Sandy Blake has been appointed as Clinical Lead for the National Falls Harm Prevention Programme. She is the Director of Nursing, Patient Safety and Quality, at Whanganui District Health Board, where she led the development of the DHB’s falls injury prevention programme, and sponsored a care indicator survey in the hospital and community to measure the prevalence and impact of falls.
In her previous position as state-wide nursing director of patient safety for Queensland Health, Sandy led the state falls injury prevention programme, directed policy development and implementation, and development of an online education module.
Sandy was the Project Lead for the National Falls Injury Prevention and Pressure Injury Prevention Mapping Project undertaken in late 2011.
Sandy says falls requiring significant additional treatment or causing life threatening injury represent a significant number of the serious and sentinel adverse events reported by New Zealand hospitals.
“Harm from a fall can change a patient’s life – it’s the number one reason for admission to aged residential care. We are compelled to do something; we must do whatever we can to reduce patient harm from falls."
There will be more information coming from the Commission around the scope and prioritisation of activities within this programme shortly. The Commission will work collaboratively with all stakeholders, service providers and health professionals to ensure we complement, not duplicate efforts in this important area.
Dr Shankar Sankaran
Dr Shankar Sankaran is a Consultant Geriatrician at Middlemore Hospital and also Clinical Head, Community, Health of Older People, Counties Manukau District Health Board (CMDHB).
Shankar was Chief Advisor, Health of Older People, Ministry of Health until October 2013. He accepted the role as Chair of the national programme, Reducing Harm from Falls, in 2014, taking over from Karen Orsborn, Commission General Manager, who had chaired the EAG since its inception.
Shankar has been involved in many falls-related initiatives at CMDHB, including the Falls Prevention programme, Orthogeriatric Service, Community Geriatric Service, Bone Density Service and Specialist Older People Service Support to Emergency Care, Residential Care and Primary Care. Of these, the Falls Prevention programme was recognised with the David Lange Award at the South Auckland Health Science Fest in 2000, and by Quality Health NZ with the Quality Improvement Award in 2001.
Passionate about older people’s health issues, Shankar has been involved in many groups, societies and projects which provide a broad range of connections for the EAG:
- Australian and NZ Society of Geriatric Medicine
- National Advance Care Planning Cooperative
- National Dementia Care Cooperative
- NZ Gerontology Association
- Alzheimer’s Society
- interRAI NZ (Chair, Governance Board)
- Northern Region Health of Older People (Steering Group member)
- Aged Residential Care Nursing Workforce Development, Chief Nurse Business Unit, Ministry of Health (Steering Group member)
- Australian and NZ Hip Fracture Registry (Workshop Member).
Dr Andrew Jull
Andrew joined the group in October 2012 and represents the ‘First, Do No Harm’ patient safety campaign initiated by the Northern Region Health Plan, which outlines a set of shared objectives for major public health care providers in the northern region of New Zealand’s North Island (i.e. Northern Region District Health Boards (DHBs) and their primary care partners, the Greater Auckland Integrated Health Network, the National Hauora Coalition and Alliance Health+).
He holds positions in Auckland University’s Faculty of Medical and Health Sciences as Associate Professor in the School of Nursing, and Senior Research Fellow in the National Institute for Health Innovation, School of Population Health. Andrew also has a role as Nurse Advisor (Quality) for Auckland District Health Board (ADHB).
From a background in clinical nursing, Andrew’s career development as a researcher has led to an extensive involvement in the effectiveness movement, including teaching evidence-based practice and clinical trial design. He has been involved in developing national guidelines, held editorial roles in international evidence-based publications, been lead investigator in clinical trials and led Cochrane reviews. In addition to his research expertise, the expert advisory group welcomes the perspectives Andrew brings from his involvement in practice-based patient safety initiatives at ADHB, such as leading implementation of an early warning scoring system and a blood products transfusion checklist, acting as a clinical lead on falls and pressure injury groups, and sitting on the Adverse Event Review Committee.
Beryl Wilkinson is a consumer representative in the Commission’s expert advisory groups for both the falls and medication safety programmes.
Her career, which began in nursing, has encompassed many roles in the public and private sector, including hospital and residential care. In more recent years, Beryl’s focus has been on the older person, with a particular interest in falls prevention for older persons - a recent project has seen her working with ACC to repeat a Falls Prevention/Step Ahead programme for the Whangarei community.
Beryl has been involved with Age Concern Whangarei for 23 years in Branch President and Chairperson roles, and is a member of Northland DHB Disability Support Advisory Committee and the Manaia PHO Advisory Group. For the Office for Senior Citizens, Ministry of Social Development, Beryl is one of ten Ambassadors nationwide and the Volunteer Community Coordinator for Whangarei. She also represents consumer and health of the older person perspectives nationally in her membership of two Accident Compensation Commission advisory groups.
She has been recognised as a Companion of the Queen’s Service Order in 2007 for her services for older people and voluntary service in the community.
Beryl has a strong commitment to the national falls programme addressing the practical concerns of older people in the community:
"I’m here to promote positive ageing and quality of life for our seniors. There are few champions for older people at a time when some are finding themselves living in inappropriate environments, where there are higher risks for falling. We can have policies and procedures for falls prevention, but we must ask ‘Does the older person have what they need to keep from falling?’."
Sandy is a Registered Nurse with extensive experience in aged residential care in Clinical Manager and Care Home Manager roles. She currently holds a national role at Bupa Care Services as Deputy Director of Nursing, having been in a national Quality and Risk Management role with Bupa for seven years. She has a range of responsibilities including continuing education and professional development for qualified nurses; leading the Professional Development Recognition Programme and Competency Assessment Programme; clinical policy development and review and clinical support to care homes. A key part of Sandy’s role has been to oversee the coordination of Bupa’s clinical incident data, ensuring this is collated accurately, analysed and benchmarked within the group.
Bupa is an international company providing a range of health services globally. In New Zealand, Bupa Care Services is a major New Zealand provider of aged residential care (3,600 beds nationally, including rest home care, hospital care, dementia and psychogeriatric services, mental health residential care and rehabilitation), retirement villages as well as some community based services supporting independent living.
Sandy joined the expert advisory group mid-2014 as the nominee of Gina Langlands, General Manager – Quality and Risk, Bupa Care Services, who was a member of the expert advisory group from its inception until early 2014.
Sandy is passionate about reducing the use of restraint and has led a five year campaign to reduce restraint use across all Bupa care homes by more than 50%. This reduction has been sustained, and the falls rate has not increased during this period.
“As the largest provider of aged residential care in NZ, I am excited that Bupa has this fabulous opportunity to be involved in a national initiative to reduce harm from falls. This gives us the opportunity to share and influence the best practice within our own care homes and the wider aged residential sector.”
Jan is the Chief Operating Officer (COO) for Waikato District Health Board, having been appointed to that position after holding general management positions and the Director of Nursing and Midwifery role.
Jan trained as a nurse and midwife in the United Kingdom, and held a variety of posts in both the National Health Service and the private sector before migrating to New Zealand in 1992. She has post graduate qualifications in both nursing and management.
Jan has a significant interest in quality at all levels including the quality of services delivered. She served two terms of office on the Nursing Council of New Zealand, was Deputy Chairperson for three years, and was involved in the development of competency assessment for nurses in preparation for the Health Practitioners Competency Assurance Act.
Waikato DHB’s Quality and Risk team report to Jan, and she has been instrumental in the development of Waikato DHB’s Falls Minimisation Programme. Jan says: "The cost and impact of falls with harm are significant to the person involved, their family and health care organisations. I’m very pleased to be involved in the expert advisory group that will raise awareness and work with wider sectors to reduce the impact of this significant patient safety issue."
Jan is the link to the national DHB Chief Operating Officers group as its Chair.
Nicola Turner is General Manager of Enliven, Presbyterian Support Central (PSC). Initially an occupational therapist, Nicola has a Masters in Business Studies, and has been in health management roles for the last 23 years, working for the Royal New Zealand College of General Practitioners and Hutt Valley District Health Board.
Enliven, PSC is a not-for-profit organisation that supports almost 1000 older people in aged residential care and over 4000 people at any one time in their own homes. Since older people are at greater risk of harm from falling, Nicola describes how this is a strong focus for Enliven:
“Enliven has a comprehensive approach for residents, which includes falls risk assessment and individualised prevention strategies which recognise the tension between a person’s independence and quality of life, and the provider's obligation to manage falls risk.”
Nicola was nominated to the EAG to represent the New Zealand Home Health Association (NZHHA), a membership organisation of home health providers which must be certified to the sector standard to gain membership. NZHHA members support approximately 65,000 people in their own homes, and while falls prevention is not explicitly covered in many contracts, there is potential to reach a multitude of frail older people who have identified disability.
Nicola is also able to link the Programme’s work with Presbyterian Support Services throughout New Zealand, the New Christian Council of Social Services and the Eden in Oz and NZ network.
Sonia Gamblen is the Director of Nursing for Tairawhiti District Health, a position which also carries the DHB portfolio for quality and risk management, and as such has great influence on patient safety.
Sonia’s nursing experience has been gained in three health care systems; England, Scotland and New Zealand. In her senior nursing roles she has worked across professional groups and health agencies to improve processes, systems and patient experiences.
Sonia describes her journey in making patient safety paramount: “About 12 years ago I started asking myself, and the people with whom I worked ‘Why do patients have so very differing experiences of health care? Why does patient A have a good experience and patient B have a completely different experience?’. I have seen marvellous patient outcomes, but also patients suffering various forms of harm as a result of their hospital experiences – and while I firmly believe none of these were intentional, they were often not seen as preventable. The change in thinking – to consider and implement measures that prevent adverse patient outcomes – makes it an exciting time to be working in health care”.
Sonia represents the national DHB Directors of Nursing group on this project, providing a link between the Programme’s work and nursing leadership in each DHB. Sonia also makes a specific connection with Carey Campbell, Chair of the New Zealand Private Surgical Hospital Association Directors of Nursing.
Professor Ngaire Kerse
Professor Ngaire Kerse is a general practitioner with training in geriatric medicine and a PhD from Melbourne University in health promotion for older people. She is Professor of General Practice and Primary Health Care and Head of School of Population Health, University of Auckland, and runs a programme of research with the aim of preventing falls and improving quality of life for older people in all settings.
Her involvement in falls prevention is extensive.
- At Auckland University she lectures medical students and registrars about falls prevention.
- In Auckland and regionally, she provides continuing medical education on falls prevention and prescribing Vitamin D.
- She is on the executive of the Australia and New Zealand Falls Prevention Society, and is an advisor on the ACC Fall and Injury Prevention Strategy Group.
- Internationally, Ngaire is a member of the cochrane review group for falls prevention in nursing care facilities and hospitals.
- She ran several trials of falls prevention for older people and collaborated on several others.
She led the Life and living in advanced age: a cohort study in New Zealand (LiLACS NZ) study which examines predictors of successful aging in Māori and non-Māori.
Preventing falls is important, Ngaire says “because staying upright maintains independence and quality of life in older people.”
Ngaire will be taking sabbatical until mid-2014, but continues to be available for expert opinion, with Honorary Research Associate Professor Clare Robertson joining the EAG.
Judith is a Registered Nurse (RN) with extensive experience in education and aged care, including owning and operating facilities and holding senior management roles in large companies. She is currently a self-employed consultant and her core contract as clinical adviser to the New Zealand Aged Care Association (NZACA) includes running an 0800 helpline for members and providing items for a weekly newsletter and other publications. Judith organises seminars for managers, RNs and carers in the sector, also presenting at these seminars and conferences.
In her education role, Judith makes falls prevention and harm reduction an important focus. Additionally, when she is in an advisory capacity for a site (either contracted directly or by a DHB to take over management if standards are a concern), measures to prevent falls are naturally a priority. She brings a quality systems perspective and experience in guiding sites in development of an effective falls prevention programme.
Working in aged care with a quality improvement interest means paying attention to falls prevention, but Judith became particularly motivated after her mother had a fall.
“My mother had a fall in her late 80s, fracturing her neck of femur. I witnessed the trauma and change of quality of life she experienced in the last year of her life following the fall.”
Judith’s role as clinical adviser to NZACA means that she is in contact with over 80 percent of the aged care sector nationally.
Associate Professor Clare Robertson
Associate Professor Clare Robertson joined the EAG in February 2013 to replace Professor Ngaire Kerse who is on sabbatical leave. Clare is an internationally recognised falls prevention expert who has recently retired after working for 20 years as a falls prevention researcher at the Dunedin School of Medicine, University of Otago. Clare has had formal training in science, information systems, statistics, and health economics. She has a PhD in Public Health from the University of Otago.
Clare worked closely with geriatrician Professor John Campbell who was already a well known falls prevention expert when she joined his research group in 1993. Their New Zealand based research includes studies of a home safety programme for older people with visual impairment, withdrawal of sedative medications, and multifactorial interventions in the community and in aged residential care facilities. They were responsible for the design, development and comprehensive evaluation of the Otago Exercise Programme, a falls prevention programme for older people that has been adopted internationally and translated into many different languages.
Clare Robertson is a co-author of the Cochrane systematic reviews of interventions for preventing falls in older people in hospitals and aged care facilities (2012) and older people living in the community (2012). She has been a writer and reviewer in the team producing a set of online learning activities for the Commission, 10 Topics in reducing harm from falls.
Clare is passionate about ensuring that older people can take advantage of appropriately targeted, effective falls prevention programmes. "We know that preventing falls will prevent fractures and other injuries, making falls prevention programmes an excellent investment from both the individual and the health system perspective," she says.
Dr Paul Watson
We would like to acknowledge these people for their input as members:
Gina Langlands (General Manager – Quality and Risk, Bupa Care Services) from the group’s inception until early 2014
Bubsie MacFarlane (Chief Executive Officer for Aroha Mai Cancer Support Services) from mid 2013 to mid 2014
Caroline Gall (Manager, Public Injury Insurance at ACC).
Carmela Petagna, Senior Portfolio Manager
Gabrielle Nicholson, Senior Project Manager (Implementation)
Shelley Jones, Programme Advisor (Development)
Gillian Bohm, Principal Advisor Quality Improvement