Title: The National Audit of Falls and Bone Health in Older People
1The National Audit ofFalls and Bone Healthin
Older People
insert name Strategic health Authority date,
venue
- Speakers name and designation
- On behalf of the Clinical Effectiveness and
Evaluation Unit, - Royal College of Physicians, London
- Funded by Healthcare Quality Improvement
Partnership
2Commissioning A Systematic approach to falls
bone health Four key objectives
3How do we know how we are doing?
- We can only be sure to improve what we can
actually measure - Lord Darzi, High Quality Care for All, June 2008
4Clinical audit evaluation
Evidence based standards
National Hip Fracture Database
BOA/BGS Blue Book High quality hip fracture care
Blue Book, NSF, NICE Fracture Liaison
Service Falls Clinic
National Audit of Falls and Bone Health
NSF, NICE Exercise programmes Falls
clinics Bisphosphonates
NSF Health promotion
Where audit fits in this model
5National Clinical Audit 2007 Sample and Results
3184 hip fractures Mean age 83, 80 women 57 left AE within 4hrs (target 100) 87 to specialist ward --------------------------------- Mean LOS 16 days 25 gt 26 days 59 back to usual residence 27 to intermediate care bed 5642 non-hip fractures Mean age 79, 86 women 64 attended in office hrs 1/3 admitted 96 of the rest went home ------------------------------------- Integrated acute-community pathways are needed
6Hip fracture management
- Pre-operative management was generally good for
pain relief, fluids, routine observations - only 46 pressure risk assessments, 54
mattresses - Surgery within 24h - 35, 48h - 69
- Organisational delay was responsible for 29
- Low rates of routine medical review
- Lack of acute orthogeriatric services
- Only 39 had multidisciplinary team review within
1st week
7Secondary prevention - Bone health Hip fracture
v Non-hip fragility fracture
50 osteoporotic
8n 7860/31094
n 1476/15025
n 2551/15025
n 1862/2551
n 261/14651
n 700/14651
n 305/700
Hippisley-Cox, J., Bayly, J., Potter, J., Fenty,
J. Parker, C. (2007) Evaluation of standards of
care for osteoporosis and falls in primary care.
The Health and Social Care Information Centre.
9Secondary prevention - Falls risk assessment Hip
fracture v Non-hip fragility fracture
10Aspects of integrated falls care in patients 75
and over (n 270,028)
n 1,076 / 251,049
n 1,335
n 15
n 10
n 319
Hippisley-Cox, J., Bayly, J., Potter, J., Fenty,
J. Parker, C. (2007) Evaluation of standards of
care for osteoporosis and falls in primary care.
The Health and Social Care Information Centre.
11Secondary prevention
- Most patients receive inadequate secondary
prevention so are at unnecessarily greater risk
of further harm - Non-hip fragility fracture patients receive less
attention than hip fracture patients
12The Second National Audit of the Organisation of
Services for Falls and Bone Health in Older
People (2008)
13Participation
- Acute trusts 100 (158/158)
- Primary Care Organisations 88 (150/171)
- Health Social Care Trusts 88 (7/8)
- Mental Healthcare Trusts 76 (44/58)
- Care homes 73 homes
- (sample drawn from 2 national providers)
14Key Results
15Commissioning for falls and bone health
TAG 87 National Institute for Health and
Clinical Excellence, Technology Appraisal
Guidance, Number 87
16Acute trusts - case finding
17Secondary prevention of falls
18Key Messages
19Services fail to achieve evidence based standards
- Services are variable in quality and many lack
key evidence based components - Lack of integration between falls services and
fracture services - Significant gaps along patient journey for falls
and fractures - Inadequate levels of secondary prevention for
both falls and bone health - Secondary prevention for non-hip fragility
fracture is less good than for hip fracture
20Opportunities to prevent recurrent falls and
fractures are being missed
- Risk assessments in AE departments and Fracture
services are inadequate - Services with Falls Coordinators and Fracture
Liaison Nurses have better case finding systems
in place to identify high risk fallers - Many trusts do not provide these important posts
- Many of the exercise programmes being provided
are not evidence based - Services for bone health appear less well
developed than services of falls prevention -
21Commissioning for falls and bone health is weak
- Only 64 (110/171) of commissioning bodies have a
written strategy on falls prevention - Only 23 (38/171) have a strategy for bone health
- Important public health information on fracture
rates is inadequate or not collated - Only 39 (67/171) of commissioning trusts report
having a mechanism to assess local compliance
with national guidelines on osteoporosis treatment
22Thank You
23Falls risk assessment
Falls history Syncope considered Medication reviewed CVS examination Vision assessment Vision impaired Gait balance assessed Exercise programme Home hazard assessed Non-Hip () 25 17 31 40 10 38 (most treated) 28 22 14 Hip () 45 22 44 89 19 40 (most treated) 68 44 51