Falls Prevention Resource Suite - PowerPoint Presentation

1. Falls Prevention Resource Suitefor Care Homes

2. E.H.C.H –Enhanced Health in Care Homes The NHS has an ambition to strengthen its support for the people who live and work in and around care homes. People living in care homes should expect the same level of support as if they were living in their own home – this can only be achieved through collaborative working between health, social care, voluntary, community, and social enterprise (VCSE) sector and care home partners.The NHS Long Term Plan commits to rolling out the Enhanced Health in Care Homes (EHCH) model across England by 2024, starting in 2020. This model moves away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff.

3. Collaborationhttps://www.youtube.c/omwatch?v=v2dVT_Q8uxA

4. Enhanced Health in care homes Elements Hydration Nutrition Oral health Continence Rehab FallsExercises Increase independence and resilienceMedication review

5. Achieving High standards of Care for our Residents(CQC)

6. FrailtyFrailty is associated with an increased risk of falls. The clinical frailty scale (CFS) is based on Person’s illnessesTheir function Cognition The scale ranges from 1 (very fit) to 9 (terminally ill)Most care home residents will be between 6 - 9

7. FallsFalls in care home residents are at least 5x more frequent than in community Even when falls do not result in fractures, they frequently result in other forms of injury. They cause fear of falling which contributes to a cycle of functional decline and increasing dependency with associated care costs

8. Falls in Care Homes across LLR

9. Falls

10. The Benefits of Proactive Care and Using a Falls Checklist Tool.

11. Evidenced Based Practice

12. Community Therapy Falls Training Programme

13. Assessment ToolFalls Risk Assessment Tool (FRAT)Multifactorial Falls Risk Assessment Tool (MFRAT)This training will cover the assessment of falls risk and identify interventions to decrease this risk in people aged 65 and over. It is a 5 page check list to help reduce the risk and incidence of falls and the associated distress, pain, injury, loss of confidence, loss of independence and mortality. (NICE guideline)Double click on picture to open the PDF files / will also be emailed and provided in paper form

14. Assessment ToolMultifactorial Falls Risk Assessment Tool (MFRAT)

15. Who is checklist for?NICE guidelines 2013Care providers who care for older people who are at risk of fallingPeople aged 65 or older who fall or are at risk of falling in the community, and their families and carersInpatients aged 50 to 64 who have been identified as being at higher risk of fallingStandardise assessment that is used across all professionals

16. Falls Risk Assessment Tool (FRAT) If the resident has answered 'YES' to 2 or more of these questions, please complete the Multi-factorial Falls Risk (MFRAT)

17. Multifactorial Falls Risk Assessment Tool(MFRAT)Record details of any falls history, including frequency/ context/ direction of fall.Action:What caused the fall? Are there any patterns? Are they always falling in particular area/time?Make a note of any information and link in with your weekly ward round with the GP to discuss and request advice.If a resident has just fallen and is unable to recall falling or hitting the ground? (refer to falls decision tree) Was there any dizziness (Vertigo), loss of consciousness (Syncope) or light-headedness?

18. MedicationsIs the resident on four or more medications?Has medication been reviewed in the last 12 months?Action If medical staff advise night time medication can increase risk of falls: be aware of their ability and consider transfers only at night and provide additional supervision or Assistive technology falls sensors.Discuss medication with the GP at the weekly ward round? Could their medication be related to falls, discuss timing of the medicationIf medication has not been reviewed in the last 12 months request for a review by Pharmacist/GP/medical staff

19. ContinenceDoes the resident suffer from urgency, frequency and/ or incontinence of urine/ faeces?Action: Offer to take resident to the toilet more frequently Consider continence aids; pads, convene ( Continence Training available)Is the resident able to get to the toilet/ commode or ask for support (have their got their buzzer next to them)Is their pad wet/ damp as this will affect their balanceIs it burning? Strong smell? - underlying infection (?Complete a set of observations if able) Is the urine dark – ?dehydration (encourage fluids – water, smoothies, fruit juices).

20. Dizziness on standing – Postural HypotensionAction: Allow extra time upon standingEncourage the resident to pump their ankles prior to standing/ changing position (lying to sitting)Increase fluids

21. Healthy Lifestyle , Nutrition and Hydration, • Approximately 75% of diseases are lifestyle related with poor nutrition being one of the of the leading causes (ex. diabetes and high blood pressure among others).• Poor nutrition and dehydration can also lead to symptoms that can increase our fall risk, including dizziness, fatigue, and reduced physical activity.Action:Does the patient have adequate nutritional intake? Is the patient's fluid intake less than 6 glasses per day?Any previous or current alcohol/ substance misuse?Encourage fluids; water, smoothies, fruit juices, dilute drinks Any swallowing difficulties? -Refer to speech & language therapist (SALT)Does the patient have a special dietary requirement? Likes/ dislikes? Food should be your primary source for nutrients. Focus on fruits, vegetables, and whole grains as opposed to refined sugar, excess sodium, and processed foods.Considers soupsCalcium and Vitamin D are in particular important for the strength of our muscles and bones.Adapting crockery to take account of disabilitiesMaking a social event of ‘coffee time

22. Sensory AbilitiesVisual impairment?Altered spatial awareness? Auditory impairment?Action: Hearing aids? Are they in and turned on? both or one? Batteries? Glasses? – reading? distance? When was their hearing and vision last checked?

23. Footwear/Foot CareIs poor grooming or caring for feet affecting mobility?Does their footwear fit? Too loose? Too tight? There are lots of changes to our feet that occur as we age; swelling? Deformity? Action: Have they got slippers with grips? Is the footwear the correct size? Do these need replacing? Footwear:Limited heel height, a firm insole and midsole, an outsole with sufficient tread An easy and effective closing mechanism such as Velcro (not slip on shoes).Observe lower limbs for any swelling : elevate, pump ankles, review with GP Are their toe nails trimmed? Onwards referral for podiatryDo they have any sores? Blisters? – are they putting equal weight bearing through both feet or is their ability effected due to pain.

24. Fear of FallingIs there a fear of falling?Is there an avoidance of activities due to falls?Action: Provide reassurance Provide close supervision and progress to distance Have carers available to encourage mobility until confidence grows

25. The Falls Cycle

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27. Home and Environment Safety,EquipmentAre there any hazards around the home? We may not even realize it, but there are a variety of risk factors in homeIs there a clear view of where we are going to be walking. Action; Rugs slip hazard; if they’re not secured to the groundTrip hazard; if the corners are coming upCords or wiringPoor lighting can result in not being able to see what hazards may present – consider motion sensor lightingClean slippery looking floor will increase fear of falling Ensure all equipment is in good working order e.g. Equipment on wheels, brakes in working order, is equipment suitable for the specific resident Is there a need for equipment to aid with tasks? Consider therapy referral and assistive technology

28. Mobility/TransfersHas there been a marked changes in mobility/ability to transfer over the past 12 months?Have their got the appropriate mobility aid?Action: Be aware that residents may attempt to get up without their aid and ensure to place the mobility aid within easy reachCheck ferrules are intact Do not share mobility aids – these are prescribed to an individual Review Chair, bed, toilet height (approx. 90 degree angles see picture is the optimum height for transferring)Consider referral to therapy – contact care home team for advice.

29. BalanceIs the resident unsteady on their feet?Why is the resident unsteady? Fear/ confidenceStiffness/ reduce range of movement Pain Dizziness Action: GP review on weekly ward round Chair based or standing exercises – consider referral to therapy Consider therapy review for mobility aid prescriptions (home visit or walking aid clinic).

30. Exercise is the miracle cure we’ve always had, most people neglect to take the recommended dose, and our health is now suffering as a consequence.“If exercise were a pill, it would be one of the most cost-effective drugs ever invented” Dr Nick Cavillhttps://gps.northcentrallondonccg.nhs.uk/education/video/falls-prevention-services https://www.charnwoodcommunitymedicalgroup.co.uk/uploads/preventing-falls-exercises.pdf

31. Agitation/ConfusionNote any memory or comprehension difficulties, agitation or confusion, cognitive impairments, challenging behaviour or psychosis?Action: Provide reassurance Make tasks functional Is there a specific pattern of behaviour?Understand the patient’s past routine (early bird, night owl?)Try again another timeIs this new- is there an underlying infection? Complete observation if able Discuss at weekly GP round

32. Within the resident notes and care plan,document a summary of; Risk factors Action steps that you have identified by using the checklistRemember to; Communicate to the whole teamDocumentationCommunication DateRisk factors Action steps 25.05.22MedicationOn sleeping tablets. Provide supervision at night. Limit to transfers Example of summary

33. In the Event of a Fall

34. Falls Decision Tree

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37. Resource SuiteTailored Training Packages built around your workforceFace to Face Web basedRefresher sessionseLearningPDF Falls checklistPDF Falls Decision TreeCertificate of collaborationSpecific contact numbers for support.FallsContinencePressure Ulcer PreventionOral Health and nutrition

38. Certificate of Falls Prevention Training and Collaborative workingTrainer: Fazila Hajat Date:……………………….Care Home:………………………………………………………………………………….Attendees:……………………………………………………………………………………………..……………………………………………………………………………………………..……………………………………………………………………………………………..……………………………………………………………………………………………..

39. Further Resources

40. SupportNo question is a stupid questionArrange TrainingSignpostingWere Here To Help

41. Thank you for ListeningFazila Hajat:Falls Trainer07917 086550 Questions ?

42. References NICE Guidelines: https://www.nice.org.uk/guidance/cg161Article: https://www.carehome.co.uk/news/article.cfm/id/1661192/FallsSlide 6 https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-falls#:~:text=Frailty%20is%20associated%20with%20an%20increased%20risk%20of%20falls.&text=The%20incidence%20of%20falls%20in,fallen%20in%20the%20previous%20year.&text=Frailty%2Dinduced%20falls%20are%20associated,of%20fractures%2C%20hospitalisation%20and%20institutionalisation. Slide 1-2 NHS long term care plan Slide 7 https://www.nottingham.ac.uk/research/groups/communityrehabilitation/documents/finch-protocol-finalfv2-28-08-2018.pdf