The aim of the Falls Quality Improvement (QI) Project - 'FallStop' is to minimise the risk of falling and the risk of injury from falling, for all patients who receive care from Camden and Islington NHS Foundation Trust (C&I).
The aim of the Falls Quality Improvement (QI) Project: ‘FallStop’ is to minimise the risk of falling and the risk of injury from falling, for all patients who receive care from Camden and Islington NHS Foundation Trust (C&I). All falls, even those which do not result in injury, can be distressing and cause anxiety to patients, relatives, carers and staff. Falls can affect patients’ physical function, confidence, and independence. Some falls can result in serious injury, such as hip fracture and serious head injuries, and these can result in death.
The Trust aims to minimise the risk of falling for all service users who receive care from the Trust. To achieve this the Trust is committed to enhancing the knowledge of staff, ensuring that staff identify those at risk of falling, making sure staff take preventative action to reduce the risk of falls, ensuring patients who have fallen are offered appropriate interventions with the aim of reducing injury and the incidence of further falls. The Trust also works with patients, carers and family members to mitigate the risk and consequences of any falls.
In 2015, the Trust recruited a Matron for Falls Prevention and Training. The Matron for Falls, in conjunction with the Deputy Director of Nursing and the Trust’s Falls Management Group, has lead the programme of work to improve the management and prevention of falls across the Trust. A team of enthusiastic Falls Champions has been created across the organisation, all of whom have been trained in the latest best practice.
There are over 30 Falls Champions across the Trust who are either band 5/6 nurses or occupational therapists, or clinical support workers. The Champions are responsible for leading their local teams in consistently delivering falls risk management strategies and assisting with the implementation of the falls management agenda in their clinical area. The Champions have been able to develop their leadership skills, along with their skills in quality improvement, using measurement for change, audit and change management.
To ensure the falls prevention message has been embraced by staff the Trust has launched an original campaign called FallStop. The awareness campaign encourages staff from all professions to work with each other to help keep patients safe from falls. All service users are now required to have their falls risk reviewed, no matter where they are in our care or how young they are.
The Trust’s Community Services FALLSTOP Review is completed on all service users who are treated in the community setting. The Review identifies service users who are at risk of falls and who are at risk of osteoporosis, and signposts these patients to the Community Healthcare Teams, Community Falls Services or GP.
On the inpatient wards, within the 24 hour residential services, in the Day Centres and in the Day Units, all patients identified as at risk of falling will undergo the Trust’s FALLSTOP Assessment. This is a comprehensive multifactorial and multi-disciplinary falls risk assessment. The Assessment uses/utilises FALLSTOP as a mnemonic with each letter representing a key component of the falls risk assessment. For example the letter F stands for Falls history and Fear of falling. A stands for Assess cognition, and Assess continence and so on.
The Assessment prompts staff with how any risk factors which increases a service users chances of falling could be managed, utilising various teams and services internal and external to the Trust. Owing to variations in service provision, there are 4 versions of the FALLSTOP Assessment.
The Pharmacy Team developed the ‘Pharmacist Medication Assessment’ which assists with the identification and management of service users’ medication to help reduce medication-related falls in 24 hour bedded services.
There have been improved mechanisms for communication between staff to highlight which patients are at risk of having a fall and who are at a higher risk of injury from a fall (i.e. fracture/sub dural haemorrhage). Mechanisms include the use of alert magnets on ward boards, alert signs in patients bedrooms and alerts on the electronic patient record system. There have also been improved communication mechanisms between staff and patients, with the development of an inpatient falls information leaflet for service users which explains the risk factors for falling in hospital and designed to help service users engage in falls risk reduction strategies.
Two post falls protocols have been developed, one for the inpatient services and one for the community services, which takes into account variations in staff mix and equipment availability. A team debrief take place following a falls incident, the fall is discussed with the MDT and feedback relevant to the incident is shared across the whole team. There is also a comprehensive training programme for staff, and some exciting future developments around falls, with utilising the Trusts new Simulation Suite for falls training and looking at how the use of technology can enhance safety around falls within the Trust.
C&I’s Falls Quality Improvement Project: ‘FallStop’ has so far demonstrated a 15% reduction in falls in the 24 hour settings and an 80% reduction in falls resulting in fracture in 2015/16, compared to the previous year. This reduction was achieved due to the support of the programme from staff from all levels, all Divisions and all Departments within the Trust, and importantly from the team of enthusiastic and dedicated Falls Champions.
There is improved awareness and knowledge in teams in the Community Services of the role that they can play in reducing the risk of service users falling in the community, ultimately improving the quality of life of our service users.
In 2015 the Deputy Director of Nursing and Matron for Falls Prevention and Training visited the 2gether NHS Foundation Trust to share good practice.
The Royal Hospital Chelsea was also visited to review their dementia friendly environment. Learning from this visit, and guidance from the Kings Fund and NHS England, assisted with the development of an improved dementia friendly environment on one of the Older People’s Ward.
Integral to the success of the project was collaborative working between staff, patients and carers. The project empowered staff and service users to improve service delivery by encouraging innovation and the bringing of new ideas into practice based. New ideas were tested through PDSA cycles. Once strategies were refined through PDSA cycles the Champions led their teams in embedding the new way of working.
It was pertinent that the project lead worked collaboratively with colleagues to achieve consensus and drive change. The psychology behind change management was used to assist with the spreading of changes.
The Falls Management Group meets bi-monthly and supports the continuation of the project. There is monthly falls data collection which is completed by the Champions and supported by the Governance and Assurance Team. Falls risk management training is also part of the Trust’s Induction Programme for new starters and the Newly Qualified Nurses Preceptorship Programme.
C&I’s Falls Quality Improvement Project: ‘FallStop’ has so far demonstrated a 15% reduction in falls in the 24 hour settings and an 80% reduction in falls resulting in fracture in 2015/16, compared to the previous year. This reduction was achieved due to the support of the programme from staff from all levels, all Divisions and all Departments within the Trust, and importantly from the team of enthusiastic and dedicated Falls Champions.
There is improved awareness and knowledge in teams in the Community Services of the role that they can play in reducing the risk of service users falling in the community, ultimately improving the quality of life of our service users. Early feedback from C&I’s recent CQC inspection ‘praised fulsomely’ the falls work being undertaken and how it has been ‘embedded’ into practice.
The Trust is currently is discussions with one of the local Acute Trusts as they wish to implement the FallStop Project across their Trust. The FallStop QI Project was presented at a recent Mental Health Nursing Conference which was hosted by The University of Middlesex.
