FallSafe Care Bundle Application across 3 Trusts in the North East region

Overview summary

This two phase project led by The Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) who worked collaboratively with South Tees Hospitals NHS Foundation Trust and County Durham and Darlington Hospitals NHS Foundation Trust involved:

  1. A regional multicentre improvement programme to standardise the application of the Royal College of Physicians (RCP) FallSafe Care Bundle to support the testing of falls prevention interventions commonly used within the acute trust setting
  2. A further roll out to 13 wards in the Directorate of Medicine and Care of the Elderly within NUTH

By implementing a standardised care bundle nationally, the RCP FallSafe project reduced falls by 20%. These projects aimed to replicate the methodology used in FallSafe but the same level of reduction in falls was not expected due to the Trusts involved already reporting a reduction in falls prior to the projects commencing.

Challenge/problem identified

A fall in hospital can be devastating. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and increased morbidity and mortality. Falling also affects family members and carers of people who fall, and has an impact on quality of life, health and social care costs.

Falls are the most commonly reported patient safety incident in NHS Trusts in England. 5% of falls at home result in fractures. Overall, falls cost the NHS more than £2.3 billion per year (source – NICE 2013). The Royal College of Physicians (RCP) FallSafe Care Bundle is a set of guidelines for preventing falls within hospitals. Project I aimed to embed the RCP FallSafe Care bundle across 13 wards within 3 regional trusts.

Project II expanded the reach to include all wards across the Directorate of Medicine and Care of the Elderly (a total of 13 wards) within NUTH.

“Two elderly patients a week die in hospital falls as reports show they attempt to stand up but can’t weight bear.” National Patient Safety Agency (NPSA)

 Overview of Innovation

The RCP FallSafe care bundle recommended core elements of a care bundle to be included for all patients and then additional elements for patients aged 65 years and over. The project falls care bundle therefore incorporated these core elements across all 3 sites.

Actions taken

  • Used evidence to support increased implementation of the FallSafe Care Bundle as recognised by the RCP
  • Implemented leadership and cultural change across organisations to alter the prevailing culture that ‘inpatient falls are inevitable’ to ‘falls are preventable’
  • worked collaboratively, sharing data, learning and improvement stories of each organisation, as part of the alignment to the NE Regional Falls Task Group, and the Sign up to Safety campaign
  • delivered transparency of data, with all participating Trusts collecting and submitting and monitoring a core data set
  • standardised the criteria on who is assessed (e.g. all adult in-patients, patients 65 years old and over) and when (e.g. on admission, on transfer, post fall etc.)
  • ensured all Trusts met a standard reporting criteria of ‘what is a fall?’ and reported bed days in a standard format so that comparisons of falls and harm/1000 bed days was accurate
  • identified the current elements in each Trust’s falls care bundle to ensure they all complied with a standard care bundle (FallSafe)
  • identified a falls prevention intervention to be implemented and tested for reliability in preventing fall

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.” Berwick Report, August 2013

Outcome/Impact

The results show a marked increase in the number of patients across all 3 Trusts involved between the initial (pre introducing the bundle)and final (post introducing the bundle) audits, on average there was a:

  • 44% increase in patients who received all elements of the FallSafe Care Bundle
  • 35% increase in patients who had lying and standing blood pressure (L&S BP) measured
  • 18% increase in patients who received a cognitive assessment
  • 17% increase in patients who received a medication review

High rates of compliance against the care bundle are difficult to achieve and sustain as there are so many elements of the care bundle.

 

Benefit

By implementing the bundle patients receive a better standard of care; all elements which may contribute to a fall are considered and altered if necessary, in time this is highly likely to lead to a reduction in the number of falls.

This benefits the NHS by ensuring the safety of patients, reduces bed days which in turn has cost saving implications.

Support provided by AHSN

Funding was secured from the Academic Health Science Network for the North East and North Cumbria (AHSN NENC) to expand the FallSafe project across 13 wards in the Directorate of Medicine and Care of the Elderly within NUTH, this became Project II.

Plans for the future/Spread and adoption

  • Explore other sources of further funding to continue and expand the project to other wards and hospitals within the region.
  • A priority is to continue the collaborative working regionally and potentially expand this programme nationally.
  • Assist in the development of National best practice guidelines

Contact Details

NHS:      Rachel Carter, Falls Prevention Coordinator, Rachel.carter@nuth.nhs.uk

AHSN:   Donna Smith, Comms Team, AHSN NENC donna.smith@ahsn-nenc.org.uk

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