The national reducing harm from falls programme led by the Health Quality & Safety Commission, working in partnership with a wide range of stakeholder organisations, ran from 2012–13 until 2017–18. Work began in mid-2012 with the appointment of a clinical lead and formation of an expert advisory group and small programme team.
Older people (over-65s for non-Māori and over 55s for Māori) were 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 that can increase the risk of falling and injury. The programme aimed 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 was for a sustainable and integrated approach to falls in older people, that involved older people and their family/whānau in meeting their goals for wellness, independence or coping.
Since a whole-of-system approach was required to meet these aims in this population, the expert advisory group represented a wide range of perspectives and was able to facilitate strategic partnerships at a national level. The programme strongly supported 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. In particular, falls are high harm events for hospital patients and are consistently about half of all 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 the need to be able to quantify a return on the Commission's investment, meant that the programme team, with assistance from the expert advisory group, prioritised reducing in-hospital falls that resulted in hip fractures (with a reduction in in-hospital fractured hips being chosen as the success or outcome measure for the programme).
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 were 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 ran an annual April Falls Quiz in 2013, 2014 and 2015 as 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 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. They were updated in 2016–17 and will be again in 2019–20. 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 were designed to evaluate the success of the programme interventions; they measure care processes and outcomes.
In May 2017 the Commission published the Falls Open for Results, which summarised the programme for the five years from April 2013 until April 2017. It shows that since late 2015, the rate of falls in hospital that led to a broken hip (known as a fractured neck of femur) has been 30–40 percent lower on average than it was before the programme started in 2013.
The results to end September 2017 show that 107 fewer fractured neck of femurs as a result of an inhospital fall occurred across New Zealand than would otherwise have been expected. This equals a saving of direct costs of NZ$5 million and, because on average an avoided broken hip gives an extra 1.6 years of healthy life, adds up to an additional 175 years of healthy life, worth NZ$31.7 million.
The falls programme’s quality and safety marker information by district health board can be found here.
2017-18 was the final year of significant investment in and active management of the Commission’s reducing harm from falls programme. From 1 July 2018 the programme moved to sustainability mode, with the Commission’s focus and ongoing investment being in key legacy items, for example:
- monitoring and following up on QSM results
- maintaining the evidence base, with an annual rapid review and, every three years, an indepth review (with the next in depth review due for completion in time for April Falls 2020)
- three-yearly update of the 10 Topics in reducing harm from falls (with the next update due for completion in time for April Falls 2020).
- 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.