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Reducing falls & fractures in Sheltered Housing. South Ayrshire Partnership Project JIT Telecare Development Programme. Dr. H Hall Feb 2011. Partnership Falls Project (telecare). N&S Alert Services, Sheltered Housing, ICT, Care and Repair. Phase 1: Data management All falls
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Reducing falls & fractures in Sheltered Housing South Ayrshire Partnership Project JIT Telecare Development Programme Dr. H Hall Feb 2011
Partnership Falls Project (telecare) N&S Alert Services, Sheltered Housing, ICT, Care and Repair • Phase 1: • Data management • All falls • RED FLAG Repeat fallers Phase 4: Fast Access to ICT Phase 2: Cross sector Training Phase 3: Role development
Preliminary data for one locality (SA) indicated approx 200 fall call outs per month with 20% repeat fallers 20 additional cases per month for community rehab team Capacity not available To complete pathway: Without putting severe pressure on ICT To set specific health care targets Isolated SA Sheltered Housing sector for a similar but smaller scaled initiative JIT project proposal March 2010 Partnership project (Alert)
South Ayrshire JIT falls project • Based in Shelter Housing Units: designed to • Reduce falls & fractures • Shift the balance of care from reactive to preventative approach. • Aims: • Reduce falls in the sector by 10%, • Unscheduled hospital admissions by 20% • Deliver joined up services • Inform development of falls pathways for larger cohorts of high risk fallers across Ayrshire & Arran
5 phased project • Consisting of: • Data management & identification of fallers through registers • Falls education & role development of wardens • Fast access for fallers to community rehabilitation via the Integrated care team (ICT) – falls pathway • Self management of residents: fall prevention ‘cascade training’ by wardens to residents: “Positive Steps” • Evaluation (Jan – March 2011)
Evaluation Inform the development of future A&A fall prevention programmes • Measure care targets (10% reduction in falls, 20% reduction in unscheduled hospital admissions from SH) • Improve our understanding of ‘self management’: assessing the impact of ‘warden led’ falls prevention training to SH residents • Determine the type & nature of intervention used in the delivery of ‘home based falls prevention approach’ • Gain an understanding of the capacity needs & costs involved in delivering the home based preventative approach
Pre-project work… • SH falls data was reviewed prior to start date • 5 months data: • 116 falls, 18 A&E attendances,14 unscheduled hospital admissions recognised need to shift care balance from reactive to preventative • 3 month trial of referral link (Wardens ICT): • All appropriate, managed within existing ICT capacity, those referred had no further falls or hospital admissions
Preliminary work • Audit of ICT case load: • 20% of existing case load identified as ‘fallers’ requiring home based preventative approach • Little information concerning the nature of care delivered - ? evidenced based, OTAGO • Joint sessions to review & augment the ICT data system to: • capture additional information concerning care outcomes, disciplinary input, interventions employed, liaison & time spent with patients
Data management Training Role development Intervention (ICT) Evaluation Updated registers across all SH units Falls prevention & management training delivered to all SH wardens Joint meetings – ICT, SH Joint sessions to co-design ‘Positive Steps’ training for residents i.e. format, content, delivery method, associated hand held teaching aids Compiled the ‘Positive Steps’ boxes for each unit – cost, contents A final joint session – nags & snags Engaged the assistance of the NHS resource centre staff: Promote “Positive Steps” House master copy Review & update JIT SH project: March - Aug 2010 Falls engagement process
Organising & selecting the learning material for the “Positive Steps” boxes
Data management Training Role development Intervention Evaluation Launch of “Positive Steps”: Oct Osteoporosis Event Day Oct Wardens Bone health training Development of self management & well being programme – increased NHS input (dementia, healthy eating) – led to older persons educational scoping project in A&A Development of “Little Steps” Data collection – falls registers Winter planning workshops – falls Evaluation: Questionnaire devised & distributed for residents undertaking “Positive Steps” training Analysis of 30 faller data files JIT project Aug - Dec 2010
Analysis of 30 data files • 30 randomly selected falls patients, referred from various agencies to the ICT, between March & July 2010 • type, nature & cost of care involved in home based falls prevention programmes • link with IRF work stream
Mean age 83.6 years • senior elderly population most relevant to receiving home based prevention • Less than ½ of the cohort were identified as fallers by referring agencies (mostly GPs) • hidden problem? • Prevalent outcomes: to increase patient safety & prevent deterioration that could lead to hospital admission • 9 patients however were admitted with either an existing or new health issue
Care needs were complex (chronic + acute) • Range of disciplines, MD health & social care interventions • Most had multiple risk factors for falls, • ½ had equipment needs • All but one needed ‘Case management’, • 22 had onward referral needs • High liaison contacts – 19+ care agencies contacted to facilitate care • Large variation in length of care: • mean length of time to complete programme = 4 weeks + 5 days • shortest 45 mins, • longest 9+ weeks
4 disciplines involved in delivering home based falls care • Principle input was for facilitation & coordination of care (geriatric specialist nurse) & for physical rehabilitation (Physiotherapy/TI) • Total cost of team to deliver care to cohort (based on active time spent with patients, pay scale band at mid point with employers NI/SA added) & travel costs: = £3156
Falls Prevention in Sheltered Housing – summary • Although a small pilot sample, it appears cost effective to deploy NHS/local authority resources to prevent falls • Reasonably modest levels on input for the interventions can have significant effects • Reshaping care to multi-disciplinary hubs will impact on the effectiveness of falls prevention through assisting the coordination & communication of care • Age of cohort has suggested a developing & continued need for home based falls prevention in A&A • Future capacity: predominant need for ‘coordination of care’ by geriatric specialists (traditionally nurse led) & Physiotherapy • Future capacity: PSI led continuing community based exercise programmes • High satisfaction levels (Sheltered Housing staff, SAC & health staff) for targeted partnership working which has delivered staff training, role development & fast access for residents to specialist health care
JIT project Jan-March 2011 • Evaluation • Currently gathering data for final analysis to determine if met targets – 10% reduction in falls, 20% reduction in unscheduled hospital admissions • Qualitative impact of “Positive Steps” • Resident questionnaire analysis • Focus groups • Need for additional learning resources – final spend • Cost analysis for preventative approach • Calculating the reactive care costs of the 9 patients admitted to hospital • Seeking involvement of a health economist • Progression of the “Repeat faller” reports across A&A