falls are harmful to patients • 32 Amber falls of which 16 were hip fractures (decreased from 20 in previous year) • 5 Red incidents where patient died as a direct result ( 4 head injury, 1 hip fracture) • 4 involved bedrails • all investigated by coroner. • Compensation claims are increasing

6. GOOD NEWS !Falls Rate April 09 to Oct 12. National Av Q2 PHT Ave National Average-------------

7. Where do the falls happen? • Mostly from bed, chair, toilet or commode. • All wards are affected (except paediatrics!). • Some wards have more falls than others. • Some patient groups more likely to have falls than others.

8. So what to do….. • Identify and treat common reversible risk factors on admissionand with regular review esp. post fall • Falls & injuries can indicate underlying & often modifiable factors. • Requires a comprehensive assessment with a medical diagnostic model and therapies – not just nurses problem!

9. Its all in the history! • Falls assessment starts from before admission….. What has brought them to hospital? • The patient’s story can often give us clues to diagnosis.

10. No history? • Doesn't mean to say they are not at risk now or tomorrow… • Need to risk assess regularly • Daily triggers = fall, unsteady, wandering, confusion, new urinary frequency or incontinence, altered level of consciousness.

11. Risk factors for falling • Balance gait and mobility problems • Sensory deficits • Impaired cognition or depression • Orthostatic hypotension • Neurological disease • Cardiovascular disease (structural or arrhythmias) • Urinary incontinence • Fear of falling/ poor perceived functional ability • Inappropriate footwear • Polypharmacy

12. Risk factors for osteoporosis / fracture • Previous fragility fracture • Parental history of hip fracture • Low BMI < 22kg/m (MUST score) • Current smoking • High alcohol intake ( 2- 4 units per day) • Current oral corticosteroid therapy • Medical conditions (e.g.rheumatoid arth, thyrotoxicosis)

13. What about the environment? • De – clutter • Try to look at the ward through the patients eyes • Lighting • Flooring • Signage • Everybody’s problem

14. Look familiar?

15. Cognitive impairment AMTS Sepsis screen for delirium Depression screen Orientation Position in ward Noise Light Special obs Hydration Nutrition

16. Management of very high risk fallers - equipment DO NOT USE BEDRAILS Name……………………... Date………………………..

17. Risk Management or restraint?

18. What if my patient falls over? • Primary and secondary survey to exclude spinal or hip injury. • Up from floor using appropriate method. For spinal injury bleep 1170 for help (or ortho bleep holder). • Do NOT USE sling hoist for suspected fractures. • Manage patient as per post falls checklist on the back of the care plan. • Ask for medical +/- therapy review (STICKER)

20. Why we need to use the hover jack …………

21. What do I do now ? • Find out who is the Falls Link Champion for my area. • Familiarise myself with the risk assessments and care plan. • Book myself on falls training session – ring 6675, bleep 1363 or email me. • Level 3 training now available on ESR

22. Thank you for listening ..Any questions? julie.windsor@porthosp.nhs.uk Bleep 1363 or xt 6675 Please hand in your evaluations !