Reducing Harm from Falls is a national programme lead by the Health Quality & Safety Commission, working in partnership with a wide range of stakeholder organisations. Work began mid-2012 for the three-year programme with the appointment of a clinical lead and formation of an expert advisory group and small programme team.
The programme's development has been an organic process encompassing envisioning, enquiring, engaging, enabling and evaluating.
Older people are the population of concern because although falls occur at all ages, in older people, a high incidence of falls combines with a high prevalence of underlying conditions which increase the risk of falling and injury. The programme aims to reduce harm from falls by working from an evidence-base to reduce the risk of falling, rate of falls and severity of injury, and promote the best possible outcomes for those who have suffered harm related to a fall. Our vision is for a sustainable and integrated approach to falls in older people, that involves older people themselves and their family/whanau in meeting their goals for wellness, independence or coping.
Since a whole-of-system approach is required to meet these aims in this population, the expert advisory group represents a wide range of perspectives and has been able to facilitate strategic partnerships at a national level. The programme also strongly supports the development of regional approaches, as reducing harm from falls is a natural concern for health of older people networks working locally.
The first priority and focus for the programme was identified as falls in older people in care settings - hospital, aged residential care and receiving care at home. In care settings two things can be assumed: a degree of vulnerability on the part of the older person and the need for a safe care environment. Falls in older people will remain a focus as falls are high harm events for hospital patients and are consistently about half of all serious adverse events reported to the Commission.
However, enquiry to scope the cost of falls and the case for investment indicated that the volume of falls in the community and return on investment requires prioritisation of a public health approach aiming to keep older people 'on their feet'. Consequently, programme activities have built from the initial emphasis on preventing falls in older inpatients and residents to supporting and promoting primary care and community-based efforts for older community-dwellers (both those who are generally healthy and active, and those at risk of falling by virtue of frailty or other factors).
To engage the interest of those working directly with older people or involved in service provision, the expert advisory group committed to a set of activities to raise awareness of falls risks and falls prevention in an annual April Falls promotion. The national falls programme was the first in the Commission to lead off in the national patient safety campaign, Open for better care, which in May 2013 launched the Ask, assess, act project – a process to screen older people for risk of falling, identify and address their risk factors. Other key projects to improve care begun in 2013 relate to risk assessment and care planning, and a system signalling level of assistance needed to mobilise safely.
Key messages are that 'Falls hurt' and that although nurses (and care assistants) have a special responsibility given their 24/7 contact with patients and residents, 'Falls are everyone's business'. A critical programme partnership is demonstrated in the promotion of materials developed by ACC in patient information resources.
The programme's annual April Falls Quiz is an informative self-test of knowledge about falls and falls prevention, designed to spark interest in learning about falls prevention and how to improve practice. The results have helped direct the expert advisory group in what to emphasize in programme activities and communications.
The 10 Topics in reducing harm from falls are a set of self-directed online learning activities covering current evidence on core issues. The 10 Topics are designed to enable the development of capability for best practice, and present a soundly-based collation of readings, videos, case studies and other web resources. Educators, falls champions and anyone involved in promoting falls prevention are encouraged to use the 10 Topics as ready-made learning packages.
The Commission's quality and safety markers, designed to evaluate the success of the campaign and programme interventions, measure care processes and outcomes. Processes of risk assessment and individualised care planning for older inpatients in district health boards have increased overall, but it is too early to report an improvement in the outcome measure (fractured hip related to an inpatient fall).
The programme consolidates in the 2014-2015 year, and activities include scoping evaluation of the programme.
- Rubenstein LZ. 2006. Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing 35-S2:ii37-ii41.
- Health Quality & Safety Commission. 2013. Making health and disability services safer - Serious Adverse Events report 2012–13. Wellington: Health Quality & Safety Commission.
- De Raad JP. 2012. Towards a value proposition… scoping the cost of falls. Wellington: New Zealand Institute of Economic Research.
- Robertson MC, Campbell AJ. 2012. Falling costs: the case for investment. Report to Health Quality & Safety Commission. Dunedin: University of Otago.