A falls prevention initiative at Greater Manchester Mental Health NHS Foundation Trust (GMMH), led to a 23% reduction in falls on high risk wards, and 19% overall reduction in falls on mental health inpatient units across Bolton, Salford, Trafford and Manchester.
The results of the initiative were announced at the Advancing Quality Alliance (AQUA) North West Regional Mental Health Improvement Event on 15th March 2023.
In December 2020, GMMH embarked on an initiative to reduce falls at the Trust, in response to mounting evidence of the scale and impact of falls in the NHS.
A report released by the ONS in May 2019 showed that the number of older people in the UK dying as a result of a fall has risen by 70% – from 3003 in 2010 to over 5000 in 2017.
In 2020, almost 1000 people across the North West died as a result of a fall at home, with 730 being over the age of 75.[1]
Even in the case of falls that do not result in death or serious harm, the impact for the individual can be profound and long-lasting, causing distress, pain, injury, loss of confidence, and loss of independence.[2]
Falls are a significant challenge for the NHS, with 240,000 falls reported in NHS hospitals in England and Wales every year - over 600 a day[3] – which are estimated to cost the NHS more than £2.3 billion per year.[4]
GMMH’s falls initiative initially focused on ten ‘innovation wards’ - the inpatient wards with highest falls risk, including all those for later-life patients, and for alcohol and drug detoxification - which made up 51% of all falls reported at GMMH.
The aim of the initiative was to reduce falls on these wards – and associated harm to service users – by 15%; with the longer-term aim of rolling out learning and improvements across all mental health inpatient units at the Trust.
An ‘expert faculty’ was selected to provide leadership and oversight of the project; and, throughout, input was provided by Experts by Lived Experience to understand their first-hand experiences of falling whilst in hospital, the impact this has had, and where they feel improvements could be made.
Together with ward staff and stakeholders, five key drivers for improvement were identified: Prevention; Leadership and Organisation; Education; Communication; and Environment.
Then, change ideas were captured by each ward, tested and assessed using the ‘Plan-Do-Study-Act cycle’. From this, five key improvements were identified, which were then incorporated into a ‘change package’ which could be rolled out across the Trust:
Highlighting patients at risk of falls
The use of non-slip socks in falls prevention
Weekly exercise programme
Ramblegard falls prevention technology (through motion detection)
Frailty assessments
The results of the initiative were very positive, showing a 23% reduction in falls on the innovation wards by December 2021.
Associated harm was also reduced, with the majority of incidents being categorised as insignificant or minor, compared to previous years.
Learnings and actions from the initiative were also cascaded to inpatient teams in Bolton, Salford, Trafford and Manchester, leading to a 19% overall reduction in falls in these areas too.
These results were announced at the AQUA North West Regional Mental Health Improvement Event on 15th March 2023. On the day, past GMMH service user and Expert by Experience, Celine, spoke about her experience.
She said:
Quote
“Before my fall, I enjoyed an active lifestyle. I was a proud member of the Irish Hurling team, I went to the gym every day, I enjoyed an active social life with my friends and family, and I worked full time as a Receptionist.
“At age 37, I became unwell with my mental health and I was admitted into hospital. Whilst in hospital I had a fall in the shower and I was badly injured.
“My life is very different now. I am paralysed on the left side of my body and have osteomyelitis. I am a wheelchair user, and I no longer go to the gym. I have lost my independence and rely on care support.
“It was important to me to tell my story in order to prevent this happening again to anyone else. Even small changes can make a big difference. In my case, I fell in the shower, and something as simple as an anti-slip mat and grab bar could have prevented it.
“I am now a member of the GMMH Falls Expert Faculty Collaborative. As a Lived Experience member, my role is to raise awareness of the impact falls can have, share my own reflections and suggestions for improvement, and ensure that staff take falls seriously and do everything in their power to prevent them.”
Samantha Stansfield, Lead Professional for Physical Healthcare at GMMH said:
Quote
“Our falls prevention initiative has been one of the most challenging yet important pieces of work for the organisation, and I am proud that so many different teams across our Trust have taken it to heart.
“The enthusiasm across each of our innovation wards to identify change ideas and start to test those ideas using the Plan-Do-Study-Act cycles, with an aim to improve patient safety and experience, has been amazing. When I visit our services, I am constantly impressed with the creative ways in which staff are overcoming challenges to reducing falls and subsequent harm.
“We are absolutely delighted with the significant improvements we’ve seen so far, but we’re still just at the start of our journey. A Trust-wide Change Package has now been introduced, to ensure the sustained roll out of key changes across GMMH’s inpatient units, which we believe are likely to result in improvements that will really impact on patient safety and experience across our footprint.”
[1] https://www.nice.org.uk/guidance/cg161/chapter/Introduction
[1] http://www.mtpinnacle.com/pdfs/slips-trips-fall-2007.pdf
[1] https://www.nice.org.uk/guidance/cg161/chapter/Introduction
[2] https://www.nice.org.uk/guidance/cg161/chapter/Introduction
[3] http://www.mtpinnacle.com/pdfs/slips-trips-fall-2007.pdf
[4] https://www.nice.org.uk/guidance/cg161/chapter/Introduction
Main Photo ©: Image 1 pictures from left to right: Alison Schofield (Quality Improvement Lead, GMMH), Celine (Expert by Experience, GMMH), Eleanor Ford (Physiotherapist, GMMH) - presenting the results of the initiative at the AQUA North West Regional Mental Health Improvement Event on 15th March 2023.
Photo ©: Image 2 pictures Celine (Expert by Experience, GMMH).
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