This significant reduction in falls is a result of collaborative working from ward areas across the Trust, following its involvement in a programme with NHS Improvement. Part of this work involved changing the documentation used by staff when assessing a newly admitted patient, prompting them to consider any safeguards they might need to put in place for patients who could be at risk of falling.
The Trust set a local target of 98% compliance with completion of falls action plan within 12 hours of admission. Recognising poor cognition, delirium and frailty is vital to good falls prevention.
In February 2019, 98.7% of all patients were assessed within six hours of admission to identify those who were at risk of falling. This is a huge improvement compared with 88.1% in the previous year – evidence that the changes implemented by the Trust really are working.
Carol Bowler, Senior Clinical Practitioner at North Tees and Hartlepool NHS Foundation Trust highlights ‘we want to promote healthy ageing by reducing falls, and we will achieve this by providing tailored care for all patients who are at risk including those who have already suffered a fall injury to ensure they do not fall again.
‘Falling over has a significant impact on a patient, on their mortality, their pain and anxiety, reduces their independence and can lead to long term care in the hospital. It causes suffering to families and staff members too, invoking feelings of distress and guilt. We want to look after our patients the best that we can and putting preventative measures in place is a key part of delivering excellent care. Of course, some patients will still fall despite our best efforts to minimise risk. That’s why we work closely with families using initiatives such as the Johns campaign which enables loved ones to stay during the patient’s time in hospital to alleviate stress and anxiety, both of which are factors in a person falling.’
The new documentation was implemented Trust-wide in December 2018 and it means that every single patient has to go through a cognitive impairment screening with their assigned nurse. Factors such as delirium, dementia, blood pressure both lying and standing are all considered as part of the initial assessment. Staff are looking for indicators such as is the blood pressure dropping when the patient is stood up? Are they on medication that might make them more susceptible to falling?
In January 2019, the Trust set up the Falls Response Team to further support staff and patients within both hospitals. The team involves staff from across the Trust including Clinical Site Managers, Trauma Practitioners, Outreach Nurses and Porters. The role of the response team is to attend to the scene of a reported fall and administer urgent care to the patient using the new hover jack equipment which helps lift all patients who have fallen, including bariatric patients. A quick response is critical in these situations as a frail patient can deteriorate quickly.
This is not just a local priority, it’s something that is being looked at nationally too where it has been identified there is a need for significant improvement. Current evidence suggests that hip fracture is fatal in 20% of cases and permanently disables 50% of those affected, with as few as 30% of patients making a full recovery.
Rowena Dean, Care Group Manager for Collaborative Care at North Tees and Hartlepool NHS Foundation Trust explains ‘ The Trust identified a need for improvement and the team have responded quickly and efficiently, putting a robust process into place that has been piloted and now successfully implemented across the whole Trust. Throughout the project there has been a huge focus on sharing learning and training across the hospital sites to make sure every single patient is better protected. By setting local targets it’s at the forefront of every clinician’s mind when they are treating their patients and, as a result, we have seen a significant reduction in in-patient falls.’