Managing Falls and Fractures in Care Homes for Older People: DVD Education Pack

Facilitator notes

• ThiseducationpackshouldbeusedinconjunctionwiththeManagingFallsandFracturesinCareHomesforOlderPeopleGoodPracticeSelfAssessmentResourceandaccompanyingDVD.

• Familiariseyourselfwiththeresource,supportingdocumentsandDVDbeforeusingthiseducationpack.

• Printoffinformationforfacilitatorandforstaffbeforedeliveringtheeducation.

• Deliveringtheeducationinfullwilltake2–3hours.Itisrecommendedthatthetrainingbedeliveredinfull,however,ifthisdoesnotmeettheneedsofyourcarehomeeachsectioncanbedeliveredindividually(seeappendices),forexampleuseofcasestudyonitsowntofacilitatediscussion.

• Pleasebeawarethisisaneducationpackforallstaff.Yourstaffmayhavevaryinglevelsofknowledgeandexpertise.Itisrecommendedthatstaffcompletethetrainingingroupswithsupportfordifferentlevelsofknowledgeandexpertise.

• Theeducationpackcanbeusedwithstaffwhodonotdirectlyassess/deliverresidentfallspreventionmanagement,forexamplecateringstaff,administrationstaffandhandymen,however,additionalsupportmayberequired.

• Additionalresourcesarelistedattheendofthecasestudyshouldstaffrequirefurtherinformationonthetopicsraisedinthiseducationpack.

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2 Falls and fractures: DVD education pack 3

• Forstaffwhoarenotdirectcarestaffitisusefultoprovideadditionalexamplesofhowfallspreventionispartoftheirrole,forexamplechefsprovidingbalanceddietandhydration,handymensupportingasafeenvironment.

Planning the Session

The purpose of this sessionThissessionwillpreparecarehomestafftocontributetothepreventionandmanagementoffallsandpreventionoffragilityfracturesintheirdaytodayworkwitholderpeople.

Learning OutcomesTheselearningoutcomesarebasedontheNationalPreventionandManagementofFallsandFragilityFracturesinOlderPeople(2011)–RefertoAppendix1forfurtherinformation.

1. Inordertosupportselfmanagement,beabletoadviseandinformolderpeopleandcarersaboutfallsandfragilityfractures.

2. Identify,recordandreportrisks,physicalandpsychologicalconsequencesoffallsandfragilityfracturesforolderpeopleandtheirfamilyandcarersasappropriate.

3. Understandtherangeofsolutionsavailabletoreducerisks,includingstepstotaketoenableselfmanagement,andapplythiswithinyourscopeofpractice.

4 Falls and fractures: DVD education pack

Material required

Content of facilitator pack: Guidancenotesandplanforthesession(nextsection) ManagingFallsandFracturesinCareHomesforOlderPeopleGood

PracticeSelfAssessmentResourceandtoolkit ManagingFallsandFracturesinCareHomesforOlderPeopleDVD Copiesofcarehomefallspreventiondocumentation/tools Alldocumentsincludedinthestaffpack:

Content of staff pack(*acopyshouldbeprintedforeachpersonattendingthesession*): Fallsquiz Fallsquiz(answers)(**tobeprovidedattheendofthesession**) Keypointshandout(**tobeprovidedattheendofthesession**) Casestudyandfallsdiary Casestudy(discussionpoints)(**tobeprovidedattheendofthe

session**) Actionplan Declarationform Evaluation

4 Falls and fractures: DVD education pack

Supporting documentation

(Click on the links below)

Fallsquiz

Fallsquiz(answers/discussionpoints)

Keypointshandout

Casestudy

CaseStudySpreadsheet

CaseStudyFallsdiary

Casestudy(discussionpoints)

Actionplan

Declarationform(tobesignedbyparticipants)

Evaluationform

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Guidance notes and plan for session

1. Introduce self and outline the learning outcomes for the session (as per page 3).

Thissessionwillpreparecarehomestafftocontributetothepreventionandmanagementoffalls,andpreventionoffragilityfracturesintheirdaytodayworkwitholderpeople.

2. Falls quiz –askstafftocompletethefallsquiz.Answersaregivenattheendofthesession.

3. What is a fall?

Discuss with group what their definition of a fall is.

Advisethegroupthattherearedifferentdefinitions. Itisimportanttoknowthedefinitionforreportingpurposessothat

everyoneisclearwhentoreport.

Thisisthedefinitionofafallthatismostrecognised:

*Thisincludesfallsthatarenotwitnessed,forexamplewhereyoufindaresidentonthefloor.*

A fall is:‘An unintentional event that results in a person coming to rest on the ground or another lower level, not as a result of a major intrinsic event (such as stroke or epilepsy) or overwhelming hazard (such as being pushed).’ (Gibson et al, 1987).

6 Falls and fractures: DVD education pack

6 Falls and fractures: DVD education pack

4. Why falls matter?

Discuss with group why falls matter to them.

Discusswithgroup:

• 1in3peopleovertheageof65willfallinayear. • Asageincreasesfallsriskincreasesto45%inthoseover80 (DoH2009). • Oneintwowomenandoneinfivemenovertheageof50have

Osteoporosis(thinningbones).IfapersonwithOsteoporosis fallsthentheyaremorelikelytobreakabone.Thisisdescribed

asafragilityfracture. BUT…. • Olderpeoplelivingincarehomesarethreetimesmorelikelyto

fallthancommunitydwellingolderpeople. • Theyaretentimesmorelikelytohaveahipfractureinacare

homethaninotherenvironments. • Onethirdofcarehomeresidentswillbedeadfourmonths

followingahipfracture. • Thestatisticsarehigheriftheresidenthasdementia. • Therateofemergencyadmissionsduetofallsinpeopleagedover

65livinginCareHomesisalmostfour times higher. • Thecostoftheseadmissionsisestimatedtobeintheregionof

£22 million.

Thereisafinancialcostoffallsandfractureshoweverthehumancostismuchgreater.

Discuss with the group about the physical and psychological cost of falls.

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*Falls are not an inevitable part of ageing*Inmanycases,takingtherightstepsattherighttimecanpreventfallsandenableanolderpersontocontinueaphysicallyactivelife.Carehomestaffhaveakeyroletoplayinfallsprevention,buttheyneedtohavetheknowledgeandunderstandingandsupportofthewiderhealthandsocialcareteam.

*Falls are everyone’s business and everyone in a care home has a responsibility to help prevent and manage falls.*

5. Watch DVD.StopDVDatkeypointsanddiscussthesekeypointswithgroup.Thegoodpracticetoolsthatareassociatedwitheachsectionarelistedandshouldbediscussed(oryourowncarehometoolsasappropriate).

Physical PsychologicalDehydration Feelings of uselessness Cuts, bruises, soft tissue injuries Increased dependencyFractures Loss of confidenceHypothermia Carer stressDeath Immobility Anxiety/DepressionIncontinence EmbarrassmentPressure ulcers/ Low self esteemLeg ulceration Loss of controlDislocation Emotional distressHead injuries Social isolation/Pneumonia/chest infection withdrawal Fear of further falls

8 Falls and fractures: DVD education pack

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Key point discussion

Time KeyPoints GoodPracticeTools

7.0610.00

Multifactorial falls risk assessment and action planning

•Assessingeveryresident’sriskoffallsandfracturesfollowedbypersonalisedcareplanningtomanageriskiskeytofallsandfracturepreventionandmanagementinacarehome.•ALLresidentsshouldhaveamultifactorialfallsriskassessmentcompletedonadmission,reviewedmonthlyandifthereisanychangeincircumstancessuchasillness,fall,changeofmedication,changeinmobility,changeinmood/cognition.AnewassessmentmaynotberequiredbutitMUSTberegularlyreviewed.•Residentperceptionoftheirriskoffallingorexperiencinganearfallwillhaveanimpactontheirfalls.Forexampleifapersonhasdementiathentheymaynotrealisetheirrisk.Ifaresidentisfrightenedoffallingthentheywilllimitactivityandthisputsthematahigherriskoffalls.

Tool3Tool5Tool6Tool7

Tool17

10.00 Reporting and recording falls•Theactionstakenafterafallarecriticaltoaresident’swell-beingandfutureriskoffalling.Tool8providesapathwayandinformationfortheimmediatecarefollowingafall.•Analysingoffalls/identifyingcausesoffallsiskey.Thegoodpracticetoolsprovidearangeofwaysofreviewingresidentsfallsorpatternsoffalls.Forexamplearesidentmayfallgettinguptothetoiletatnight.Theremaybeapatternoffallsatcertaintimesofdayoraparticularareasuchasthediningroom.•10blooksatpostfallsanalysisforanindividual.•13band14benablestafftolookatlocationsoffalls.

Tool8Tool10aTool10bTool11aTool11bTool13aTool13bTool14aTool14b

25.00 Risk factors for prevention and management of falls•Riskfactorsforfalling•Oftenanolderpersonwillhaveacombinationofriskfactors;themoreriskfactorspresent,thegreatertheriskoffalling.•Riskcanrelatetotheindividualand/ortheirsurroundingenvironment.

Tool1Tool2Tool4Tool9Tool12Tool15aTool15bTool16Tool18

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1110 Falls and fractures: DVD education pack

Risksrelatingtotheindividualinclude:

•previousfalls•ageing-causingchangesinthebody•certainmedicalconditionssuchasParkinsonsdisease,stroke,dementia,arthritis•beinglessphysicallyactive•side-effectsofmedicationsoracombinationofmany•excessivealcohol.

Risksrelatingtothesurroundingenvironmentinclude:•poorlighting,especiallyonstairs•lowtemperature•wet,slipperyorunevenfloorsurfaces•clutter•chairs,toiletsorbedsbeingtoohigh,loworunstable•inappropriateorunsafewalkingaids•inadequatelymaintainedwheelchairs,forexample,brakesnotlocking•improperuseofwheelchairs,forexample,failingtoclearfootplates•unsafeorabsentequipment,suchashandrails•loose-fittingfootwearandclothing.

6. Summarise with staff about your care homes policies, procedures and documentation related to falls and bone health and what is required of them. Give staff key Points handout.

7. Complete Case Study and discuss with group.ConsiderTool5oryourownmultifactorialfallsriskassessmentasaguide.Givestaffanswerstocasestudyattheend.Youcanuseareallifecasestudyofoneofyourresidentsifyouprefer.

8. Quiz answers/recap.

9. Complete an action plananddiscusswhatindividualactionsstaffcantakeandwhatcanbedoneasagroup.ThismaybeusedtosupportimprovementusingPDSA(20a,b,c).

10. Complete staff evaluation and sign declaration form.

12 Falls and fractures: DVD education pack

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12 Falls and fractures: DVD education pack