East Kent Hospitals University NHS Foundation Trust is delighted to have been the recipients of the Patient Safety Learning Award 2019 for ‘Professionalising Patient Safety’ for our FallStop programme.
FallStop is a quality improvement programme, developed in 2016, when we found there was a high number of falls at one of our hospitals and a failure to learn from serious incidents. The same site had performed poorly in the National Audit of Inpatient Falls in 2015 and we knew we needed to make a change.
Our aim was to reduce the incidence of falls and harm and embed falls prevention into everyday practice, by engaging clinical staff to identify patients at risk and implement harm prevention strategies. We chose target wards, on a rolling programme, starting with areas with a high number of falls and those where serious falls had occurred.
Integral to the success of FallStop is for wards to understand and own their data and culture. We discuss their fall incidents, rates and falls risk assessment audit results for the previous year. The focus is for each area to decide what they need and want to improve, which we do with their Falls Link Workers and Ward Manager.
To support the programme we recruited, to work with the nursing team, a single FallStop Associate Practitioner, whose primary role is to deliver a comprehensive training session to clinical staff. This covers completion of our Falls Risk Assessment and Care Plan, use of harm prevention strategies and post fall care. Over 1,000 clinical staff have received the full training, but the FallStop Associate Practitioner also supports clinical induction sessions every 2 weeks for new clinical staff, by providing a falls awareness session. A thorough falls risk assessment and development of a comprehensive care plan is the most important part of preventing falls and this is emphasised during training.
The programme has evolved and we have used innovative ways to improve all aspects, including keeping the data simple. Wards can self -audit their compliance with risk assessments and post fall care by using quick and simple electronic audits and have immediate results in colourful bar and pie charts. We also created a Falls Dashboard for overall Trust data, which is now being further developed to enable wards to drill down to their own data.
One of the things we sometimes find is that staff do not think that falls is a problem in their area. By sharing their data, discussing serious incidents and talking about training they become much more self-aware and are able to set and own their own goals.
- In 2016-2017 (pre FallStop) the Trust fall rate was 5.79 per 1000 occupied bed days with the problem hospital rate at 5.55.
- 2017- 2018 (practitioner in post and programme being rolled out) the Trust rate was 5.34, problem hospital rate at 5.48.
- In 2018-2019 (FallStop implemented), Trust rate at 5.05, problem hospital rate at 5.13. The avoidable hip fracture incidents have halved from 8 in the previous year to 4 in this year.
We are now helping wards to triangulate their own data. If they can see that staff have received FallStop training and that the number of falls and harms have decreased, they are able to recognise the value of the programme for their patients and team.
We have listened to our staff and are developing the Trust’s Falls Steering Group. Whilst it will continue to be chaired by the Deputy Chief Nurse, a representative body of band 7 clinical staff (usually, but not restricted to, Ward Managers) will become members. These are all volunteers who are passionate about preventing falls. We hope that this will enable a cohesive ward to board approach where we can all understand the issues facing clinical staff, whilst keeping clinical staff aware of local and national expectations. It has already improved understanding and is breaking down the barriers. As a result we are planning events for staff to ‘drop in’ and discuss falls and present their own ideas.
To celebrate staff achievements we are about to implement ’FallStop Friends.’ Our friends will be presented with certificates and appear in our Trust news and Twitter feed.
When we developed FallStop we wanted a unique branding and came up with our own logo. It is widely known across the Trust and we have shared this concept with our peers at other hospital Trusts. We use it for all our communication tools, from reports to desktops, posters to risk assessments.
Our next step is to choose what to do with our prize. We have decided to listen to our clinical staff at ‘drop ins’ and find out what they think makes a difference. We will then choose one or two of their ideas to help the Falls Prevention Team visit a hospital, team or service which is successfully addressing the chosen idea. We are committed to continue to develop FallStop locally and share our experience to support our peers in other Trusts with their own programmes.