final 5.4 falls prevention - nhshighland.scot.nhs.uk · improvement scotland pathway “up and...

Highland NHS Board7 February 2012

Item 5.4PREVENTION OF FALLS

Report by Judith Catherwood, Associate Director of AHPs and Christine McArthur,Prevention and Management of Falls Co-ordinator on behalf of Heidi May, Board NurseDirector

The Board is asked to:

Note the progress in implementation of the community pathway for the preventionof falls in NHS Highland.

Note the progress in a number of work streams in the in-patient setting to reduceincidents of falls and harm due to falls in the hospital setting.

Note the QOF 2012/13 which will standardise prescribing practice for those withosteoporosis and/or post fracture secondary prevention

Endorse the development of training and education in falls prevention and supportit as mandatory training requirement for staff working directly with older people andothers at risk of falling.

Note the progress of the national work streams in relation to falls in particular theSelf Assessment Resource for Care Homes.

1 Background and Summary

The NHS Highland Falls Prevention and Bone Health Strategy, 2009 was endorsed by NHSHighland Senior Management Team on 27.01.10 and was approved by Argyll and ButeCouncil and Highland Council. The Strategy supports the implementation of the NHS QualityImprovement Scotland pathway “Up and About” (2009). In comparison to other NHS Boards,NHS Highland was a late implementer in developing and approving a Strategy for Preventionand Management of Falls and Fragility Fractures. Earlier attempts to develop a strategywhich could be implemented had not been successful. Limited resources were available onwhich to support implementation which posed NHS Highland and partners a challenge;however since January 2010, significant progress has been made. The main part of thispaper reporting on progress is presented in 4 sections.

The first section covers progress made in the community setting with the development of aNHS Highland community pathway. This provides equity of service across the board area toensure better, local and faster access to health care and to sustain and improve the health ofpeople in our communities. The lack of urgent care pathways to address the issues of fallsand frailty is highlighted and it is anticipated that the QOF proactive management ‘ReducingEmergency Admissions Pathway for Falls’ will further raise awareness around this issue.

In addition partnership activities with Public Health colleagues through a population basedapproach will encourage active ageing in NHS Highland. Falls and fall-related injuries amongolder people are major issues for health and social care providers because of the increase inlife expectancy of the UK population during the 21st century. Local people and communitieswill be offered opportunities to participate in activities to identify and reduce their risk of fallsand to improve their health. The Change Fund has provided an opportunity to target someresources specifically within operating areas.

In the second section in-patient falls are considered and this paper highlights the increasingfocus on falls as part of the planned inspections of the Standards of Care of Older People inAcute Care however we seek to ensure this improvement work is undertaken in all of ourhospitals.

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The third section highlights the progress being made in education and training and theimportance of falls being mandatory training for staff to ensure quality in service provision.The fourth section in the main part of the paper provides a brief update on the nationalprogramme.

2 Progress Report on Strategy Implementation

Community ReportThe high-costs associated with injurious falls, unscheduled care and ongoing health andsocial care costs are well recognised and in NHSH the total cost to health and social careservices of hip fractures passing through Raigmore alone in 2009 was estimated at£11,360,0001. The NHS Highland Falls Prevention Strategy identifies that while specialistfalls prevention services were available in 2009 they had grown opportunistically and in anuncoordinated manner, mainly in centres of larger population. In remote and rural areasservices were absent and owing to the difficulties inherent in providing services to a widelydispersed and sparse population, it can be accepted that the Executive Lead for falls faced asignificant challenge to ensure provision of equitable service across NHS Highland. It wasnecessary to take an entirely new approach where falls and falls prevention are not seen asspecialities but as core business and a part of everyone’s role. Designed to address thesegeographical challenges, a community pathway has been developed to ensure evidencebased measures for effective assessment; treatment and rehabilitation are able to bedelivered equitably across the board area. This pathway is entirely consistent with thedeveloping national falls workstream.

In NHS Highland the community pathway has been disseminated and local falls championshave taken the work forward in early implementer sites. The pathway is being embeddedwithin existing services and in North Highland, as part of reablement service development.The pathway uses multi factorial screening as an approach to identify and minimize falls riskin an individual and can take place in their own home or any health or social care setting.Importantly the generic multifactorial screening tool can be used by different levels of staffincluding support workers (after training and with support) and can be used by all communitystaff in contact with older people at risk of falls. This approach seeks to ensure theprevention of falls is ‘everyone’s business’. The reliance on champions has resulted invariation in implementation success, where in some localities the pathway has swiftly movedinto practice whereas in other areas the pathway is not yet fully implemented. A significantorganisational driver in the implementation of the community falls prevention pathway, isnoted in the Quality and Outcome Framework (QOF) pathway for proactive management‘Reducing Emergency Admissions Pathway for Falls’. The use of measurement to monitorand improve the quality and effectiveness of services is important and national measures arebeing introduced across Scotland as part of the national workstream. When this system ofmeasurement is implemented in Highland this will demonstrate where the pathway is in placeand where there are gaps. This data set is in development and will inform improvement.

Urgent Care Pathway FallsScoping around an urgent care pathway to reduce unscheduled admissions due to falls wasundertaken in 2011 by the NHSH falls prevention co-ordinator. A fall is often closely relatedto frailty and key markers of frailty during emergency response are the presence of confusionor a history of recent falls and/or blackouts and /or loss of mobility. Currently SAS are undera duty of care to convey frail older people to hospital if they considered it unsafe to leavethem at home. Redesign and integration of current services to provide a proactive integratedcare management approach to keep those at risk of emergency admission to hospital in theirown homes is urgently required. Unless this is successfully established the current defaultposition is that the person will continue to be conveyed to hospital.

1NHS HIGHLAND FALLS PREVENTION AND BONE HEALTH STRATEGY 2009, p. 5.

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A National Reshaping Care for Older People Task and Finish Group is developingrecommendations around this agenda and these will be available in June 2012. It isanticipated that robust out of hours services with a rapid response time will be required toassure SAS that people can safely remain at home. In North Highland the implementation ofreablement provides a vehicle to address the deficits in community support systems to allowan alternative to hospital admission to be put in place. To co-ordinate an immediate responseto crisis situations to prevent unscheduled hospital admissions the potential of the HighlandHub as a Single Point of Access or local Single Points of Access in different localitiesrequires to be explored.

Bone HealthThe Board is asked to note that progression of the bone health element of the strategy hasbeen made and that recommendations are that this work is commissioned to ADTC. Earlywork has indicated there is a need to standardise prescribing practice for those withosteoporosis and/or patients in post fracture care pathways. Osteoporosis is a DES (directedenhanced service) in Scotland at the present time but will become a QOF for all GPs in2012/13 and as a result NHSH GP’s will follow the National Guidance. This may result in anincreased demand for DEXA scan for those between 54-74 and increased prescription ofbone sparing medications but should ultimately result in a decrease in fragility fracturesthereby making savings.

Population based approachEffective health promotion can increase awareness around the preventable nature of falls.Taking a population based approach to encourage active ageing and self management as anupstream alternative will reduce falls in the population. Older people and their families andcarers, need to know about measures that prevent falls and how to access the services thatcan help to reduce their risk. National research by Age UK indicated that only 44 per cent ofpeople over 65 are aware that certain exercises prevent falls however research evidenceindicates that specific programmes for improving strength and balance can reduce the risk offalls by as much as 55 per cent2. Across Highland a concerted effort is being made to raiseawareness in our communities through our health and social care providers and events suchas National Falls Awareness Week (NFAW). These annual events see NHSH practitionerswork with community members, the third sector and our partners from Age Scotland to raiseawareness of modifiable falls risks. The development of a community educational resource isplanned in Argyll and Bute with the ambition to engage third sector partners in raisingawareness with communities. This will be available across Highland if it proves successful.

In-patient Report

The most common patient safety incident reported in hospitals in the NHS is a fall,comprising a third of all patient safety incidents in acute hospitals and two-thirds of those incommunity hospitals3. NHS Highland Datix recorded 2693 falls incidents representing 27% ofall recorded incidents in 2010-11 (Appendix 1). With a frail elderly population those admittedto hospital are often those at highest risk of falls and the National Patient Safety Agency(NPSA) note the ‘very real challenge in reducing levels of harm without compromising thedignity and independence of patients’. Falls are a focus of the planned inspections of theStandards of Care of Older People in Acute Care. Self assessment by Boards of theircurrent standards of care and the application of evidence based measures are a requiredimprovement activity which must be demonstrated. Actions most likely to reduce the risk offalls and injury must be consistently and reliably implemented in our hospitals. In NHSHighland a preparatory resource pack has been developed to enable staff to identify specificissues on their ward and to produce a falls reduction action plan. This resource has beentargeted initially (with support of the Lead Nurse and Lead AHP in each CHP) to areas withthe highest falls rates. The resource uses improvement methodologies and will be available

2Logan et al., 2010

3 National Reporting and Learning Service, 2010

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to download from the intranet. To support this work online data has been developed byClinical Governance and is available on the intranet for all wards. To allow comparisonbetween sites, falls rates per 1000 Occupied Bed Days (OBD’s) have been used. This allowsus to demonstrate where the highest rates of falls are occurring and wards are encouragedto monitor their falls rates and seek improvement.

Raigmore had a total of 724 slip, trips and falls last year and as part of the SPSP a 90 dayimprovement target has been set in Raigmore to reduce falls rates by 50% in one ward. Thisis a deliberately ambitious target as the NPSA suggest multifaceted targeted interventionscan reduce falls by 18 per cent. Initial results are very positive.

Education and training Staff need to be aware of evidence based measures to reduce fallsand apply this knowledge consistently. Falls training should be mandatory for all staff incontact with older people and other patient groups at risk of falls and will be available onlinethrough LearnPro in NHS Highland in 2012. Targets will be set to guide operating areas onthe implementation of this training.

National Programme A work stream is underway to test a set of falls prevention and management quality

measures from Wales (Appendix 2). A test site is underway in Fife and the NHSHighland Falls Prevention Co-ordinator is contributing actively to the national workstream. Information Services Division (ISD) NHS Scotland will be providing national, NHSboard and CHP data relating to falls and fractures on a regular basis to support this work.Economic modelling by a healthcare economist is also part of the work stream and thisinformation will be available for NHSH. The national data set in development will beutilised in NHS Highland and it is currently being introduced in Argyll and Bute throughthe Change Fund to collate data for measurement and improvement.

The Self Assessment resource for care homes was distributed by the Care Inspectorateand their follow up audit will determine the use of the resource. It is anticipated thatsupport from NHS Highland will be required in some areas to ensure Care Homes meetthese standards.

Summary of key improvements and aims for NHS Highland A new approach where ‘falls are everyones business’ Equitable service across Highland with the availability of multifactorial screening Increasing focus on anticipatory care approaches to raise awareness and

engagement in our communities with a plan to develop educational communityresources

Mandatory requirement for staff to complete falls awareness training through theNHSH Learnpro module

The identification of need for an urgent care pathway to prevent unscheduledadmissions by identifying falls and frailty at contact and responding urgently to keeppeople at home and to use reablement approaches

Improvement work targeted to wards with high falls rates to prepare for theinspections on standards of care for older people

The development of a robust data set for in-patient falls available on the intranet forstaff to inform ward falls reduction plans and targets. Further work is required toensure adequate corporate reporting and monitoring requirements are in place andwill be progressed.

Progress is being made in all these areas, however embedding of changes in practice arestill be progressed in operational areas and this is still being completed.

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Key Challenges and Risks Staff do not engage with the community pathway seeing it as ‘someone else’s job’ Staff require to be supported to deliver their public health role in supporting self

management and this needs to be reinforced in job planning processes withinoperational units.

Competing agendas divert staff from the falls agenda Lack of time to complete training and advance knowledge Lack of capacity with sparse coverage or absence of AHP’s in rural areas Single point of access does not presently exist/services are difficult to create in some

areas Poor referral routes and communication between services GP’s/ SAS / A&E with the

unscheduled admissions continuing and increasing as the population ages Inpatient resources are not used effectively due to lack of awareness and support

3 Contribution to Board Objectives

The approaches outlined above in this paper clearly align with the objectives of the strategicdirection and vision of the Board. Consistency of approach through the falls pathwayensures equity across the Board area and will mean that health need can be met as thebalance of need and resource becomes tighter. The approach taken to address falls risk isentirely consistent with the characteristics of service delivery outlined by the Board inparticular

1. promoting good health, self care and independence2. high quality, integrated, equitable, needs and evidence-based, and cost-effective3. increasingly community-based4. integrated with, and complementary to, local authority, voluntary and independent

sector care5. run by healthy, well-motivated and well-trained staff working to their maximum

potential and capability

4 Governance Implications

Staff Governance – prevention of falls is a key objective for all NHS Highland and hasimplications for all staff in their interaction with older people. An emphasis on prevention offalls as ‘core business’ raises issues of training and education. The evidence-practice gap inprevention of falls is well recognised and a consistent approach is required to ensure all staffaccess training to increase their knowledge and competence through the Learnpro module.Patient and Public Involvement – National Fall Awareness Week (NFAW) takes placeannually with resources and support from Age Scotland. Our commitment to publicengagement is demonstrated in the many events that took place across Highland in 2011with NHSH practitioners engaging local people to hold local events for older people to raiseawareness about prevention of falls in our communities.Clinical Governance – the Board has a demonstrated commitment to improving quality andpatient safety and prevention of falls is key to this. The increase in the older population isproducing particular demographic challenges in relation to falls and to address this balanceof care is shifting to anticipatory proactive approaches to facilitate self efficacy andindependence in line with our strategy. We are seeking to ensure reliable data is available toinform all of our work around prevention of falls and that evidence based practice is beingused across the board area.Financial Impact – Falls are a significant economic burden on society with a daily cost to thehealth service of £4.6 million4. In NHSH the costs are demonstrated through our OccupiedBed Days (OBD’s). The report included with this paper for 2009/2010 shows a total of OBD’sdue to falls of 19145 for Highland (this data excludes Argyll and Bute but a complete data set

4Royal College of Physicians, 2010

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will be in place by end of January 2012) with an associated cost of £5,211,827 (see tab costpivot in data supplied Appendix 3) more recent costings are being prepared and includeArgyll and Bute. In addition, as mentioned previously, the cost of the hip fractures goingthrough Raigmore in one year is in the region of £11,360, 000 in costs to health and socialcare. Care of older people accounts for 40% of the health service and 60% of the social workbudget in Scotland5 and hip fractures cost £1.7 billion to the NHS annually. Human costs areapparent with 14,000 deaths per year following hip fracture6. The board is requested toprovide ongoing support to redirect the activity of our clinicians to preventative, anticipatoryapproaches rather than reactive care. Prevention of falls should be seen as core businessfor health and social care. Cultural changes are necessary and board support is crucial tohighlight the importance of the community falls prevention pathway to implement it effectivelyto reduce variation and ensure evidenced based practice is available. In NHSH we haveallocated additional resources to address the challenge of prevention of falls through theChange Fund. The Falls Lead for the Board will continue to be resourced to support thetranslation of the research evidence base into practice. Consideration is being given todeveloping this role into an AHP Falls Consultant role.

5 Impact Assessment

EQIA is not necessary as this paper is a progress report following an earlier Board paper thatdid contain EQIA recommendations.

Judith CatherwoodAssociate Director of AHPs

Christine McArthurPrevention and Management of Falls Co-ordinator

27 January 2012

5National Framework for Service Change in the NHS: Scottish Executive, 2005

6Older People’s Experiences of Falls and Bone Health Services (England), Royal College of

Physicians, 2008

Slips, Trips and Falls

INCIDENT REPORT

QUARTER 4 January to March 2011

Clinical Governance Support Team Page 2 of 14 February 2011

1. SUMMARY - Year End – 01/04/2010 to 31/03/2011Please note that this report provides data and analysis for all incidents recorded onDatix not just those which have been finally approved. Those incidents which have notyet been graded may be still awaiting final approval and review.

Highlandwide

1.1 During the period of 1 April 2010 to 31 March 2011 a total of 9946 incidents and nearmisses were recorded. Of the 9946 incidents a total 5 were graded very high (0.05%), 112 (1.13%) were graded high, 3739 (37.6%) were graded medium and 5876 (59%)were graded low. A total of 214 (2.1%) incidents have not yet been graded.

1.2 The following table shows the status of these incidents:

Awaiting final approval 538

Being reviewed 117

Finally approved 9166

In holding area, awaiting review 125

Grand Total 9946

The top 5 categories of incidents for NHS Highland for the year are noted as:

Slips trips and fall – 2693 (27%) Disruptive, violent and aggressive behaviour – 1850 (19%) Medication – 851(8%) Accident – 506 (5%) Absconder/Missing Patient –350 (4%)

2. SUMMARY – Quarter 4

Highlandwide

1. During the period of 1 January 2010 to 31 March 2011 a total of 2618 incidents andnear misses were recorded. Of the 2618 incidents a total of 2436 incidents weregraded as follows, 2 were graded very high (0.08%) , 27 (1%) were graded high, 960(36%) were graded medium and 1447 (55%) were graded low. A total of 182 (7%)incidents have not yet been graded.

2. The following table shows the status of these incidents:

Awaiting final approval 462

Being reviewed 104

Finally approved 1931

In holding area, awaiting review 121

Grand Total 2618

The top 5 categories of incidents for NHS Highland for Quarter 4 are noted as:

Slips trips and fall – 733 (28%) Disruptive, violent and aggressive behaviour – 486 (19%) Medication – 199 (8%) Accident – 150 (6%) Tissue Viability –145 (6%)


3. HIGHLANDWIDE INCIDENT AND NEAR MISS DATA – Quarter 4 and Year End

Grade and Unit of Incidents and Near MissesQuarter 4

GradeArgyll &

ButeMid North

SouthEast

Raigmore OtherQuarter 4

LOW 304 132 204 309 446 52 1447

MEDIUM 192 117 77 214 345 15 960

HIGH 4 3 1 11 4 4 27

Very High 0 1 0 0 1 0 2

NotGraded

49 26 18 11 71 7 182

Total 549 279 300 545 867 78 2618

April 2010 – March 2011

GradeArgyll &

ButeMid North

SouthEast

Raigmore Other

1 April2010 – 31

March2011

LOW 1347 566 831 1145 1769 154 5876

MEDIUM 767 455 303 763 1336 99 3739

HIGH 23 9 3 29 43 5 112

Very High 0 2 0 0 3 0 5

NotGraded

51 33 20 18 80 12 214

Total 2188 1065 1157 1955 3231 270 9946

Incidents by Quarter and Grade

1447

960

27 2

182

1517

917

22 2 17

934

331 4

928

30 0 11

1509

1403

0

200

400

600

800

1000

1200

1400

1600

Low Medium High Very High Not Graded

Quarter 4 Quarter 3 Quarter 2 Quarter 1


4. HIGHLANDWIDE – TOP 5 CATEGORY AND GRADE OF INCIDENTS Quarter 4 and Year end

Top 5 Categories of Incidents for Quarter 4

Category LOW MEDIUM HIGHVeryhigh

NotGraded

Quarter 4Januaryto March

2011

Slips, Trips & Falls 490 204 4 0 35 733 (28%)Disruptive, Violent, AggressiveBehaviour 253 206 8

019 486 (18%)

Medication (including vaccines) 123 61 0 0 15 199 (7%)

Accident 87 43 5 1 14 150 (6%)

Tissue Viability 37 94 1 0 13 145 (6%)

Top 5 Categories of Incidents for period April 2010 – March 2011

Category LOW MEDIUM HIGHVeryhigh

NotGraded

Total

Slips, Trips & Falls 1893 756 70

372693

(27%)Disruptive, Violent, AggressiveBehaviour 969 817 43

021

1850(18%)

Medication (including vaccines) 586 248 20

15851

(8.5%)

Accident 294 184 6 1 21 506 (5%)

Absconder/Missing Patient 194 143 7 0 6350

(3.5%)


RAIGMOREA total of 216 incidents/near misses were categorised as slips, trips and falls during quarter 4, and a total of724 slip, trips and falls for the year.Subcategory of Slips, Trips & FallsThe following table displays the subcategory of the slips trips and falls.

Sub categoryQuarter 1

Apr to Jun 2010Quarter 2 July –

Sept 2010Quarter 3

Oct to Dec 2010Quarter 4 Jan to

Mar 2011

Fall from a height, bed or chair 75 (46%) 85 (48.3%) 73 (44%) 91 (42%)Fall on level ground 71 (43.6%) 70 (39.8%) 63 (38%) 89 (41%Slips on ice or snow - - 3 (2%) 4 (2%)

Suspected fall 13 (8%) 15 (8.5%) 22 (13%) 24 (11%)Tripped over an object 3 (1.8%) 5 (2.8%) 6 (4%) 4 (2%)

No subcategory 1 (0.6%) - - 4 (2%)

Grand Total 163 177 167 216

Injuries Relating to Slips, Trips and FallsThe following tables shows the injuries recorded in relation to slips, trips and falls. This has beenseparated out to show patient and staff injuries.

Injury PATIENTS STAFFQuarter 4

1 Jan to 31 Mar 2010

Not recorded 7 4 10 (14%)

Abrasion (inc scratches) 22 1 23 (31.1%)

Bruise/Swelling 12 2 14 (19%)

Laceration 16 0 16 (22%)

Multiple Injuries 1 0 1 (1.4%)

Other 2 0 2 (2.8%)

Pain only (no obviousinjury) 9

0 9 (12.2%)

Fracture 0 1 1 (1.4%)

Total 66 8 74


SE CHP

A total of 167 incidents were categorised as slips, trips and falls during the period of 1 January to 31 March 2011 anda total of 497 for the year 2010/11


Apr to Jun 2010Quarter 2 July –

Sept 2010Quarter 3


Mar 2011

Fall from a height, bed or chair 24 (20%) 37 (38%) 35 (32%%) 48 (29%)

Fall on level ground 84 (68%) 48 (49%) 62 (56%) 100 (61%)

Slips on ice or snow - - 1 (1%) -

Suspected fall 11 (9%) 10 (10%) 10 (9%) 16 (10%)

Tripped over an object 3 (2%) 2 (2%) 2 (2%) 1 (1%)

No category selected - - 2

Grand Total 122 97 111 167

Injuries Relating to Slips, Trips and FallsThe following tables shows the injuries recorded in relation to slips, trips and falls. 50 of the 167incidents resulted in injury.


1 Jan to 31 Mar2010

Abrasion (inc scratches) 13 0 13 (26%)


Fracture 2 0 2 (4%)


Other 2 1 3 (6%)

Pain only (no obviousinjury) 10

0 10 (20%)

Total 47 3 50


NORTH

A total of 125 incidents/near misses were categorised as slips, trips and falls during quarter 4, and a total of472 for the whole year.Subcategory of Slips, Trips & FallsThe following table displays the subcategory of the slips trips and falls.


Apr to June 2010Quarter 2

July to Sept 2010Quarter 3


Mar 2011

Fall from a height, bed or chair 55 (46.2%) 45 (42.5%) 38 (37.6%) 57 (42.2%)

Fall on level ground 56 (47.1%) 50 (46%) 54 (52.5%) 62 (45.9%)

Slips on ice or snow 0 0 0 4 (3%)

Suspected fall 5 (4.2%) 10 (9.2%) 9 (8.9%) 11 (8.1%)

Tripped over an object 3 (2.5%) 3 (3%) 0 1 (0.7%)

Grand Total 119 108 120 125

Injuries Relating to Slips, Trips and FallsThe following tables shows the injuries recorded in relation to slips, trips and falls. 35 of the 125incidents resulted in injury however only 28 actual injuries were recorded.


1 Jan to 31 Mar2010



Pain only (no obviousinjury)

21

3 (11%)

Fracture 1 0 1 (4%)


Musculoskeletal Injuries 1 0 1 (4%)

Total 23 5 28

MID CHP


A total of 95 incidents/near misses were categorised as slips, trips and falls during quarter 4 and a total of 339for the year 2010/11.Subcategory of Slips, Trips & FallsThe following table displays the subcategory of the slips trips and falls.


Apr to Jun 2010Quarter 2 July toSeptember 2010

Quarter 3-Oct toDecember 2010

Quarter 4 Jan toMar 2011

Fall from a height, bed or chair 31 (40.3%) 24 (32%) 26 (28%) 30 (31%)Fall on level ground 36 (4.7%) 41 (54.6%) 51 (16%) 59 (63%)Slips on ice or snow - - 2 (2%) 1 (1%)

Suspected slip, trip or fall 7 (42.5%) 9 (12%) 9 (10%) 4 (4%)Tripped over an object 2 (2.6%) 1 (1.3%) 4 (4%) 1 (1%)

No subcategory 1 (1.3%) - -

Grand Total 77 75 92 95

Injuries Relating to Slips, Trips and Falls

The following tables shows the injuries recorded in relation to slips, trips and falls. This has beenseparated out to show patient and staff injuries. 2 of the 34 incidents resulting in injury did not havethe injury recorded, therefore the following table relates to the remaining 34.



Abrasion (inc scratches) 10 10 (29%)


Death 1 1 (3%)

Laceration 5 5 (15%)

Musculoskeletal Injuries 1 1 (3%)

Pain only 4 4 (12%)

Sprain/Strain 0 1 1 (3%)

Other 2 2 (6%)

Grand Total 32 2 34


ARGYLL and BUTEA total of 162 (32.1%) incidents/near misses were categorised as slips, trips and falls during 1 October to 31 December2010.Subcategory of Slips, Trips & FallsThe following table displays the subcategory of the slips trips and falls.


Apr to Jun 2010Quarter 2 July to

Sept 2010Quarter 3


Mar 2011

Fall from a height, bed or chair 62 (35.2%) 45 (25.9%) 54 (32%) 50 (41%)Fall on level ground 95 (53.4%) 99 (56.9%) 83 (49%) 61 (50%)Slips on ice or snow - - 2 (1%) 1 (1%)

Suspected fall 17 (9.7%) 26 (14.9%) 26 (15%) 8 (7%)Tripped over an object 1 (0.6%) 4 (2.3%) 3 (2%) 1 (1%)

No subcategory 2 (1.2%) - 2 (2%)

Grand Total 177 174 168 123

Injuries Relating to Slips, Trips and FallsThe following tables shows the injuries recorded in relation to slips, trips and falls. This has beenseparated out to show patient and staff injuries.



No subcategory recorded 2 0 2 (6%)




Fracture 0 1 1 (3%)

Spring/Strain 0 1 1 (3%)

Total 33 3 36

Data per Hospital per ward recorded

Slips, Trips and Falls per ward – Quarter 4 Raigmore

Raigmore Hospital by ward – Quarter 4 Total

A & E 4

Acute Medical Admission Assessment Unit 8

Audiology Department

Cafe/Shop/Tea Room 2

Car Park 2

Children's Ward 1

Coronary Care Unit 1

Corridor / Stairwell / Lift 1

Grounds 1

Highland Heartbeat Centre 1

Kitchen 1

Location not listed 1

MacMillan Suite 1

Renal Unit 1

Surgical High Dependency Unit 2

Ward 11 11

Ward 2A 15

Ward 2C 2

Ward 3A 20

Ward 3B 2

Ward 3C 9

Ward 4A 2

Ward 4C 11

Ward 5A 67

Ward 5C 8

Ward 6C 10

Ward 7C 27

Ward 8 1

Not recorded 4

Grand Total 216


Quarter 4 – North CHP

Location/Hospital Migdale Hospital Lawson Memorial Lawson Memorial - Cambusavie Unit Dunbar Hospital Caithness General Town and County

Bignold Wing 7

Car Park 1 1


Day Case Unit 1

Dining Room 1

Female Ward 1 10

Harmsworth Ward 19

Location not listed 1 2

Lower Floor 3

Male Ward 1 2

Newton Ward 8

Outpatients Department 1

Patient's Home 1 1

Queen Elizabeth Wing 22

Renal Unit 1

Rosebank Wing 17

Speech & Language Therapy

Upper Floor 10

Ward 11

Total 13 4 12 17 49 29Quarter 4 – Mid CHP

Location/Hospital Aultbea Surgery Ferguson Med Centre MacKinnon Memorial Ross Memorial Belford Hospital Invergordon Community Hosp Portree Hospital

A & E 1

Belhaven Ward 4

Combined Assessment Unit 5

Entrance / main reception 1

Fyrish Ward 12

General Ward 6 6

Glamaig Ward 11

Health Centre / Practice / Base 1

Marsco Ward 4

Patient's Home 1 1

Rheumatology Unit 1

Step Down Ward 6

Sutor Ward 34

Total 1 1 6 7 16 48 15


Quarter 4 - SE CHP

Location/Hospital Ian Charles Hospital New Craigs RNI St Vincents Hospital Nairn Town and County Hospital John Dewar Building

Clava Ward 19

Community 1


Day Hospital 4 1

Findlay 1

Greenfields House 1

Grigor 2

Gynack Ward 29

Heather 4

Lynwilg Ward 4

Mackintosh 1

Maree Ward 2

Morar Ward 3

Noble 1

Office / Base 1

Ramsay 2

Rowan 5

Ruthven Ward 2

Thistle 8

Torvean Ward 1

Ward 11

Ward (all areas) 2

Ward 1 33

Ward 2 24

Willows Ward 2

Total recorded 12 30 62 33 27 1


Quarter 4 – Argyll and Bute

Location/Hospital Helensburgh Med Centre A&B Hospital Rothesay Victoria Hospital Annexe Campbeltown hospital Cowal Community Hospital

A & E

Acute Unit 3

Bengullion Ward 6

Car Park 1

Cara Ward

Community 1

Community Building

Corridor / Stairwell / Lift

Cowal Ward 8

Day Room 1

Glenaray Ward

Knapdale Ward

MFTE Ward 9

Office / Base

Patient's Home 1

Ward 1 Female 9

Ward 2 Male 8

Ward A

Ward B

Ward C (Inc Day Bed Unit)

Ward E

Total recorded 1 8 10 9 19


CONTINUED A&B Q4

Bowmore Hospital Mid Argyll Community Hospital Dunaros Hospital Lorn and Islands General Hospital Victoria Integrated Care Centre

A & E 1

Acute Unit 10 3

Bengullion Ward

Car Park 1

Cara Ward 5

Community

Community Building 1


Cowal Ward

Day Room

Glenaray Ward 14

Knapdale Ward 2

MFTE Ward

Office / Base

Patient's Home 1

Ward 1 Female

Ward 2 Male

Ward A 5

Ward B 7

Ward C (Inc Day Bed Unit) 1

Ward E 22

Total Recorded 11 21 3 38 1

Appendix 2

The National Falls Programme

Implementation of care bundles to prevent falls and fractures in the community

National benchmarking activities and discussions with Falls Leads have identified three priorityareas for falls prevention in Scotland:

The consistent delivery of evidence-based practice. The continued development of accessible, co-ordinated local care pathways for falls and

fracture prevention and management. The use of measurement to monitor and improve the quality and effectiveness of services.

To address similar issues, the Welsh 1000 lives plus Campaign’s Multi-agency FallsCollaborative has adopted an approach that combines the use of four care bundles* with the IHIModel for Improvement. The four care bundles cover case-finding, multifactorial risk screening,intervention and monitoring.

In Scotland, a similar approach would provide an opportunity to address the priorities outlinedabove whilst:

building on progress to date, identifying and addressing variation in quality of care that continues to exist, supporting sustainable change, and impacting positively on outcomes for older people who fall.

Three areas of work are underway/planned:

1. The development of an agreed set of Scottish community falls prevention care bundles(based on the Welsh bundles) and associated data set.

2. Testing the implementation of the agreed care bundles within one Health Board area.3. An evaluation of the benefits and costs of implementing the bundles.

A Health Economist has commenced the evaluation, the objective of which is to quantify, foreach health board and at Scotland level, the potential clinical benefits following implementation,the resources and associated costs required to implement and sustain the activities required todeliver each care bundle.

*The IHI developed the idea of care bundles to help health care providers more reliably deliverthe best possible care for a patient. A bundle is a structured way of improving both theprocesses and outcomes of care: a small, straightforward set of evidence-based practices —generally three to five — that, when performed collectively and reliably, have been proven toimprove an individual’s outcomes.

The power of a bundle comes from the evidence base behind it and the method of execution, i.e.with complete consistency. The practices included in a bundle are not necessarily new; they arewell established evidence-based or good practices, but they are often not performedconsistently, making interventions unreliable, at times idiosyncratic. A bundle ties key practicestogether into a package of interventions that people know must be followed for every patient,every single time.

Ann Murray, National Falls Programme [email protected] 2011

Falls related Inpatient Cost per 1000 Population 65+

(at 2009/2010 full cost)

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

Lochaber Ross &Cromarty

Skye &Lochalsh

Caithness EastSutherland

North WestSutherland

Badenoch &Strathspey

Inverness Nairn &Ardersier

Mid CHP North CHP S.E.H CHP

Total

Sum of Cost £

CHP Name Locality Name Financial Year

Sum of Cost £CHP NameLocality Name Financial Year TotalMid CHP Lochaber 2007/8 290521.8811

2008/9 285287.25262009/10 259114.1102

Ross & Cromarty 2007/8 148777.61732008/9 149548.48582009/10 151861.0912

Skye & Lochalsh 2007/8 192786.17262008/9 166733.98712009/10 190180.954

North CHP Caithness 2007/8 133480.06882008/9 123212.37122009/10 137587.1478

East Sutherland 2007/8 176219.82362008/9 166053.29532009/10 189775.1946

North West Sutherland 2007/8 153664.24162008/9 276595.63492009/10 225374.221

S.E.H CHPBadenoch & Strathspey 2007/8 241311.08692008/9 349485.02242009/10 274595.3747

Inverness 2007/8 187608.82662008/9 187608.82662009/10 160679.33

Nairn & Ardersier 2007/8 131255.15962008/9 151277.13312009/10 111233.1861

Grand Total 5211827.497

Falls Related New Admissions per 1000 Population 65+

0

5

10

15

20

25

30

35

40

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0


Skye &Lochalsh






Total

Sum of New Adms


Sum of New AdmsCHP NameLocality Name Financial Year TotalMid CHP Lochaber 2007/8 30.07315091

2008/9 29.531292332009/10 26.82199946

Ross & Cromarty 2007/8 17.241379312008/9 17.330712882009/10 17.5987136

Skye & Lochalsh 2007/8 31.092436972008/9 26.89075632009/10 30.67226891


East Sutherland 2007/8 21.086780212008/9 19.87023522009/10 22.70884023



Inverness 2007/8 20.752656142008/9 20.752656142009/10 17.77380598

Nairn & Ardersier 2007/8 20.521739132008/9 23.652173912009/10 17.39130435


Falls related OBDs Per 1000 Population 65 and over

0

200

400

600

800

1,000

1,200

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0

2007/8

2008/9

2009/1

0


Skye &Lochalsh






Total

Sum of OBDs


Sum of OBDsCHP NameLocality Name Financial Year TotalMid CHP Lochaber 2007/8 582.6063397

2008/9 549.60715252009/10 548.0357627

Ross & Cromarty 2007/8 368.70644992008/9 469.91245312009/10 447.2395926

Skye & Lochalsh 2007/8 330.84033612008/9 366.59663872009/10 386.3445378


East Sutherland 2007/8 487.34793192008/9 461.23276562009/10 510.1784266



Inverness 2007/8 497.16016282008/9 537.20583852009/10 483.6361831

Nairn & Ardersier 2007/8 326.15652172008/9 403.44347832009/10 241.3217391


CHP Name Locality Name Financial Year OBDs New Adms Cost £Mid CHP Lochaber 2007/8 583 30 290,522Mid CHP Lochaber 2008/9 550 30 285,287Mid CHP Lochaber 2009/10 548 27 259,114Mid CHP Ross & Cromarty 2007/8 369 17 148,778Mid CHP Ross & Cromarty 2008/9 470 17 149,548Mid CHP Ross & Cromarty 2009/10 447 18 151,861Mid CHP Skye & Lochalsh 2007/8 331 31 192,786Mid CHP Skye & Lochalsh 2008/9 367 27 166,734Mid CHP Skye & Lochalsh 2009/10 386 31 190,181North CHP Caithness 2007/8 471 27 133,480North CHP Caithness 2008/9 408 25 123,212North CHP Caithness 2009/10 424 27 137,587North CHP East Sutherland 2007/8 487 21 176,220North CHP East Sutherland 2008/9 461 20 166,053North CHP East Sutherland 2009/10 510 23 189,775North CHP North West Sutherland 2007/8 402 20 153,664North CHP North West Sutherland 2008/9 1,125 36 276,596North CHP North West Sutherland 2009/10 618 29 225,374S.E.H CHP Inverness 2007/8 497 21 187,609S.E.H CHP Inverness 2008/9 537 21 187,609S.E.H CHP Inverness 2009/10 484 18 160,679S.E.H CHP Badenoch & Strathspey 2007/8 789 23 241,311S.E.H CHP Badenoch & Strathspey 2008/9 888 33 349,485S.E.H CHP Badenoch & Strathspey 2009/10 859 26 274,595S.E.H CHP Nairn & Ardersier 2007/8 326 21 131,255S.E.H CHP Nairn & Ardersier 2008/9 403 24 151,277S.E.H CHP Nairn & Ardersier 2009/10 241 17 111,233

Age Band 65+SEX (All)PRACTCODE (All)ADMTYPE EMERG

Data

CHP Name LOCALITY_NAME Sum of NEW ADMSum of Bed DaysSum of Total

Mid CHP Lochaber 96 1926.62 927408.7 9660.507

Ross & Cromarty 194 4993.92 1674046 8629.102

Skye & Lochalsh 69 900.65 427829 6200.42

North CHP Caithness 134 1835.62 671012.5 5007.556

East Sutherland 56 1255.99 467985.6 8356.886

North West Sutherland 22 464.66 169256 7693.456

S.E.H CHP Badenoch & Strathspey 66 2201.66 703513.4 10659.29

Inverness 178 4870.23 1609161 9040.232

Nairn & Ardersier 50 696.32 319795.4 6395.908

Grand Total 865 19145.67 6970008 8057.812

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