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Our Vision: To lead out-of-hospital community healthcare Proactive Falls Prevention in Care Homes (CLCH) Natasha Moseley Improving Outcomes Through Physiotherapy Innovation
Our Vision:
To lead out-of-hospital community healthcare
Proactive Falls Prevention in
Care Homes (CLCH)
Natasha Moseley
Improving Outcomes Through Physiotherapy Innovation
Contents
• Background & Project Aims
• Falls Prevention Model
• Project Key Performance Indicators
– Falls Prevention Indicators
• Outcomes to date
– Service User Feedback
– Value Added
• Next steps
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Hosted by CLCH NHS Trust in partnership with:
• London Borough of Hammersmith and Fulham
• The Royal Borough of Kensington and Chelsea
• London Borough of Westminster
• NHS Hammersmith and Fulham Clinical Commissioning Group
• NHS West London Clinical Commissioning Group
• Central North West London Mental Health NHS Trust
• West London Mental Health NHS Trust
Host & Partnerships
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Host & Partnerships
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Hosted by CLCH NHS Trust in partnership with:
Background & Aims: Proactive Care Home Pilot
• 19 Care Homes (extra care, residential and nursing homes) across 3 Inner London Boroughs
• Addressing the needs of 1000 care home residents
• Overall Proactive Care Home Pilot Aims:
1. Standardise care provision across homes
2. Target cause of non-elective preventable acute admission / A&E attendance
3. Ensure consistent skill set amongst care home staff
• Project is underpinned by principles:
1. Mutual respect between participants
2. Autonomy of residents and their carers
3. The need for proactive care to prevent urgent care
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Resident
Care Co-ordination
Team
Medicines management
Falls prevention team
Consultant geriatrician/mental health
GP review Care home
team
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Social care
CPN
Core care team
Team Members:
Palliative care nurse
Falls Prevention Model
• Train care home teams in using a multifactorial falls risk assessment approach
• Embed individualised falls risk assessments & care planning for ALL residents
• Embed routine root cause analysis of ALL falls in the homes
• Target therapy assessment & management for those residents most at risk of falling
• Upskill care home staff to offer person centred evidence based falls prevention in homes:
– Engage staff to undertake an accredited falls prevention exercise qualification to enable care home residents to participate in strength & balance training
– Falls prevention education for all staff
– Promotion of other courses e.g. Trusted Assessor
– Provision of falls prevention resources and written information
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Project KPIs
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• Metrics to evaluate the impact of the care homes pilot are in the table below:
• Final evaluation for the project will take place in December 2014.
• Interim results are being presented on a quarterly basis, so there are limitations to what is currently known.
Falls Process Indicators
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• Improved core team skills and capability – Falls Prevention training
– Root Cause Analysis Systems
– Manual Handling
– Training Material, Catalogues
– LaterLife Training
• Early Intervention to reduce inappropriate referrals to Community Falls Prevention Teams – Direct assessments / reviews
– Advice during MDTs
– Care Plan Reviews
– Early Intervention SPOR
• Culture Change re: Care Coordination – MDTs
– Liaison / Advice / Linking Care Home staff to existing services
• Increase number of residents on bone health optimisation where appropriate
Outcomes - Falls
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• Q2 report interim results for H&F Care Homes
0
20
40
60
80
100
120
Falls H&F
Average
Lower NaturalProcess Limit
Upper NaturalProcess Limit
Interim Outcomes - All
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• Overall results are difficult to interpret due to some missing data from
historical datasets (dating back pre-project).
• For those homes for which there is a complete data set (over varying
amounts of time) there is evidence of change but the change is not
always favourable (see the table below):
Qualitative Evidence
Resident survey showed 56% point increased satisfaction for residents regarding knowing their own care plans
Staff survey showed 16% point increase in reporting that care was being proactively managed
‘We have become a good team, all of us the doctor and the physio and the pharmacist’ (Care home manager)
‘I get a bit of learning from the nurses […] I learn other pathways and how to care for these people. The falls team is excellent […] I’ve learned new ways of caring for some of the patients in a way’ (GP)
‘It is a good opportunity to build a relationship with health professionals and even when we finish the project it’s going to continue’ (Care home manager)
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Value added
• MDGs plus integrated care planning = Right Care at Right Time by Right People
• Bespoke training for care home staff beyond common falls risk factors e.g. Challenging Behaviour/Dementia & falls, how to assess a resident post fall
• While outside of the scope, we have also… – Instigated an audit of equipment within the care homes to highlight gaps
– Assisted in demystifying safeguarding practices across providers within care homes to improve care quality & enable shared learning
– Been able to open discussions with Commissioners regarding evolving short falls in the care home contractual agreements e.g. variation in how homes access funds when residents’ needs change
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Next Steps
Outcomes • Review of Q2 update to
identify possible reasons for changes and implement more widely
– AHPs
– Care Home Staff
– Other Process Indicators
• Final evaluation due Dec 14 which will inform decision making around service continuation/ commissioning intentions
Processes
• Equipment gap???? (solution =? Trusted assessor training)
• Commissioned in homes
• Policies re: post fall protocol
Other:
• Share learning through publishing Proactive Care Pilot results & barriers/recommendations for practice
References
• AGS / BGS Clinical Practice Guideline: Prevention of Falls in Older Persons http://www.medcats.com/FALLS/frameset.htm [ accessed on 08.08.14]
• Interventions for preventing falls in older people in nursing care facilities and hospitals (Review): Cameron ID et al. The Cochrane Collaboration.The Cochrane Library. 2010, Issue 2
• Oliver D, Connelly BC, Victor CR, Shaw FE, Whitehead A, Yasemin G, et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 2007;334(7584):82–7.
• Connell BR. Role of the environment in falls prevention. Clin Geriatr Med 1996; 12:859–80.
• Dromerick A, Reding M. Medical and neurological complications during inpatient stroke rehabilitation. Stroke 1994;25(2):358–61
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Contact Details
For further information please email:
