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AINTREE UNIVERSITY HOSPITALS NHS FT
AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
• Acute healthcare
• Urban population of 330,000
• North Merseyside and surrounding areas
• Provides some tertiary services for a wider area
• > 73,000 episodes of inpatient and day case care each year
Summary
AINTREE UNIVERSITY HOSPITALS NHS FT
Goals
• Ensure initial assessments are done in a timely fashion
• Assess modifiable risk factors
Actions taken since 2009
• Changes in documentation
Aintree University Hospital Foundation Trust
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
AINTREE UNIVERSITY HOSPITALS NHS FT
SWOT analysis
Strengths
Assessment on day 1 or 2 of admission:
Falls risk 67% ���� 85%
Hx of previous falls 29% ���� 91%
Gait 75% ���� 85%
Cognition 62% ���� 86%
Opportunities
Link objectives to other trust targets
eg dementia strategy
New electronic documentation may
improve things
Weaknesses
Review of anxiety of falls: 0% ���� 7%
Medication review: 95% ���� 15%
Assessment for bedrails: 15% ���� 29%
Eyesight checked: 33% ���� 17%
Postural blood pressure: 11% ���� 8%
Threats
Ever increasing work load on staff due
to competing demands on time
eg VTE assessment
EAST LANCASHIRE HOSPITALS NHS TRUST
AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
SWOT ANALYSISStrengths
• High level support in the Trust
• The Trust has a non stratified screening
tool and evidence based policy
• 68% patients had their cognitive /
mental state reviewed on admission
• 55% had their gait reviewed
• Transforming community services
• Safety Express – Harm Free Care
Opportunities• Awaiting commissioner intervention:
• RE: support of a falls prevention programme in the community
• RE: support of a fracture liaison service
• Falls champions sharing information
• Strengthening of inter disciplining ways
• Dementia pathway and CQIN
• Orthogeriatrics
Weaknesses• Medication review• Need to improve compliance with
Trust policy• Cohesive bundle for medical
interventions for fallers• On-going monitoring of cognition
needs to be strengthened
Threats
• Communication and engagement
• Resistance to change
• Small falls “team” not a fully cohesive
service across pathways (but improving)
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
EAST LANCASHIRE HOSPITALS NHS TRUST
LANCASHIRE TEACHING HOSPITALS NHS FT
AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
Goals for 2011 audit:
• Complete Falls Assessment Tool with Moving and
Handling and Bed/Trolley rail assessment
• Lying and Standing Blood pressure
• Communication with patient is documented
• Improve the Falls Referral on Discharge for continuity
of care
Rolled out the Falls Assessment tool throughout the Trust
Supported staff in understanding the important of Lying
and Standing Blood Pressure
Several audits in the trust identify Falls Assessment tool is
completed
Blood Pressure is not being completed -- Criteria now in
place for age 65 and over to improve figures.
Summary
LANCASHIRE TEACHING HOSPITALS NHS FT
2011 Audit Results:
80% Falls Assessment was
completed on admission
98% Moving and Handling Plan
0% Lying and standing Blood
pressure
32% had a urinalysis checked
Hearing and vision very low %
23% Anxiety about falling
Population covered is 340,000 Central Lancashire
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
Outcomes:
1 All patients identified at risk of falls have
appropriate plan of care
Documentation Audit – reduction on
in-patient falls and severity of injuries
2 Encourage urinalysis on admission and
assessment of vision and hearing
Ward audits and ECAP audit
3 RCA to be encouraged on all injuries
following a fall
Data on injuries and RCA collected on
Datix
4 Improve education and training for all staff Training records, e-learning
5 Documentation Ward Performance audits, NHSLA and
ECAP
Outcome Indicators:
Action Plan
LANCASHIRE TEACHING HOSPITALS NHS FT
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
Aims for the 2011 audit were
to improve assessment
processes and care planning.
This was achieved in the majority of
cases with marked improvement
from 2009 in the majority of areas.
Summary
EAST CHESHIRE NHS TRUST
East Cheshire NHS Trust has 306 acute beds and serves a population of
approximately 450,000.
There is a high proportion of elderly patients in this area –
approximately 80% of the inpatient population are over the age of 75
There is still work to do around:
• The number of ward transfers
• Patients’ experience
• Pharmacy reviews
• Reduction the actual number of falls
per 1000 bed days
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
EAST CHESHIRE NHS TRUST
SWOT analysis Strengths
Strong clinical leadership
Designated Falls Lead identified
Regular monthly MDT meetings
Assessment documentation reviewed and fit for
purpose (falls and bed rails)
Regular documentation audits via patient metrics
Operational staff engaged in falls prevention agenda
Falls improvement initiatives in place
Equipment available
Osteoporosis and Bone Protection
Opportunities
Integration with Community Business Unit
Exec engagement and focus on falls prevention
Participation in ‘Safety Thermometer’
Opportunity to dovetail with other projects eg
dementia strategy, development of acute elderly care
unit
Introduction of ‘Datix’ incident reporting system
Weaknesses
Training
Pharmacy input and medication reviews
Continence care
Change in incident reporting system ? Inconsistent
information
Patient Information
Threats
Access targets influencing number of ward moves
Period of change within organisation – change in
personnel etc
Limited resource available
MID CHESHIRE HOSPITALS NHS FT
AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
MCHFT - 560 beds serving population of 400,000.
N West audit - 60:40 Female:Male
53% Gen Med. 23% Surgical 23% Orthopaedic
Average age 80 yrs. Average length of stay 15 days
Goals from 2009
Improve Bedrail Screening
Lying/Standing BP (increase in recording)
Medication Review particularly psychotropic's.
Documentation of Interventions
Summary
MID CHESHIRE HOSPITALS NHS FT
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
What have you done to meet those goals?
Reviewed and amended FRASE documentation to include bone health assessment and Lying/Standing BP.
Dissemination of instructions to wards for recording L/S BP.
Online falls summary to include medication review.
What has or has not worked?
New documentation not implemented until July ‘11 so audit completed using old documentation.
Ward-based pharmacists to review all medication, particularly following falls.
Assessment of bedrails much improved.
Summary
MID CHESHIRE HOSPITALS NHS FT
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
MID CHESHIRE HOSPITALS NHS FT
SWOT analysisStrengths
Identified during 2009 audit what needed
to change.
Improved documentation.
FaB Newsletter
Falls Leads and Cascade training.
Monthly ward projections.
Regular falls group meetings (now with
executive representation)
Opportunities
FallSafe Project
Online falls reporting
Development fracture clinic
Physiotherapy re falls prevention classes
within trust.
Non-hip fracture nurse.
Weaknesses
Time taken to implement change therefore
not reflected in 2011 audit.
Lack of Falls Lead/admin assistance.
Medical engagement
No prevention training in Non ward areas.
Lack of continence strategy
Threats
Process to implement change
i.e. Governance channels.
Different challenges for time within trust and
changing working practices.
Economic climate (funding issues for new posts)
ST HELENS & KNOWSLEY HOSPITALS NHS TRUST
AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
Population : Elderly, chronically ill, low socio-economic group
Goals for 2011 audit: Evaluate progress since 09
How goals were met: Detailed service review, revised falls service provision (inc. policies, assessment tools, care plans, training) increased liaison with primary care / emergency care colleagues
What has worked? Almost everything!
What hasn't worked? Time frame for implementation
Main issue = changing existing culture ∴∴∴∴ takes longer to reach full implementation
.
Summary
ST HELENS & KNOWSLEY HOSPITALS NHS TRUST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
ST HELENS & KNOWSLEY HOSPITALS NHS TRUST
SWOT analysisStrengths:
Committed staff: Nomination for
most improved service provision in
Trust
Falls leads, regular falls group
meetings, new reporting
mechanisms, multidisciplinary
approach, internal audit programme
+ resources
ALL = improved clinical practice
Opportunities:
Audit (local, regional, national)
National projects eg. FallSafe, Patient
Safety Express,
Offsite visits to explore gold standard
practice elsewhere
Networking through Steering Group /
Audit Meetings & Workshops etc
Weaknesses:
Pervasive 'negative' culture,
limited staff (clinical & audit) +
financial resources
Threats:
Large, complex , time consuming project
Prospect of reduced financial / staff
resources in future
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
What is your population like?
Population– 264,000, 800 bed hospital, recently taken on two community settings –Tameside (inc 2 in-patient areas) and Stockport PCT, Total 5,300 staff.
Number of admissions 18 and over April 2011-March 2012 – 72,707. Number of Falls Including Near Misses April 2011–March 2012 - 1579
What were your goals for the 2011 audit?
To check improvement since the 2009 audit. To re-focus work regarding falls at the Trust, taking into account North West Falls Audit recommendations.
What have you done to meet those goals?
Bed Rails – Policy updated and re-launched. Falls Risk Assessments updated and easily accessible, Lying & Standing BP including in Falls Risk Assessments and Training. FRAX tool in use.
What has or has not worked?
Found in practice that some issues implemented still don’t work despite training! More work required – Cognitive/Mental States.
Summary
STOCKPORT NHS FT
Strengths
Multi-Disciplinary Falls Group
Executive Director Led/Board of
Directors & Governors commitment
Falls Risk Assessments done early on
admission – quickest and improved
Falls Training – Mandatory
Multi-disciplinary initiatives to help
reduce falls
Opportunities
New Harm Free Care Committee
Thermometer Survey
Falls Collaborative in place on high risk
wards.
More Focus Work – modifiable factors
Corporate Objective to reduce
numbers/harm rates
Weaknesses
“So What” – Theory and Practice Gap
Review mental status
Threats
Motivation in current climate – increase
quality, reduced costs.
Just another thing!
Measurement
Number of patient transfers
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
STOCKPORT NHS FT
SWOT analysis
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT
AUDIT RESULTS
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
UHSM is an acute teaching hospital NHS Trust providing services for adults and children at Wythenshawe Hospital, Withington Community Hospital and in the Community.
The Trust has around 920 inpatient beds with a total of approx89,000 admissions per year.
In relation to Incident Reporting, we reported 8448 incident reports in 2011-12, of which 1608 were inpatient falls of these 29 were moderate / major harm.
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT
Summary
Goals for 2011 Audit
• To compare our progress against the previous audit
results.
• Has the introduction of the Trust Fall Falls Intervention Tool improved compliance with the assessment of Inpatient Falls Risk?
• To understand whether we have improved our compliance with Risk Benefit Medication reviews.
• To identify if the recording of Lying / Standing blood pressure has improved.
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT
What have you done to meet those goals?
• The Falls Intervention Tool was introduced across the Trust
over the last 2 years to all inpatient areas.
• The recording of lying and standing blood pressure is
reinforced during teaching sessions on how to use the tool.
• There have been a number of initiatives piloted to formalise
the Risk Benefit review of Medications.
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT
What has or has not worked?• The Inpatient Falls Intervention Tool has improved the risk
assessment compliance, and also vision and hearing
assessment.
• The recording of Lying and Standing Blood Pressure has not
improved as expected – need to include this in training
programmes.
• The Risk Benefit review of medications has deteriorated as
there is no formalised process for this review. All
medications are reviewed by a pharmacist on admission
and this may be why the original audit in 2009 recorded
91% compliance.
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT
Strengths
Full-time Falls Service Facilitator.
Quarterly falls group meetings.
We assess patient’s risk in line with our
policy 95% of the time (within 24 hours).
Combined Falls, M&H and Bed rails
assessment.
Opportunities
Full-time Falls Service facilitator .
Introduction of Ward based “Falls
Champions – Fallsafe.”
E-learning package - RCP Falls Training
Package.
Weaknesses
Identification of Risk Benefit review of
Medication.
Recording of Lying and Standing BP.
Audit sample was an equal cross section
across all areas of the Trust – previously
focused on Unscheduled Care.
Threats
Resources at ward and department level.
Setting of unrealistic targets for compliance
– suggest stretch targets for improvement.
Nature of audit is in some places subjective
and open to interpretation.
The purpose of some questions is not clear
– medications for example.
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT
SWOT analysis
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
What is your population like? - The audit population ranged from 65 –92 yrs, mixture of male and female.
What were your goals for the 2011 audit? - The goals were to benchmark the Trust with last year results to mark our own improvement and how it compared with the rest of the region.
What have you done to meet those goals? - A focus group was established. An action plan was developed. New falls documentation was developed out of the results of last audit and implemented. A Trust wide patient safety falls programme was implemented. RCA investigations and audits of falls documentation.
What has or has not worked? – RCA, falls audits and implementation of action plans have been a great success for the Trust and Patient Safety
.
Summary
TAMESIDE HOSPITAL NHS FT
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
Outcomes:
1 Improve documentation to support the
patient from falling during their in patient stay
The Trust patient safety programme was
launched in May 2011. Monthly audits
show encouraging results. Falls
documentation was revised and
Launched in November 2011
2 To increase the number of falls risk
assessments complete from 79% to 95%
Falls documentation is audited monthly
and non compliance managed
3 To increase the number of vision risk
assessments from 16% to a minimum of 50%
Admission documentation has been fully
revised and will be launched July 2012
4 To increase the number of cognitive
assessment from 70% to a minimum of 95%
Admission documentation has been fully
revised and will be launched July 2012.
Eyesight test feature in the audit to be
completed within 12 hours
5 To increase the number of hearing
assessments 28% to a minimum of 50%
As above point 4
Outcome Indicators:
Action Plan
TAMESIDE HOSPITAL NHS FT
WRIGHTINGTON, WIGAN & LEIGH NHS FT
AUDIT RESULTSPREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
IMPROVED ☺☺☺☺
EARLY FALLS RISK ASSESMENT
RELIABLE RISK STRATIFICATION
URINE ANALYSIS
ASSESMENTS :
- CONTINENCE
- ALTERNATIVE BEDS
- BED RAILS
- OSTEOPOROSIS
Summary
WRIGHTINGTON, WIGAN AND LEIGH NHS FT
NOT MUCH CHANGE :
AVERAGE AGE
SEX DISTRIBUTION
BASE LINE MOBILTY
WARD DISTRIBUTION & LOS
EARLY FIRST REVIEWS
MEDICINE USAGE REVIEW
PREVENTION & MANAGEMENT OF INPATIENT FALLS AUDITNORTHWEST
Action Plan
WRIGHTINGTON, WIGAN AND LEIGH NHS FT
ACTIONS:
IMPROVE ASSESSMENTS
IMPROVE BED MANAGEMENT (DECREASE WARD TRANSFERS)
IMPROVE TRAINING AND EDUCATION
ADDRESS BONE HEALTH
ESTABLISHED INITIATIVES ☺☺☺☺ :
FALLS REPORTING ON DATIX
QSMs (reported falls - moderate to severe harm)
FALLS SCRUTINY COMMITTEE
RCAs
FALLS RAPID RESPONSE TEAM ( POST – FALLS)