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COMPLEX CARE Beardmore Conference Centre Tuesday 14th December 2010 A collaborative approach to falls and fragility fracture prevention

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Title: COMPLEX CARE Beardmore Conference Centre Tuesday 14th December 2010 A collaborative approach to falls and fragility fracture prevention


1
COMPLEX CAREBeardmore Conference Centre
Tuesday 14th December 2010 A collaborative
approach to falls and fragility fracture
prevention
Ann MurrayFalls Programme ManagerFramework for
Adult Rehabilitation ann.murray3_at_nhs.net
2
Todays workshop
  • Outline some key messages
  • Brief summary of the problem of falls
  • The national perspective
  • HDL and Rehabilitation Framework
  • NHS QIS Resource Up and About
  • The National Programme- this years focus
  • Some examples of emerging practice
  • Questions for you

3
Key messages for today
  • Falls and fracture prevention and management is
    part of long term conditions management.
  • Falls are not an inevitable consequence of
    ageing.
  • Early identification of risk followed by
    intervention can prevent the downward spiral of
    recurrent falls, inactivity, functional decline,
    loss of independence and increased dependence on
    health and social care.
  • There has been a national focus on falls since
    2007.
  • There is an active network of CHP Falls Leads in
    Scotland.
  • There have been considerable amounts of work
    going on to improve outcomes for people at risk
    of falling.
  • Falls prevention and management is everybodys
    business.

4
Falls
  • For an individual older person a fall can be
  • trivial, profound or fatal,
  • the first sign of a new or worsening health
    problem,
  • a tipping point leading to loss of
    independence, and increased dependence on family,
    and health and social services,
  • a marker for the onset of frailty.
  • A fall is a symptom not a diagnosis.

5
Prevalence of falls and fractures
  • For example
  • Based on a CHP population of 207,000 which
    includes approximately 30,000 people over 65.
  • Of these
  • 35 (10,500) will fall each year
  • 15 (4,500) will fall twice or more
  • 15 (1,575) of fallers will attend an AE
    department
  • 15 (1,575) of fallers will call the ambulance
    service
  • 7 (735) will sustain a fracture, 2 (210) to the
    hip (actual 525 NHS Grampian 2008)
  • Based on Falls and fractures effective
    interventions in health and social care (DoH 2009)

6
Mean LOS all ages 7.9 days Mean LOS femur 25.7
days Mean LOS falls 9.67 days
UK Hospital Episode Statistics 2005
7
  • I was never the same after the fall
  • I suddenly became an old person
  • I dont really feel the same person
  • I was thoroughly demoralised
  • NHS QIS Focus Groups, October 2008

8
Falls are not an inevitable consequence of old
age
  • Falls are nearly always due to one of more
    underlying risk factors
  • Recognising and modifying these risk actors is
    crucial in preventing falls and injuries
  • Multifactorial targeted interventions, based on
    risk assessment, can reduce falls by up to 30
  • From Falls and fractures developing a local
    joint strategic needs assessment. (DoH, 2009)
  • In people with osteoporosis, the risk of further
    fracture can be halved by anti-resorptive drug
    therapy
  • From The care of patients with fragility
    fracture. (British Orthopaedic Association, 2007)

9
A multifactorial intervention programme targeting
the individuals modifiable risk factors,
identified through multifactorial falls and
fracture risk assessment
  • An exercise programme targeting strength, balance
    and gait
  • Gait training and the provision of appropriate
    walking aids
  • Medication review with modification/withdrawal
  • Home environment assessment and intervention to
    reduce identified hazards
  • Interventions to promote the safe performance of
    daily activities
  • Management of foot problems and footwear
  • Vision assessment and referral
  • Management of postural hypotension
  • Management of heart rate or rhythm abnormalities
  • Cardiac pacing as indicated
  • Provision of vitamin D supplements as indicated
  • Information provision and education
  • Teaching the individual strategies to cope in the
    event of a fall and avoid the consequences of a
    long lie on the floor
  • Referral to social services or home care to
    assess the need for support at home
  • Pharmacological management of osteoporosis
  • Long term support for adherence and persistence
    with osteoporosis treatment
  • Non-pharmacological management including diet and
    exercise

10
Falls and Bone Health in NHS GGC
  • In 2006 the NHS GG Falls and Osteoporosis
    Strategy was launched although work towards
    aspects of this strategy has been ongoing since
    1998.
  • Over a 10 yr period in GGC, there has been a 32
    reduction in admissions due to falls at home and
    a 3.2 reduction in admissions due to hip
    fractures.
  • Taken from NHS GGC Strategy for Osteoporosis and
    Falls Prevention 2006-2010. An evaluation. (2010)

11
The Rehabilitation Framework and HDL (2007)
  • Rehabilitation and Falls HDL (2007) 13
  • NHS Boards need to have a combined falls and bone
    health strategy which CH(C)P will implement
  • CH(C)Ps need to develop an operational falls
    prevention and bone health implementation
    strategy
  • CH(C)Ps need to appoint a falls prevention lead
    or co-ordinator to work along side the
    rehabilitation coordinators
  • Supported by a two year national programme (NHS
    Quality Improvement Scotland)

12
From Improving the health and wellbeing of
people with long term conditions in Scotland. A
national action plan. SG CEL 23 2009
HEAT Targets T10 Reduce rate of attendance at
AE T12 Reduce emergency bed days in people
aged over 65
13
8. NHS Highland Claire Wood (North
Highland) Rhiannon Pitt (South East Hland)
Christine McArthur Mary Wilson(Argyll
Bute) Margaret Moss (Mid Highland)
  • CH(C)P Falls Leads
  • denotes interim lead
  • LA denotes local authority lead

1.NHS Ayrshire Arran Heather Hall
12
2. NHS Borders Elaine Auld
9. NHS Lanarkshire Senga Cree(South
Lanarkshire) Nadia Ait-hocine (South
Lanshire) LA Melinda Shakespeare (Nth
Lanre) LA Rose Letham(North Lanarkshire)
3. NHS Dumfries Galloway Maggie Morrison
Sarah Kirk
11
10. NHS Lothian Roz Eccles (East
Lothian/Midlothian) Lisa Stewart
(Edinburgh) Kirstie Stenhouse (West
Lothian)
4. NHS Fife Norma Hamilton-Dyer (all CHPs)
14
5. NHS Forth Valley Lesley Yarrow
(Stirling) Jean Nelson (Falkirk) Hilary
Fantom (Clackmn)
11. NHS Orkney Lesley Platford
Shauna Stockan
8
6
6. NHS Grampian Shona Strachan
(Aberdeenshire) Anne McKenzie (Moray)
Ruth Scott (Aberdeen City)
12. NHS Shetland Edna Mary Watson
13
7. NHS Greater Glasgow Clyde Margaret
Anderson (Acute and Community) Gerry Dykes
(Renfrewshire) LA Hilary Bell (North
Glasgow) Vacancy (Inverclyde) Christine
Jackson (East Glasgow) Grace Cowan (South
West Glasgow) Mary Angela McKenna (W
Dunbartonshire) Caroline Horn (East
Dunbartonshire) Jill McNeill (South East
Glasgow) Josephine Wight (East Renfrewshire)
Irene Bannerman (West Glasgow)
13. NHS Tayside Angela Millar (Dundee)
Lynne Houston (Angus) Greg Cox (Angus)
Carolyn Wilson (Perth Kinross)
4
5
7
10
9
2
1
14. NHS Western Isles Aline Macauley
3
N
Please note that this diagram is only approximate
for some Board interfaces
14
Up and About Pathways for the Prevention and
Management of Falls and Fragility Fractures
  • A resource to assist
  • in identifying and promoting best practice
  • in identifying gaps in service provision, and
  • planning service improvement.
  • http//fallspathway.nhshealthquality.org


15
Up and About the evidence base
  • National Institute for Clinical Excellence.
    Falls The assessment and prevention of falls in
    older people. Clinical Guideline 21 online.
    2004. Available from http//www.nice.org.uk/Guid
    ance/CG21
  • American Geriatrics Society, British Geriatrics
    Society. Clinical practice guideline for the
    prevention of falls in older persons. 2010.
    Available from http//www.americangeriatrics.org/
    health_care_professionals/clinical_practice/clinic
    al_guidelines_recommendations/2010/
  • British Orthopaedic Association. The care of
    patients with fragility fracture. 2007. Available
    from http//www.nhfd.co.uk/
  • Scottish Intercollegiate Guideline Network.
    Management of osteoporosis. 2003. Available from
  • http//www.sign.ac.uk/pdf/sign71.pdf
  • National Osteoporosis Guideline Group. Guideline
    for the diagnosis and management of osteoporosis.
    2008. Available from http//www.shef.ac.uk/NOGG/N
    OGG_Pocket_Guide_for_Healthcare_Professionals.pdf


16
Up and About Pathways for the Prevention and
Management of Falls and Fragility Fractures
  • Pathways approach
  • Structured and systematic
  • Targeted and timely (with early risk
    identification)
  • Co-ordinated and integrated
  • Integrated falls and bone health
  • Equitable and accessible
  • Evidence-based
  • Person-centred
  • Everybodys business


17
STAGE ONE Supporting health improvement and self
management to reduce the risk of falls and
fragility fractures
STAGE TWO Identifying individuals at high risk
of falls and/or fragility fractures
STAGE THREE Responding to an individual who has
just fallen and requires immediate assistance
STAGE FOUR Co-ordinated management including
specialist assessment
http//fallspathway.nhshealthquality.org
18
Up and About Pathways for the Prevention and
Management of Falls and Fragility Fractures
  • Toolkit, which includes
  • A descriptor for the stage.
  • Key service aims.
  • Key service actions.
  • Professionals, services and agencies involved.
  • Examples from practice in Scotland.

19
National Falls Programme (2009-2011)
Implementing Up and About
  • Mapping, December 2009 identified priorities
  • Stage 2 Case finding
  • Falls prevention telecare network (with JIT)
  • Scottish Ambulance Service Pathways (with SAS)
  • Care Homes Self-assessment Resource (with Care
    Commission)
  • Supporting, standardising and accrediting
    work-based learning (with NHS Education for
    Scotland)
  • Developing a set of quality indicators for falls

20
Falls and the Scottish Ambulance Service
  • SAS responds to circa 111,000 emergency incidents
    per year to over 65 year olds
  • Falls cases 19,000 responses per year or 365
    per week or 52 per day
  • At 17 of total responses - falls cases are the
    largest single presentation in over 65s
  • SAS responds to more falls incidents in over 65s
    than
  • Unconsciousness 11
  • Chest Pain 11
  • Breathing Problems 9
  • Typically circa 15 (3,000) falls cases attended
    by SAS wont be conveyed to hospital

21
National Falls Programme (2009-2011)
Implementing Up and About
  • Mapping, December 2009 identified priorities
  • Stage 2 Case finding
  • Falls prevention telecare network (with JIT)
  • Scottish Ambulance Service Pathways (with SAS)
  • Care Homes Self-assessment Resource (with Care
    Commission)
  • Supporting, standardising and accrediting
    work-based learning (with NHS Education for
    Scotland)
  • Developing a set of quality indicators for falls

22
  • .
  • .
  • .

From Falls and fractures effective
interventions in health and social care (DoH 2009)
23
Thanks to Debbie Wylie, Glasgow Life
24
Thanks to Claire Ritchie, NHS Lanarkshire
25
Thanks to Linda Macpherson, Falkirk Council and
Lesley Yarrow, NHS Forth Valley
26
Falkirk Falls Management Project
27
Thanks to Carolyn Wilson, Perth and Kinross CHP
28
Fracture Liaison Services are operating in a
number of NHS boards.
29
Thanks to Carolyn Wilson, Perth and Kinross CHP
30
Thanks to Kirstie Stenhouse, West Lothian CHCP
31
Taken from NHS GGC Strategy for Osteoporosis and
Falls Prevention 2006-2010. An evaluation. (2010)
32
Everybodys business

Older people Carer (family/friends) Family member
Care Home Manager Care Home Nurse Care Home Carer
Primary Care GP Practice Nurse District
Nurse Pharmacist AHP Healthcare Support
Worker Rehabilitation Practitioner Falls
Specialist Practitioner
Scottish Ambulance Service AE staff Minor Injury
Unit staff NHS 24
Social Worker Care Manager Occupational
Therapist Home Carer
Telecare incl Community Alarm staff Falls
Response Team Out-of-hours service
Secondary Care Doctor, Nurse or AHP Osteoporosis
Specialist Clinician Pharmacist Healthcare
Support Worker Rehabilitation Practitioner Falls
Specialist Practitioner
Sheltered Housing Warden Day Care staff Voluntary
Sector staff
Housing staff Exercise and Leisure service
Administrator
Shared Assessment Assessor
33
  • Questions
  • Is falls and facture prevention and management
    considered as part of long term condition
    management?
  • If yes, how?
  • If no, how could it be?

34
www.fallscommunity.scot.nhs.uk
  • Exchange knowledge, ideas, experience and good
    practice
  • Find useful resources
  • Access pre-programmed
  • searches
  • Find and contact colleagues
  • Discuss topics of interest
  • Keep up to date with news, events and Scottish
    initiatives
  • Access secure shared spaces

35
Thank you for listening
  • Ann Murray
  • Falls Programme Manager
  • Framework for Adult Rehabilitation
  • House 1, Strathlea Resource Centre
  • Holmes Road
  • Kilmarnock KA1 1TR
  •  Mobile 07833 095399
  • Ann.murray3_at_nhs.net
  • www.fallscommunity.scot.nhs.uk
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