Western Australian Multidisciplinary Post Fall Management Guidelines 2018

1. Western Australian Multidisciplinary Post Fall Management Guidelines2018

2. Information about this PowerPoint • It provides a summary of the updated Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings 2018. • It is designed to assist in the education of all health professionals involved in the care of a patient post fall. • All health professionals involved in the care of a patient post fall should receive this information. • It is a basic outline and contains only essential information. • It can be adapted to suit your local area and staff. • Refer to the complete guidelines. • Supplementary notes are given below the slides. • The application of local policy may indicate alternative actions or other policies to meet requirements. Please contact Falls.ManagementWA@health.wa.gov.au if you have any questions/comments or feedback

3. Presentation includes: • Information about the updated post-fall guidelines. • The 48 hour post fall process. • The role of the multidisciplinary team. • Post fall multidisciplinary huddles. • Clinical investigation

4. Western Australian Multidisciplinary Post Fall Guidelines 2018 A review of the Post Fall Management Guidelines in Western Australian Healthcare Settings 2015 was undertaken in 2018 by a large working party formed of health professionals from across public, rural, and private inpatient facilities in WA. Current best practice and evidence was rigorously examined to deliver a guideline that offers the optimal care of a patient following a fall. State-wide consultation of consumers, health professionals including aboriginal and untrained health care staff has occurred during the guideline development.

5. The Guidelines • These guidelines may need modifying to ensure their suitability for falls in children. • Are for adult inpatient and multipurpose healthcare facilities only. • Ensure the continued delivery of optimal patient care and patient safety following a fall. • Aim to reduce the risk of further falls and harm from falls. • Aims to ensure early detection of physical or cognitive deterioration. Post Fall Community Guideline can be obtained from Falls.Management@health.wa.gov.au

6. The Guidelines • Support the health professional’s decision-making about appropriate treatment and care for specific clinical circumstances. It does not replace clinical judgment

7. Overview of the changes • The process of post fall management care streamlined to 48 hours from 72 hours. • The addition of the hospital life support process DRSABCDE as the immediate response post fall. • Medical officer review of patient and fall within 4 hours if no injury apparent immediate post fall. Local Policy May Apply to Some of These Actions

8. The 48 hour post fall process: immediate actions

9. The 48 hour post fall process: Immediate actions Stop and Consider: Patients on anticoagulant, antiplatelet therapy and/or patients with a known coagulopathy (e.g. alcohol dependent persons) are at an increased risk of intracranial, intrathoracic, intra-abdominal haemorrhage D = Danger R = Response S = Send for help A = Airway B = Breathing C = Circulation D = Disability E = Exposure Complete initial assessment of patient

10. The 48 hour post fall process: Immediate actions Assess for physical injury: • Neck pain/ injury indicate the neck should be immobilised. • Head injury, hip or other fracture and/ or soft tissue injury following a fall dictates specific action. • Medical review as soon as possible for assessment and investigations. Local Policy May Apply to Some of These Actions

11. The 48 hour post fall process: Immediate actions Bedside investigations should include: • Vital signs observations. • Neurological observations and assessments, including Glasgow Coma Scale. • Cognitive assessment using AMT4/4AT/CAM. Identify: • Amnesia • Vomiting • Change in conscious level. • Delirium • New/increasing confusion • Headache • Clinical deterioration Local Policy May Apply to Some of These Actions

12. Medical Post Fall Assessment Refer to Guidelines and Website (link below) for full information http://ww2.health.wa.gov.au/Articles/F_I/Falls-prevention-education Local Policy May Apply to Some of These Actions

13. The 48 hour post fall process: Type of fall and ongoing observation Continue observations as per the type of fall

14. The 48 hour post fall process: Actions within 4 hours of the fall • Next of Kin be notified as per ‘open disclosure’ • Falls risk assessment re-screen • Documentation of the fall • Reporting of the fall Local Policy May Apply to Some of These Actions

15. The 48 hour post fall process: 6-24 hours

16. The 48 hour post fall process: 6-24 hours • Continue physiological, behavioural and cognitive monitoring. • Notify Pharmacy, Physiotherapy, Occupational Therapy and other relevant disciplines. • Ensure patient and family/carers receive information and education on falls prevention. • Review and action patient results including bloods, imaging and other tests. Local Policy May Apply to Some of These Actions

17. The 48 hour post fall process: 24-48 hours At 48hours, review patient observations. If no deterioration has occurred then return to appropriate observations. Ensure completion has occurred of actions within the post fall guideline.

18. Communication Communication is a vital component of falls prevention both within the care team and with the patients and carers/families

19. Communication • Consider additional communication strategies if disability or cultural requirements dictate. • Documentation in patient health care record • Reporting of fall and subsequent care. • All clinical communication including transfers, verbal or written handover, and discharge documentation to include details of the fall and management plan. • Visual flagging of patients at high risk of falls. Local Policy May Apply to Some of These Actions

20. Allied Health assessments • Allied health teams are to refer to their discipline specific guidelines and time lines for post fall management. • Provide expert knowledge collaboratively within the wider multidisciplinary team. Local Policy May Apply to Some of These Actions

21. Occupational TherapyPost Fall Assessment • Review patient within 2 working days of the fall. • Post fall analysis and assessment with focus on Patient’s Activities of Daily Living, including effects of vision, cognition and environment (hospital). • Appropriate interventions implemented/recommended. • Provision of information to patient, family/carer. • Refer to Guidelines for full information. Local Policy May Apply to Some of These Actions

22. Physiotherapy Post Fall Assessment • Review within 2 working days. • Multiple assessments as deemed required, including mobility, strength, balance with appropriate interventions. • Provision of information to patient, family/carer. • Refer to Guidelines for full information. Local Policy May Apply to Some of These Actions

23. PharmacyPost Fall Assessment • Review within 2 working days. • Review of medications, patients clinical condition. • Assessment of medication related contributors to the fall. • Development and communication of appropriate changes to the patients medication plan. • Provision of information to patient, family/carer. • Refer to Guidelines for full information. Local Policy May Apply to Some of These Actions

24. Medical Assessment • Video with information about the post fall medical assessment is here: http://ww2.health.wa.gov.au/Articles/F_I/Falls-prevention-education

25. Appendices information The appendices have further information/actions/tools that may enhance and complement post fall care. • Occupational Therapy Assessment and Sticker • Physiotherapy Assessment Proforma • Post fall Multidisciplinary Huddles & resources • Clinical Incident information and Investigation Tool • Sample auditing questions

26. Post fall multidisciplinary safety huddles The post fall safety huddle is a multidisciplinary, professional dialogue that is focused on a single patient to identify how and why an event occurred, and what can be implemented to prevent future incidents. Local Policy May Apply to Some of These Actions

27. Post fall multidisciplinary safety huddles • A post fall safety huddle should ideally occur at the patient bedside or other suitable area. • Discuss the fall and contributing factors, develop a post fall management plan and identify interventions to be implemented. • Provide support for patient/carers and family during discussions. • Document huddle in patient health record. • Ensure falls prevention interventions identified are implemented.

28. Multidisciplinary post fall safety huddle Local Policy May Apply to Some of These Actions The Appendix provides detailed information about how to guide the discussion with examples of questions and tools for documentation

29. Clinical incident investigation Local Policy May Apply to Some of These Actions Clinical incident reporting and investigating aims to improve patient outcomes and ensure provision of a high-quality service The template guides staff through the investigation of a fall incident, to identify contributory factors and make recommendations that address any system issues identified to prevent recurrence.

30. Summary • The updated guideline ensures optimal patient care following a fall and in the reduction of risk of further falls and harm from falls. • The changes have been made to ensure a continued focus on the recognition of clinical deterioration both physical and cognitive. • Multidisciplinary collaboration and communication have been highlighted as a significant positive factor in post fall management • Partnership with patient, family/carer continues to be promoted with updated consideration of health literacy, cultural and disability requirements • All local policy is to be adhered to when implementing the post fall guidelines More Information available from Falls.ManagementWA@health.wa.gov.au

31. Finally… • The review of the Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings 2018 was conducted by a multidisciplinary team of health professionals representing all stakeholders. • A comprehensive review of the current literature and best practice guidelines was undertaken to ensure the guideline is evidence based best practice care of the patient post fall