Safer Care North East Falls Task Group

1. Safer Care North East Falls Task Group Dr Fiona Shaw Chair, Safer Care North East Falls Task Group Consultant Physician and Geriatrician NHS Newcastle and North Tyneside Community Health

2. Safer Care Falls Task Group • ‘Do something’ to reduce falls and fractures • Across region • Doctors, nurses, falls co-ordinators, physiotherapists, OT’s, pharmacist, NEAS, osteoporosis specialists, third sector, commissioners • Link individuals and services to: • Share good practice • ‘Collective voice’ to argue for change • Support change needed for wider implementation of good practice

3. The problem ……

4. BIG cause of HARM PCT / LA (pop 300,000, 45,000 age > 65) each year: 15,000 fallers age > 65, 2,200 A&E attendances 1,100 fractures including 360 hip fractures 25% of those admitted to hospital IP > 1 month 4x increased chance of admission to Care Home Loss of confidence, social isolation Recurrent falls – double mortality Cost = £2.5 million per annum Why is falls (and fracture) prevention important?

5. Falls and fractures are PREVENTABLE Multi-factorial intervention reduces falls in community dwellers, hospital patients and care home residents by about 30% Targeted exercise reduces falls in selected community dwellers by about 30% Osteoporosis treatment would prevent 105 fractures, including 55 hip fractures per PCT / LA area in 5 years Money saved = estimated £750,000 per year Why is falls (and fracture) prevention important?

6. What we did …….. …. early 2009 - now

7. Consensus recommendations for falls and fracture prevention • Organisational issues • Services delivered • In-patient / hospital falls • Care homes • Training • Information • Quality metrics • Services mapped themselves against recommendations …….

8. Service mapping …… • Individual issues addressed: • Funding for Osteoporosis Specialist Nurse • Development of Falls Training • Recurrent themes identified across region: • Lack of robust pathways of referral from A&E to falls services • Assessment and treatment of osteoporosis

9. Falls (and fractures) CQUIN 2011/2012 written by Falls Group • Capture of falls information in A&E • Evidence of timely referral to falls service for patients who present to A&E with: • A fall • A blackout • A fracture relating to a fall • Evidence of timely and appropriate assessment by falls service including: • Initial falls assessment • Screening for osteoporosis Falls Service

10. Information sharing website • Policies, protocols, assessment tools, training documents, patient information from group • Share with professionals – regionally and nationally • Live April / May 2011

11. Care Homes: sharing of good practice • Quality Standards: Sunderland • Similar process in progress in MRCPCT and Newcastle Middlesbrough, Redcar and Cleveland Primary Care Trust

12. In-patient audit tool • In-patient audit tool based on Reducing Harm from Falls • Being analysed …..

13. Regional outcome measures • Work with NEQOS to use routine data as regional outcome measures • Admissions with fractures • In hospital mortality for patients admitted with a fracture • Split into fragility fracture and fracture neck of femur • NHFD

14. Measurable outcomes • Evidence of what we’ve done • Falls CQUIN, Website ….. • Evidence of changes in practice • Care Homes, Training ……. • Invitation to present our work at National Patient Safety Congress, May 2011 • Falls and fracture prevention? • Too early to tell …. but we should do …

15. What went well • CQUIN on Falls in A&E and osteoporosis written by Falls Group in 2011/2012 North East CQUIN Scheme • Website • Establishing good working relationships amongst Falls Services in North East • Sharing and wider implementation of good practice • Commitment of group members to work together

16. Key lessons • Importance of consensus approach • Benefits of working together and sharing ideas / good practice • Importance of identifying the right people to influence and help you get things done

17. Future plans • Regional falls work – hosted by CDDFT • Implementation – group expanded to include relevant trust managers from across the region • Regional Falls and Fracture Prevention Strategy • Implementation of A&E CQUIN • Actions from in-patient falls audit • Completion of website • Further development of regional falls indicators • Active engagement with NEAS • Re-audit against Good Practice Recommendations

18. Falls and fractures are preventable .. ….. does your organisation provide appropriate services, training and have a culture of falls and injury prevention? Contact Fiona.Shaw@newcastle-pct.nhs.uk