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The resources below have been categorised into the three audits within FFFAP: National Hip Fracture Database (NHFD) National Audit of Inpatient Falls (NAIF) Fracture Liaison Service Database (FLS-DB) Hip fracture: a guide for families and carers All about your hip fracture and what to expect on the road to recovery Recovering after a hip fracture: helping people understand physiotherapy in the NHS How should your hospital prevent and respond falls during your stay Inpatient falls Falls prevention in hospital: a guide for parents, their families and carers What should happen if you or someone you know experiences a fragility fracture Six golden rules for stronger bones Strong bones after 50 - after staying on treatment

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. Results 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. Next steps 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.

Objective Reduce incidence of falls and harm. Embed falls prevention into everyday practice. Engage clinical staff to identify patients at risk and implement harm prevention strategies. Process for target wards: Present data for the past 12 months for falls by severity, as baseline metric. Present serious falls and actions undertaken. Falls Risk Assessment audit as baseline metric. Falls Link Worker ensures a display board is refreshed with falls prevention displays and audit result. Ward team set own targets for improvement weekly. Teaching sessions delivered. These may be ward sessions or in the Quality Improvement and Innovation (QII) hub. Weekly audits continue. Evaluation: Meeting with the team to discuss programme results, falls incidences, post fall assessment themes and audit results. Link worker provides evidence of training undertaken and plan for those who have not received training. Improvement plan agreed to be delivered by the link worker.

The report suggests strategies to prevent newborn falls in the hospital, whichl include: focusing efforts on providing support for exhausted parents during the critical time following the birth offering periods of rest for new parents whenever they are tired increasing the frequency of rounding when new mothers are breastfeeding promoting a midday break in visiting hours. In cases where a newborn fall event does occur, facilities should provide support to both injured newborns and any caregivers involved. In many cases, parents and other caregivers may benefit from counselling to help them better navigate the emotional turmoil that often follows these events.