Shared learning database
Type and Title of Submission
Implementing best practice in the management of elderly fallers in the emergency department based on national guidelinesDescription:
1) TO ENSURE ELDERLY FALLERS ADMITTED INTO THE EMERGENCY DEPARTMENT ARE ADEQUATELY ASSESSED. 2) TO IMPLEMENT CHANGES IN THE MANAGEMENT OF ELDERLY FALLERS BASED ON THE NICE GUIDELINESCategory:
ClinicalDoes the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
CG21 - FallsCategory(s) that most closely reflects the nature of the submission:
Description of submission
To implement changes in the management of elderly fallers within the ED and UHL based on NICE guidance with emphasis on local practice and resources. Using prospective audit to monitor practice following the changes. Use the audit cycle to evolve a falls pathway to improve the assessment and prevention of falls in older people.Objectives
1.To ensure elderly fallers are appropriately investigated. 2.To ensure Community Matrons seconded to the Emergency Department from the PCT help with managing the elderly fallersContext
An ED audit carried out in the summer of 2004 based on the local Falls Pathway within UHL revealed very poor compliance with many instances of inappropriate management. The results of our audit revealed that the assessment and management of patients presenting with falls to the emergency department had been inadequate on a number of fronts. Assessment quality needed considerable improvement, although we were establishing the character and context of most falls' patients, we were failing to construct a proper falls history, failing to provide multi-factorial assessments and most importantly failing to inform and educate on falls prevention programmes. The NICE guidelines, CG021, were published during the winter of 2004. It was felt within the ED, in association with the Geriatricians that this needed to be implemented to improve the management of elderly fallers.Methods
Data from 489 was collected between July 2004 and July 2005 and the results analysed. 1. The emergency department performed mobility assessments on 396 (81%) of the patients with only 5 (1%) patients demonstrating the 'Get Up And Go Test'(GUAG)test. 2. Falls prevention advice was given to 16 (3.3%) patients with only 4 (0.8%) patients being referred to the falls clinic. 3. The results from the first audit show very few patients were referred to the physiotherapists, occupational therapist's and the discharge team for further input. Only 1 (0.2%) patient was referred to the social worker. Changes made included: -An ED 'Theme of the Week', a pre-determined, topic based, weekly teaching programme. -A Consultant in the ED establishing a liaison role with the Geriatricians and forming a 'Falls Interest Team' within the ED. -Community Matrons seconded to the Emergency Department from the PCT to help with managing the elderly fallers. -An ED falls pathway of care. -Establishing a Directorate of Services for Elderly People (DSOP). -Establishing a one day training conference on assessment and management of elderly fallers -The Department of Health funded 'Pacesetters' programme within UHL to observe care of frail elderly patients in the ED helped raise awareness. In the second audit, with the presence of a designated community matron on the Emergency Decisions Unit the referrals made to the professions allied to medicine much easier. The community matrons accepted 260 (79.7%) and conducted further reviews in 200 (61.3%) prior to their discharge from the emergency department.Results and evaluation
Following a period of approximately 2 years after implementing the changes we conducted a second audit to monitor progress and assess the efficacy of the changes made. The results of the repeat audit showed huge improvements. In the second audit, with the presence of a designated community matron on the Emergency Decisions Unit the referrals made to the professions allied to medicine much easier. The community matrons accepted 260 (79.7%) and conducted further reviews in 200 (61.3%) prior to their discharge from the emergency department. All assessments and referrals to falls assessment teams.Key learning points
The implementation strategy within the ED was broadly based on two approaches, training development and service delivery. This was to serve the dual purpose of achieving quick short term gains by putting into place resources and pathways as well as to achieve long term improvements by modifying attitudes and perceptions towards the management of the elderly in general and falls in particular.
|Job Title:||SPECIALIST REGISTRAR EMERGENCY MEDICINE|
|Organisation:||UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST|
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This page was last updated: 29 September 2009