My holidays are here and it's time to dust
off the suitcase and drag out the shorts from the bottom drawer. Like many
British households it's time to jump in the car, fire up the Sat Nav and race to the nearest
seaside resort. What we are presented with is over fifty different options to
get to our destination. Dodge the tolls, keep off the "B" roads and
swerve past the annual village fête. The same is true for the guidance on falls
prevention. There are multiple interventions to apply to patients to reduce falls
with harm but difficult to know what direction to take. So what advice should
we all be following?
The latest Cochrane review on "Interventions for preventing falls
in older people" tells us that there is a vast sea of uncertainty
around interventions for falls. The report found that there was
uncertainty around the effect of additional physiotherapy, questions around the
effect of bed sensor alarms and that multifactorial interventions may
reduce rate of falls, but it was difficult to say whether this had an impact on the risk of falling. I'm more certain that it will be a sunny day
in Britain in June than researchers are on the evidence for the prevention
of falls.
So then what is there left to do? Well, falls
represent a huge cost to NHS hospitals and the wider healthcare system, with
annual total costs to the NHS alone from falls among older people estimated by
the National Institute for Health and Care Excellence (NICE) at £2.3 billion. Falls can cause physical
harm to patients resulting in prolonged hospital stays, complaints and
sometimes litigation but can also cause psychological distress with patients
fearing further falls. Clearly action needs to be taken and in Scotland they
have just launched a new consultation paper looking at the "
A recent article in the HSJ told a very moving and difficult to read story about the poor care an elderly relative received whilst being treated for a fall at home. This is really
disappointing, and unfortunately is not an uncommon story in the NHS. So
clearly there is something that needs to be done about the prevention and treatment
of falls in our hospitals. These wider strategies need to be translated down to
the granularity of the daily working lives of nurses, doctors, physios and the
teams on the front lines caring for patients. We need to breakdown these overarching
policy documents into something that can be realistically achieved on the ward
and intertwined with improvement methodology that wards can manage.
There are heaps of interventions that wards
can implement and then locally study the impact of their interventions. The
issue that policy has is that there is not a one size fits all cure for improving
falls with harm. There is too much local variance for a national improvement
ideas to work across the NHS. The optimal bundle of components is not
established, but common components include risk assessments for patients,
patient and staff education, bedside signs and wristband alerts, footwear
advice, scheduled and supervised toileting, and a medication review. Guidance
produced by the National Institute for Health and Care Excellence encourages
the participation of older people in falls prevention programmes and falls
present a perfect opportunity for wards to involve patients in improvement work.
Both patients and staff respond positively to education being delivered on
their wards and raising awareness can empower staff and patients to work as a
team to address falls prevention on hospital wards.
Preventing falls in patients can only be
achieved through strong engaged clinical leadership. Going forward we will need to empower the whole multidisciplinary team to make improvement to their own environments and senior
mangers to help build a climate for improvement to thrive. Teams must feel able
to take ownership of delivering improvement work but be provided with the support of the organisation. By working with
patients, teams can begin to develop customised falls bundles to their patient
demographics and make recommendations to improve falls in their areas.