Zero Falls in Our Care is one of Mersey Care's Perfect Care Goals for 2023-2024.

This page has been developed as a resource to support staff with making improvements and changes in their practice, to help reduce the number of falls and falls resulting in harm, for the people in our care.

This page will be reviewed and updated every six weeks, so please feel free to come back and visit again in a few weeks. To contribute or comment on the content of this site, email: Jason.oflaherty@merseycare.nhs.uk

Trust-wide: Zero Falls in Our Care group.

Francesca Cairns: Deputy Director of Therapies, Psychological and Allied Health Professionals

Fran is the Trustwide Senior Responsible Officer for Falls and is Chair of the monthly Zero Falls in Our Care Trust wide Falls Group.

Jason O’Flaherty: Falls and Manual Handling Coordinator

Jason is the Corporate division lead for falls and works in a Trust wide capacity, providing clinical guidance, promoting a consistant approach across the divisions and facilitating shared learning.

Mental Health Care Division: Zero Falls in Our Care group

Ian McNulty: Head of Allied Health Professionals

Ian is the Chair of the Mental Health Care Divison Zero Falls in Our Care group and represents the division at the the Trust-wide Zero Falls in Our Care group. 

Victoria Glaze:  Highly specialist Physiotherapist

Vicky works in the Mental Health division (community and in-patient wards in Liverpool) as a highly specialist physio and contribues extensively to the divisional and trust-wide falls programme.

Latest minutes and action plans:

MHC: Zero Falls in Our Care minutes - February 2023

MHC: Zero Falls in Our Care minutes - March 2023

Community Division: Zero falls in our care group

Debbie Tubey: Deputy Associate Director of Nursing and Patient Experience

Joanne Barnfield: Head of Allied Health Professionals - Dental and Mid Mersey Place

Judith Gent-Jones: Head of Allied Health Professions - CYP, Families and Sefton Place

Anne-Marie Howard: Head of Nursing - Liverpool Place

Tracey Carver: Heald of Nursing - Liverpool Place

Angela Lacey: Heald of Nursing - Dental and Mid Mersey Place

Latest minutes and action plans:

Community Division: Zero Falls in Our Care minutes, March 2023

Community Division: Zero Falls in Our Care, Action Plan - March 2023

Secure and Specialist Learning Disability Division:

K​​​​rystina Stanway: Head of Allied Health Professionals

Falls Prevention Service - Liverpool

Referral criteria: 18 years or older, registered with a Liverpool GP, Service Users at risk of falls or who have fallen, FRAT score of 4 or highers (or 3/5 with a falls history based on clinical reasoning), would benefit from an assessment in their own home (not necessarily housebound).

Exclusion criteria: Service user's diagnosed with dementia or cognitive impairment, palliative conditions, recent fractures, resident in care or nursing home.

Falls Group inclusion: As above and also: Mobile with/without walking aid (independently mobile), no cognitive impairment (can follow commands), good hearing (able to participate in group sessions, good vision (able to participate in group/exercise, continent, service users participating in heavy alcohol consumption are not suitable, self motivated/able to engage, commitment to completion of group, sufficient stamina/exercise tolerance. Pain well controlled.

Falls team consists of: Physiotherapist, Occupational Therapist, Podiatrist, Exercise Instructor

Contact: Liverpool Community Falls Team, Lifehouse, Brunswick Dock, Liverpool, L3 4BL

Tel: 0151 296 7767

Liverpool Falls Service - Information leaflet

Liverpool Falls Service - AHP Referral form

Falls Prevention Service - Southport and Formby

Referral criteria: 65 years or older, registered with a Southport and Formby GP, Able to follow / understand basic instructions / functionally mobile / consents to referal and must be able to take part in rehabilitation programme if appropriate.

Exclusion criteria: Adults under 65 years of age, adults who score less than 2 on the falls screening tool, acute episode/exacerbation of illness that requires an acute hospital environment to deliver care needs, acute injury/trauma that requires an acute hospital environment to deliver care needs, advanced dementia patients that score 10 or less on the Mini State Mental Examination (MMSE), palliative service users, wheelchair bound, adults under the influence of alcohol/substance misuse (refer to alcohol/substance misuse), service users with a permanent impairment of the functioning of the brain as a result of a brain injury and are unable to live independently. 

Services offers: Non-urgent multifactorial falls assessments in clinic or the home environment.  Assess service users who have fallen or are at risk of falls.

Prior to referral please review and consider if the service user has recently been assessed by or currently awaiting assessment by: the falls team, north Sefton planned therapies, neuro, etc aiming to reduce duplication referrals.

Referrals via SPOA: Email: southportandformby.spa@merseycare.nhs.uk

Contact: Falls.prevention@merseycare.nhs.uk

Southport & Formby Falls Service - Information leaflet (for professional printing only)

Southport & Formby Falls Service - Referral form

Falls and Fracture Prevention Service - Knowsley

Referral criteria: 55 years or older, either with a Knowsely GP or resident in Knowsley.

Service offers: Falls assessemetns either in community clinics or home visits (depending in triage).  Wider falls prevention and education for the General public and care homes across Knowlsey.

Falls team consits of: Nurses, Pharmacist, Physiotherapist, Excercise professional, Falls assessor & falls assistant.

Contact: Knowsley.falls@nhs.net

Knowsley Falls and Fracture Prevention Service - Information Leaflet

Knowsley Falls and Fracture Prevention Service - Pop up Banner

Knowsley Falls and Fracture Prevention - Service Referral form

Falls Prevention Service - St Helens

 

 

Falling can happen to anyone, but for older people the risk is particularly high and the consequences can be severe, including distress, pain, injury, loss of confidence, loss of independence and mortality.

Falls are a common and serious health issue for older people, with around a third of all people aged 65 and over falling each year, increasing to half of those aged 80 and over (NICE 2013).

Most falls do not result in serious injury. However, there's always a risk that a fall could lead to broken bones and can cause the person to lose confidence, become withdrawn and feel as if they have lost their independence. Hospitalisation can often cause changes in a patient's ability to walk or get out of a bed or a chair and then this puts them at higher risk of a fall.

NAIF: Annual Report 2022

Clinicalskills.net is an online resource Mersey Care has subscribed to, this provides all clinical staff with a wide depository of clinical procedures (including over 40 seperate procedures relating to manual handling).  To access Clinicalskills.net you need to have an account.  Email: ClinicalSkillsTeam@merseycare.nhs.uk if you would like an account.

The following Clinicalskills.net procedures relate to the management of the falling and fallen person.

Practical training on the procedures below is provided by the Manual Handling training team.  Manual Handling training should be booked via the Learning and Development Prospectus.  For more information and support with practical manual handling, email: Manual.Handling@merseycare.nhs.uk

Procedure 6a: The falling person, lowering to the floor

Procedure 6b: Management of the fallen person

Procedure 6c: Recovery of the fallen person with slide sheets

Procedure 6d: Recovery of the fallen person using a Mangar Elk

Procedure 6e: Recovery of the fallen person using slide sheets and the Mangar Camel

Procedure 6f: Recovery of the fallen person using the Raizer Lifting Chair

Procedure 6g: Recovery of the fallen person using a flat lifting air mattress (Hoverjack / Flojac)

Procedure 6h: Recovery of the fallen person using a Hoist and Sling

Mangar ELK's are issued via some of the local Community equipment stores and there are also several ELKS and Camels located across the wards (Camels have a back rest).

Training on the use of ELK's and Camels is available by contacing the Manual Handling Team.

Email: Manual.Handling@merseycare.nhs.uk

Raizer chairs are used by some of the local falls prevention teams, these come in both manual (wind up) and battery operated versions.

Molift Partner 255 hoists are available on some of the Mental Health division wards.  There are currently no scoop stretchers located on the wards but training on how to use the Molift 255 hoist and scoop stretcher can be provided by the Manual Handling team.  Email: Manual.Handling@merseycare.nhs.uk

 

As part of the work to achieve ‘Zero Falls in Our Care’,  Level 1: Falls Prevention training has been co-designed with the subject matter experts (SMEs) from our Divisions and through the Trust Wide Zero Falls In Our Care Group including lived experience.  It has been designed for all clinically facing staff and will take no more than 20-30 minutes to complete via e-Learning.  

This training aims to help staff learn about falls, how they can have serious consequences and what can be done to reduce falls. 

Falls can happen to anyone and they can have significant consequences regardless of age.  All staff can have a part to play in managing and reducing the risk of falls by undertaking this training, being aware of falls risks and assessing, managing and referring people to appropriate services where required.

Level 2: Falls Training has been developed to support those areas where the Multi Factorial Risk Assessment Tool process is being rolled out.  Where this is the case this training will be offered to staff champions to support the successful roll out.

Level 3: Falls Training is a more advanced training course for those clinicians who work in an area where falls prevention and management is key.  This course is just in the process of being co-developed and more information will follow once the training is available to book via the L&D Prospectus

NAIF guidance: Supporting best and safe practice in post-fall management, inpatient settings

NAIF: Post -fall decision making flow chart

Falls Prevention and Bone Health Training Package (LCC, V2)

An estimation of the impacts of coronavirus (COVID-19) on physical activity and falls in older adults and recommendations to mitigate these effects.COVID-19: wider impacts on people aged 65 and over - GOV.UK (www.gov.uk). 

Public Health Englands COVID-19 Cabinet commissioned the Health Economics and Modelling Team (HEMT) to undertake work to identify the wider public health impacts of COVID-19 and carry out modelling in priority areas to quantify these impacts.  This study looks at how the wider impacts of COVID-19 have affected older people (over 65 year olds), with a focus on deconditioning and falls.

Key findings were:

  • 32% of older people were inactive (did either no activity or less than 30 minutes of moderate activity per week) between March to May 2020. This has increased from 27% in the corresponding period in 2019

  • average duration of strength and balance activity decreased from 126 to 77 minutes per week in March to May 2020 compared to the corresponding period in 2019

  • inequalities in physical activity have persisted, older people in the most deprived group (defined by Index of Multiple Deprivation) were more likely to be inactive than those in the least deprived group in both 2019 and 2020

  • older people experienced a considerable reduction in strength and balance activity between March to May 2020, with the greatest change in the 70 to 74 age group with a 45% (males) and 49% (females) decrease observed in activity

  • without mitigation, modelling predicts that: • 110,000 more older people (an increase of 3.9%) are projected to have at least one fall per year as a result of reduced strength and balance activity during the pandemic

  • the total number of falls could increase by 124,000 for males (an increase of 6.3%) and 130,000 for females (an increase of 4.4%)

  • for each year that the lower levels of strength and balance activity observed during the pandemic persist, there is projected to be an additional cost to the health and social care system as a result of the change in predicted related falls of £211 million (incurred over a 2 and half year period)

Key recommendations for the whole population are:

  • promotion and increased availability of strength and balance activity for older adults, involving a gradual increase in activity in order to reduce falls risk and to enable safe and confident participation on other forms of exercise and physical activity

  • ensuring that physical activity recovery measures reach those who stand to benefit most from them, including older adults who shielded, with multimorbidity, with dementia, in social care settings and from more deprived backgrounds

  • identifying locally which older adults have reduced their levels of physical activity during the COVID-19 pandemic, with a focus on populations where the largest reductions are likely to be found. The largest reductions in strength and balance activity identified in this report were seen in males aged 65 to 74 and females aged 65 to 84

Key recommendations for the targeted population are:

  • referral of older adults with functional loss, transition towards frailty or fear of falls resulting from deconditioning to appropriate rehabilitations services

  • raising awareness amongst health and social care staff of post-COVID-19 syndrome, communicating the risks of building up levels of activity levels too rapidly and the need to refer to post-COVID-19 syndrome clinics where symptoms are severe, in order that clinical judgement can be used about whether graded exercise therapy should be recommended

Slips-trips-falls.jpgLatest News

Mersey Care Trust board identify fove high level objectives each year for the organisation to strive to achieve significant change. For the 2nd year running, Zero Falls in Our Care remains one of the the Trust's Perfect Care Goals for 2023 - 2024.  Last year we saw the sucessful role out of the MFRAT and Level 1 Falls training.

For 2023-2024, the Trust wide Zero Falls in Our Care group has a refreshed project plan with some exciting and ambitious objectives for our work in inpatient settings and within the community.

Goodbye and best wishes to Lynn King.  For many years Lynn worked tirelessly in her role as AHP Strategic Lead.  Lynn made a massive contibution in the world of Falls Prevention and her hard work will surely be missed.

In March, Floor Level beds were purchased for every bedroom on Fern ward, Leigh Moss Hospital.  These beds should make a significant positive difference to the level of harm that can occur as a result of a fall. 

Useful websites

Leaflets and posters

Twitter

Follow @falls_network

#ThinkFalls
#FallsAwareness
#FallsAwarenessWeek