Nyngan Health Service developed a falls workbook and DVD, which was used to educate aged care residents on falls and empower them to develop personalised strategies that would reduce their risk of falling.
Aim
To reduce the number of falls at Nyngan Health Service to less than 4.5 falls per 1000 bed days, within 12 months.
Benefits
- Reduces the incidence and severity of falls in aged care residents.
- Improves residents’ understanding of key risk factors for falls, as well as their own risk of falling.
- Empowers residents to make informed decisions about their healthcare.
- Improves collaboration between residents, carers and staff.
- Reduces the time, costs and resources associated with managing falls.
- Ensures interventions meet the individual needs and preferences of residents.
- Encourages staff to actively listen to residents and foster a supportive and positive workplace environment.
Background
In Australia, more than one in three people aged 65 and over fall once a year and many fall more often. Falls are more common in aged care facilities, with up to half of all residents falling at least once a year1. Falls are a significant cause of potentially avoidable harm to older people. Each year in NSW, falls lead to approximately 27,000 hospitalisations and 400 deaths in people aged 65 and over1. However, there is strong evidence that falls can be prevented.
The WNSWLHD target for falls in multi-purpose services is less than 4.5 falls per 1000 bed days. Prior to the project, Nyngan Health Service struggled to meet these targets. Falls rates were 5.7 falls per 1000 bed days in 2014-15. In the six months prior to the project, 80% of residents had a fall and one resident had several falls. In total, there were 66 falls in 2014. In May 2015, this data was presented to a residents meeting, which sparked a meaningful discussion on the risks that contribute to falls. Residents were surprised by the number of falls occurring at Nyngan Health Service, with one commenting ‘that is at least one fall every week!’.
Strategies to reduce falls at Nyngan Health Service historically involved nurse-led interventions, including bed alarms, pool noodles and mattresses on the floor. As these did not lead to significant changes in fall rates, it was determined that residents should be engaged as partners in their healthcare and empowered to make informed decisions, with ownership of risks and interventions to reduce falls and harm from falls.
Implementation
- Incident Information Management System (IIMS) data was used to identify when and where falls occurred at Nyngan Health Service prior to, during and following project implementation.
- The Nurse Manager attended the 2015 Falls Promotion Conference in Sydney, which showcased a falls workbook and DVD used in an acute setting.
- A falls workbook was developed in collaboration with residents, staff, carers, the WNSWLHD Falls Coordinator and Health Advisory Council, with information and images tailored to residents at Nyngan Health Service.
- A DVD was created that outlines key factors contributing to falls, with strategies to reduce falls or injuries from falls. It features an activities officer who discusses exercise, a podiatrist who discusses footwear and a physiotherapist who discusses continence and mobility aids. It was filmed at Nyngan Health Service, so residents can relate to the people and places in the DVD.
- The DVD was played to residents and stopped at several intervals so residents could ask questions, discuss their concerns and make suggestions.
- After watching the DVD, residents used the workbook to develop several interventions they felt would decrease their risk of falls. For example, one resident loves wearing ugg boots despite the fact they increase her risk of falling. She chose to take that risk but decided that she would wait for staff to walk with her. This intervention was more likely to be successful as she acknowledged the risk and made a personal choice.
- The two-hour program was delivered by clinical staff and activities officers to small groups of residents (no more than three at a time). Keeping the groups small allowed residents to interact with each other and staff. The only pre-requisite for staff to run the program was that they must have a rapport with residents.
Project status
Sustained - the initiative has been implemented and is sustained in standard business.
Key dates
May 2015 – May 2016
Implementation site
Nyngan Health Service, WNSWLHD
Partnerships
- Kate Niccol, Physiotherapist, WSNWLHD
- Margot Downing, Podiatrist, Private Provider
- Health Advisory Council
Results
- Each program ran for two hours (one hour per staff member), which is less than the 4.5 hours of additional work for staff that’s required for every uncomplicated fall.
- Falls were reduced from 5.7 per 1000 bed days in 2014-15 to 4.2 per 1000 bed days between January and May 2016. By October 2016, no residents who completed the program had fallen.
- Resident surveys conducted in 2016 showed that all residents who completed the program had an increased understanding of the key risks associated with falls and a better understanding of their own falls risk.
- The program is sustainable and cost-efficient, with time the only ongoing commitment. New information can easily be added to the program moving forward. It can also be scaled to larger facilities and acute care settings with a high risk of falls.
Awards
2016 WNSWLHD Innovation Awards Winner – Patients as Partners
Lessons learnt
- The success of the program lies in engaging residents through meaningful conversation and empowering them to make informed decisions about falls risks and interventions.
- While reducing falls does impact the organisation from a financial perspective, the greatest benefit of the program is the improvement in residents’ health and wellbeing.
- The aim of the project should have measured falls by residents that completed the program, as opposed to all residents.
- All staff should have been given the opportunity to attend a training session, so they could reinforce the program on a day-to-day basis.
Further reading
- NSW Health. Falls - Prevention of falls and harm from falls among older people: 2011-2015. Policy Directive PD2011_029. NSW Health; 2011.
Contact
Jenny Griffiths
Health Service Manager
Nyngan Health Service
Western NSW Local Health District
Phone: 02 6835 1700
jennifer.griffiths@health.nsw.gov.au
