Program Highlight

Southern NSW Local Health District – Northern Cluster Hospital Acquired Complications Falls Project

Falls resulting in serious injury or death are classified by the Australian Commission on Safety and Quality in Health Care as Hospital Acquired Complications (HAC) attracting both a financial penalty to the hospital and often life changing outcomes for the patients. Local Health District fall related HAC’s in January 2019 displayed an increasing trend in five wards across the Northern Cluster.

As a result, an innovative fall prevention model was developed locally, utilising the Institute of Healthcare Improvement principles which reduced falls resulting in serious injury by 25%.

A three pronged aim underpinned the project;

Identify the structures required to build a strong team at the ward level to support quality improvement
Test if the role of local clinicians as project officers enhanced outcomes
Test the effectiveness of the interventions to reduce falls resulting in serious injury as a model for roll out across the LHD.

LHD leads provided support and structure for Project Officers to embed the approach at the ward level. Training, structured support and regular data collection were key to achieving process and outcome measures. Ward based teamwork, leadership from NUMS and engagement with the Executive sponsor have been key learnings that will enhance future projects.

Strategies implemented as part of the innovative fall prevention model included;

Teams were supported with a variety of training opportunities throughout the 8 month intervention period. Executive Sponsorship was consistent and invaluable. The Project Officers were supported by LHD clinical leads.
In collaboration with the Clinical Excellence Commission, a one day workshop was held to identify team priorities areas for improvement using ward level data. The Quality Improvement Data System was used to document project information.
Resources such as admission checklists were found to be transferrable across wards. There were opportunities to engage theatre and Emergency Departments through strategies such as ‘protected time’. ‘Protected time’ is a 15 minute window that allows clinicians on the Surgical Ward to undertake admission responsibilities without being interrupted. This required theatre to provide notice to the ward of imminent admissions resulting in less chance of multiple patients arriving on the ward at the same time which can result in patient safety risks and documentation being missed.
Both Crookwell and Bourke St Health Service utilised administration staff to enhance project outcomes highlighting that patient safety is the responsibility of all team members. The team at Crookwell surveyed patients throughout their project which was beneficial in guiding small tests of change.

This program was a finalist for the Patient Safety First Award Category from the NSW Health Awards.

Niccola Follett and the HAC Falls Project, Southern NSW Local Health District

Upcoming Events

Australian Vestibular Rehabilitation Conference Online Event
27th - 7th December, Online event
Oxford Brookes University, Healthy Ageing: Visions for our Futures Webinar series
Daily through the month of November
NSW Healthy Ageing and Fall Prevention Network Launch Webinar
11th December 12.30-1.15pm
EU Falls Festival 2021
15th - 16th April 2021, Leuven, Belgium

Research Highlight

Tailored exercise and home hazard reduction for fall prevention in older people with cognitive impairment: the i-FOCIS randomized controlled trial
Morag E Taylor, PhD, Jacqueline Wesson, PhD, Catherine Sherrington, PhD, Keith D Hill, PhD, Susan Kurrle, PhD, Stephen R Lord, DSc, Henry Brodaty, DSc, Kirsten Howard, PhD, Sandra D O’Rourke, BMedSc(Hons), Lindy Clemson, PhD, Narelle Payne, MPH, Barbara Toson, BStatEc, Lyndell Webster, BAppSc(Phty), Roslyn Savage, BAppSc(Phty), Genevieve Zelma, MOT, Cecelia Koch, BAppSc(OT Hons), Beatrice John, BSc(Hons)Phty, Keri Lockwood, BHSc, Jacqueline C T Close, MD
The Journals of Gerontology: Series A, glaa241, https://doi.org/10.1093/gerona/glaa241

Abstract
BACKGROUND
The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI.

METHODS
RCT involving 309 community-dwelling older people with CI. The intervention group (n=153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n=156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function and quality of life.

RESULTS
Participants’ average age was 82 years (95%CI 82-83) and 49% were female. There was no significant difference in the rate of falls (IRR 1.05 95%CI 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (four participants), revealed a non-significant reduction in fall rate in the intervention group (IRR 0.78 95%CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74 95%CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value=0.023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60 95%CI 0.37-0.98). There were no significant between group differences for other secondary outcomes.

CONCLUSIONS
This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function.

Trial registration: Australian and New Zealand Trials Registry ACTRN12614000603617