April No Falls 2014 (1–30 April 2014) ‘There are better ways to prevent falls’

Guide

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Acknowledgements

The Patient Safety Unit, Department of Health, would like to acknowledge Stay On Your Feet WA®

April No Falls Day Event Coordinator Pack in the development of this guide.

April No Falls 2014 Guide

Published by the State of Queensland (Queensland Health), March 2014

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a

copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Queensland Health) 2014

You are free to copy, communicate and adapt the work, as long as you attribute the State of

Queensland (Queensland Health).

For more information contact:

Patient Safety Unit, Department of Health, GPO Box 48, Brisbane QLD 4001, email

psu@health.qld.gov.au, phone 07 3646 9711.

An electronic version of this document is available at www.health.qld.gov.au/stayonyourfeet/

Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

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1. Background

April No Falls is a national and international campaign, which aims to educate and raise awareness of falls prevention and help those at risk of falling to stay on their feet.

This campaign incorporates key messages from: Queensland Stay On Your Feet®—a collaborative, statewide falls prevention program

aimed at reducing the frequency and severity of fall-related injuries among older people. Ageing with Vitality: Your Everyday Guide to Healthy Active Living—based on healthy,

active ageing principles.

April No Falls supports the National Safety and Quality Health Service Standards—Standard 10: Preventing falls and harm from falls.

The 2014 theme focuses on falls and prevention strategies for cognitively impaired persons. The annual incidence of falls in the cognitively impaired population (includes delirium and dementia) is double the normal population. In addition, up to 26 per cent of all hospitalisations in people with dementia relate to falls and fractures1.

However, falls are not an inevitable part of ageing and, even for people with cognitive impairment2; there are a number of positive steps people can take to remain active, independent and on their feet. While delirium increases risk of falls, early recognition and management will improve patient outcomes3.

What is a fall? A fall is an event, which results in a person coming to rest unintentionally on the ground or other lower level4. Most hospitalised fall injury cases are from falls on the same level from slipping, tripping and stumbling.

1Shaw, F. E. J Neural Transm (2007) 114: 1259-1264.

2Shaw, F. E,, Kenny, R. A. Age and Ageing (1998) 27: 7-9

3Han, J., Zimmerman, E., Cutler, N., Schnelle, J., Morandi A., Dittus, R., Storrow, A and Ely, W (2009). Delirium in Older Emergency Department Patients: Recognition, Risk Factors and Psychomotor Subtypes. Academic Emergency Medicine, 16(3) pp 193-200.

4Australian Institute of Health and Welfare, 2009

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How many people have falls? Falls and fall-related injuries are serious health issues and are the leading cause of injury leading to hospitalisation for older people. Every day, as a result of falls:

36 older people in Queensland are admitted to hospital (10 of these for hip fractures)

at least one older person dies

more than 32 hospital inpatient incidents are reported.

Queensland Ambulance Service provides more than 22,000 attendances annually to adults aged 65 years and older who have fallen, with more attendances in the cooler months (May to July). The rate of attendance increases with age, with the highest rate being for adults aged 85 years and over. Most attendances are inside private residences (56 per cent), followed by nursing homes (24 per cent).

Consequences of falling Falls lead to individual physical and social costs, such as:

increasing the fear of falling

restricting activity

reducing quality of life and independence negatively impacting on family and carers6.

Further information stayonyourfeet@health.qld.gov.au

www.health.qld.gov.au/stayonyourfeet

6Close, J. C. T, Lord, S. R., Antonova, E., et al. Emerg Med J (2011). Doi: 10.1136/emermed-2011-200380.

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2. Calls to action 2.1 Prevent falls in a patient who is showing signs of delirium or cognitive impairment

Staff Patient/carers/ family members

complete Falls Assessment and Management Plan (FAMP)

assess for delirium or cognitive impairment

identify and treat reversible causes of confusion

implement interventions based on the person’s fall risk factors

use the Confused Older Person in ED–Clinical Guidelines, Delirium Quick Tips and other StatewideDementiaClinicalNetworkresources.

See appendices:

1. 10 warning signs of dementia 2. 10 tips to minimise risk of

delirium/confusion during hospital admissions.

A regular routine is important to manage behaviours in the person with cognitive impairment78: keep active maintain social engagement eat a balanced diet and keep hydrated regular sleep habits healthy toileting routine wear safe shoes. Ensure the home is safe. Complete the Queensland Stay On

Your Feet® checklist to identify risks and implement management strategies.

Involve healthcare professionals to help manage medication, pain and continence. Do a regular check with your: health practitioner continence therapist optometrist podiatrist dentist. Access other falls prevention resources: www.health.qld.gov.au/stayonyourfeet

7 Meyer, C Hill, S Sow B Synnot A Hill K The Gerontologist (2013) Translating Falls Prevention Knowledge to Community-Dwelling Older PLWD: A Mixed-Method Systematic Review. 10: 1093 8Shaw F (2003) Vol 6 Num 7.

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2.2 Communication

Staff Patient/carers/ family members

Attend local events and statewide April No Falls 2014 webcast/videoconferences.

For more information go to April No Falls 2014 web page and utilise resources.

Promote April No Falls in local services and/or organisation.

‘Like’ the April No Falls messages on the Queensland Health Facebook page.

Subscribe to Twitter and retweet messages.

View the YouTube clip(s). Complete the Preventing Falls and Harm

from Falls online education.

‘Like’ the April No Falls messages on the Queensland Health Facebook page.

Subscribe to Twitter and retweet messages.

View the Youtube clip(s). For information and resources go to:

Stay On Your Feet® website

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3. Ideas for events and activities There are a variety of events and activities you can choose to do locally during the month of April. Plan your month: Design and display a calendar of events with scheduled activities. Involve your Public Affairs Officer to promote events. Consider which local community organisations or businesses may be interested in

partnering with your health service. Hold an official launch day and invite staff. Organise a stand in your healthcare facility foyer to promote Stay On Your Feet®

resources. Know your baseline data before the month starts and review the data after the month

ends. Data might include: - clinical incidents - staff and patient feedback - number of resources used.

During the month: Conduct staff education on:

- National Safety and Quality Health Service Standards Standard 10: Preventing Falls and Harm from Falls

- Falls and Assessment Management Plan (FAMP) - ED Falls Risk Screening Tool use, including ED specific interventions and

referral pathways

Scheduled events may include: - iLearn@QHealth falls prevention online education promotion - hold a competition for the ward with the most staff who have completed

the iLearn@QHealth falls prevention module - promote the suite of Queensland Stay On Your Feet® resources - focus on inpatient education–ensure every patient receives a Queensland

Stay On Your Feet® BeSafe brochure - organise a best-dressed, best themed ward competition - find a falls prevention super hero - create a ‘spot the hazard’ display.

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Engage your patients/community:

Vision focus: - partner with a local business to have optical checks - conduct eyewear cleaning - distribute vision impairment information and resources.

Partner with a pharmacist to: - conduct medication reviews - organise a medication dump point where people can leave out of date or

unused medications.

Partner with a podiatrist to conduct foot health checks and safe shoe reviews.

Partner with a physiotherapist to: - conduct balance check on staff and patients - provide information on where to access local exercise programs - explain the benefits of health exercise - organise a Tai Chi or Otago Exercise Programme demonstration for staff

and patients.

Partner with a local walking group and organise a ‘memory walk’: - make signs to carry - write a slogan or chant to say while walking - take note of uneven footpaths or other hazards to report back to the local

council.

Partner with a local information technology store to: - hold an ‘exergaming day’—use Wii and Gameboys for 10 pin bowling, and

other balance, coordination and memory games - use iPads and play Brainy Apps and other cognitive exercise games.

Partner with a local dementia or Alzheimer’s group and: - organise morning tea with a theme such as ‘healthy brain food’ or ‘food for

vitality’ - have a community speaker on Tai Chi or Otago - have a trivia night with “exercise/ageing with vitality” theme

Access and distribute April No Falls 2014 Queensland Stay On Your Feet®

resources: - crossword - word search - memory game - bingo game.

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4. Was my event a success?

It is important to measure the success of your event to:

ensure you are reaching your target audience

identify what impact it had on staff, patients residents and clients

identify improvements for next year.

You can evaluate your event through simple measures, such as:

the number of resources distributed, such as the Falls Assessment and Management Plan (FAMP) and Queensland Stay On Your Feet® BeSafe brochures ordered via Finance and Materials Management Information System (FAMMIS).

the number of people who attended your event or participated in an activity

staff and patient feedback

debrief sessions to evaluate activities held and what could be improved on for the following year.

a short survey report on data prior to April to compare clinical incidents.

Possible survey questions:

Staff:

Following this session/event/activity, my knowledge of falls prevention has improved.

Reflecting on this session/event/activity, I will be able to action relevant falls prevention strategies in my workplace.

Reflecting on this session/event/activity, I intend to change my falls prevention practices.

The session/event/activity was well organised.

Patient, resident and client:

Following this session/event/activity, my knowledge of falls prevention has improved.

Reflecting on this session/event/activity, I will be able to action relevant healthy active ageing and/or falls prevention strategies in my life.

Reflecting on this session/event/activity, I intend to make changes to be more active and/or prevent falls.

The session/event/activity was well organised.

Ensure you include a comments section for each of the surveys.

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5. Media Snippets

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6. Case Studies

6.1 2013: The Prince Charles Hospital In 2013, The Prince Charles Hospital (TPCH) focused on the relationship between medications, diuretics and falls. The week was launched in the Breeze Café with Humpteana, a character based on Humpty Dumpty, coming to high tea and reinforcing the connection between diuretics and falls. Staff, patients and the public were invited to participate in the competitions and education. They had approximately 100 members of staff and the public attend the stall to access educational material and information and to enter competitions. Education ran for the week and included presentations by physiotherapy, occupational therapy, pharmacy and nursing, reinforcing the whole team approach to falls injury prevention at TPCH. A total of 79 staff attended the education sessions.

2ND  3RD 

1st

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Slide 1: to motivate wards to enter the best themed ward competition

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6.2 2013: Townsville Hospital and Health Service Having a great time on the Wii console

Wall display

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Grab all those passing staff and engage them in a little Tai Chi

Use orange and lots of it and grab all their attention

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Having a great time on the Wii console

6.3 2013: Townsville Hospital and Health Service—rural events Walkway display board

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Safe shoes display board

Safe shoes display board

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6.4 2012: Hughenden Health Service—rural eventsGet the whole community talking about falls

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6.5 2013: Darling Downs Hospital and Health Service—rural events

Partner with community organisations and promote working together to prevent falls and to minimise harm from falls.

You can use basic resources in order to promote the Stay On Your Feet® message in your community.

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7. Templates 7.1 Newsletter article (staff target audience) April No Falls 2014—preventing falls among people living with cognitive impairment April No Falls is an international event aiming to educate and raise awareness of falls prevention.

April 1 is well known for being April Fool’s Day, but this year Queensland Health is promoting better ways to prevent falls for people living with dementia and to help those at risk of falling to ‘stay on their feet’.

Dr Paul Varghese, Chair of the Queensland Statewide Falls Injury Prevention Collaborative, said: “The research reports that people with dementia are 10 times more likely to fall and that this group is three times more likely to sustain a fracture as a result of a fall.”

Dr Edward Strivens, Chair of the Queensland Statewide Dementia Clinical Network, added: “The increased risk of falls in patients with dementia provides a clear reason for the focus on falls and dementia for April No Falls month.”

[Medical Spokesperson name], said: “Sadly, less than 50 per cent of people who are injured and hospitalised as a result of a fall will never go home again.

“In our [Service/Organisation name] all health professionals play a critical role in preventing falls. This April, in addition to standard falls risk management, staff are encouraged to ‘Think Falls: Think Cognition’.”

Staff are encouraged to implement these strategies to prevent falls in those with some signs of cognitive impairment:

assess for cognitive impairment or delirium

identify and treat reversible causes

implement evidence based falls prevention interventions.

Health professionals are encouraged to use the Confused Older Person in ED–Clinical Guidelines, Delirium Quick Tips and other Statewide Dementia Clinical Network resources. For more information: Statewide Dementia Clinical Network. For more information: Stay On Your Feet® website.

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7.2 External media release

Queensland Health launches April No Falls month

More than 30 per cent of people over the age of 65 will suffer a fall at least once a year – this is the message being shared this month, April No Falls.

Queensland Health Hospital and Health Services across the state will be promoting falls prevention this month with a focus on the risks faced by people living with dementia.

Co-Clinical Chair of the Queensland Health Statewide Dementia Clinical Network Associate Professor Edward Strivens said unfortunately more than one quarter of all hospitalisations for people with dementia were due to falls.

‘‘The good news is that there are steps families can take to decrease the chance of a family member with dementia falling,’’ he said.

‘‘Older people living with dementia are at twice the risk of falling.

‘‘Sadly, less than 50 per cent of people who are injured in a fall and go to hospital never go home again.’’

Chairperson of the Statewide Falls Injury Prevention Collaborative Association Professor Paul Varghese said prevention was important for everyone.

‘‘Falls prevention becomes paramount as we age,’’ he said.

‘‘For those who suffer from dementia it is vital that simple changes are made in and around the home,’’ he said.

‘‘Making simple home modifications can be a big help in fact, the installation of grab rails has been shown to decrease the fall rate by 30 per cent.

‘‘Simply providing support to a person with dementia to engage in activities and exercise will assist with strength, balance, flexibility and endurance.

‘‘Also, ensure the person attends regular check-ups with their health professional.’’

To make your home safer, go to http://www.health.qld.gov.au/stayonyourfeet/ and complete a Stay on Your Feet Checklist today.

For more information on dementia: http://www.qld.gov.au/seniors/health/mental-health-awareness/

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8. Resources

Falls injury prevention resources

Clinical forms

- Falls Assessment and Management Plan

- Post Fall Clinical Pathway

- Post Fall Clinical Flowchart

- Residential Care Facility Falls Assessment and Management Plan

- Residential Care Facility Post Fall Clinical Pathway

- Community Falls Assessment and Management Plan

Falls Injury Prevention Model Implementation Standard Falls Injury Prevention Model Policy

These resources are available at Stay On Your Feet® website.

Printed copies of the clinical forms are available for purchase via the Finance and Materials Management Information System (FAMMIS). To order printed copies visit: qheps.health.qld.gov.au/fammis/home.htm

Online education Preventing falls and harm from falls online education is available to HHS staff. The program includes:

introduction to falls injury prevention impact of falls on patients, families and the healthcare system falls prevention strategies post fall management.

For more information: Stay On Your Feet® . To access iLearn@QHealth visit https://ilearn.health.qld.gov.au

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Cross Continuum

Stay On Your Feet® How to Stay On Your Feet® Short Checklist Comprehensive Checklist

Hospital Patient Brochure Stay On Your Feet® in hospital and prevent falls-BE SAFE To order resources: These brochures can be ordered via: Patient Safety Unit Resources Public (external to Queensland Health) Patient Safety Unit Resources HHS (Queensland Health staff). Please note: 1. The links above must be opened in Firefox or Internet Explorer 8. 2. If your browser is not set to one of these options, please copy and paste the URL into your address bar to open this link.

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Staff poster

Screensavers Spotlight

Signature block

All promotional material will be available Stay On Your Feet® website.

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Community Ageing with Vitality: Your everyday Ageing with Vitality workbook guide to healthy active living

To order resources: The Ageing with Vitality resources can be ordered via:

Patient Safety Unit Resources Public (external to Queensland Health) Patient Safety Unit Resources HHS (Queensland Health staff).

Please note:

1. The links above must be opened in Firefox or Internet Explorer 8. 2. If your browser is not set to one of these options, please copy and paste the URL into

your address bar to open this link.

Otago Exercise Programme

The Otago Exercise Programme brochure is available at: www.health.qld.gov.au/stayonyourfeet/for-professionals/otago.asp

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Community posters

The community posters can be downloaded: Stay On Your Feet® website.

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Hospital Clinical forms

Falls Assessment and Post Fall Clinical Pathway Post Fall Clinical Pathway Management form Flow Chart

To order printed copies visit FAMMIS (for Queensland Health staff only).

Community Clinical form Community Falls Assessment and Management Plan

To order printed copies visit FAMMIS (for Queensland Health staff only).

Residential Care Facilities clinical forms

Residential Care Facility Falls Residential Care Facility Post Fall Clinical Assessment and Management Plan Pathway and Flow Chart

To order printed copies visit FAMMIS (for Queensland Health staff only).

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Social media The April No Falls campaign will have a number of social media components targeting family and carers of people who are living with dementia. Below is a breakdown of social media channels used to release posters and online video:

Facebook—www.facebook.com/QLDHealth Twitter—twitter.com/qldhealthnews YouTube—www.youtube.com/.

National guidelines Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Hospitals, Residential Aged Care Facilities and Community Care 2009.

PowerPoint presentations The Patient Safety Unit has developed a PowerPoint presentation for hospitals, residential care facilities and community. For more information or to obtain a copy please email.

Productive Ward—falls module The Patient Safety Unit has developed a module adjunct to Productive Wards. This module provides tools and processes to support the implementation of a falls prevention and management plan from admission through to discharge. Please contact the program office on phone +61 07 364 69757 or email.

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Appendix 1

10 early warning signs of dementia

What are the early signs of dementia?

The early signs of dementia are very subtle and vague and may not be immediately obvious. Early symptoms also vary a great deal. Usually though, people first seem to notice that there is a problem with memory, particularly in remembering recent events.

Other common symptoms include:

confusion

personality change

apathy and withdrawal

loss of ability to do everyday tasks.

Sometimes people fail to recognise that these symptoms indicate that something is wrong. They may mistakenly assume that such behaviour is a normal part of the ageing process. Or symptoms may develop gradually and go unnoticed for a long time. Sometimes, people may refuse to act even when they know something is wrong.

10 warning signs

This is a checklist of common symptoms of dementia. Go through the list of the symptoms, if there are several that you say 'yes' to, a doctor should be consulted for a complete examination of the person with the symptoms. Based on Is it Alzheimer's? Ten Warning Signs You Should Know, Alzheimer's Association, USA.

1. Recent memory loss that affects job skills:

It is normal to forget meetings, colleagues' names, or a business associate's telephone number occasionally, but then remember them later.

A person with dementia may forget things more often, and not remember them later.

2. Difficulty performing familiar tasks:

Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them when the meal has finished.

A person with dementia might prepare a meal and not only forget to serve it, but also forget they made it.

3. Problems with language:

Everyone has trouble finding the right word sometimes.

A person with dementia may forget simple words or substitute inappropriate words.

4. Disorientation of time and place:

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It is normal to forget the day of the week or your destination for a moment.

People with dementia can become lost on their own street, not know where they are, how they got there or how to get back home.

5. Poor or decreased judgement:

Dementia affects a person's memory and concentration and this in turn affects their judgment. Many activities, such as driving, require good judgment and when this ability is affected, the person will be a risk, not only to themselves, but to others on the road.

6. Problems with abstract thinking

Balancing your bank account may be difficult for many of us.

Someone with dementia could forget completely what the numbers are and what needs to be done with them.

7. Misplacing things:

Anyone can temporarily misplace a wallet or keys.

A person with dementia may repeatedly put things in inappropriate places.

8. Changes in mood or behaviour:

Everyone becomes sad or moody from time to time.

Someone with dementia can have rapid mood swings from calm to tears to anger, for no apparent reason.

9. Changes in personality:

People's personalities can change a little with age.

A person with dementia can become suspicious or fearful, or just apathetic and uncommunicative. They may also become dis-inhibited, over-familiar or more outgoing than previously.

10. Loss of initiative:

It is normal to tire of housework, business activities or social obligations.

The person with dementia may become very passive and require cues prompting them to become involved.

Don't assume it's dementia

Remember that many conditions have symptoms similar to dementia, so it is important not to assume that someone has dementia just because some of the symptoms are present. Strokes, depression, alcoholism, infections, hormone disorders, nutritional deficiencies and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated.

A correct diagnosis is important

Consulting a doctor to obtain a diagnosis is critical at an early stage.

For more information: www.fightdementia.org.au/understanding-dementia/diagnosing-dementia.aspx

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Appendix 2 10 tips to minimise risk of delirium/confusion during hospital admissions By taking these 10 steps, you may be able to reduce the risk of delirium:

1. Bring to the hospital a complete list of all medications (with their dosages), as well as over-the-counter medicines. It may help to bring the medication bottles as well.

2. Prepare a ‘medical information sheet’ listing all allergies, names and phone numbers of physicians, the name of the patient's usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient.

3. Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat.

4. Bring in a few familiar objects from home. Things such as family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting.

5. Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there.

6. When giving instructions, state one fact or simple task at a time. Do not overwhelm or over stimulate the patient.

7. Massage can be soothing for some patients.

8. Stay with the hospitalized patient as much as possible. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock.

9. If you detect new signs that could indicate delirium-confusion, memory problems, personality changes-it is important to discuss these with the nurses or physicians as soon as you can. Family members are often the first to notice subtle changes.

10. Find out more about delirium. The American Psychiatric Association's Patient and Family Guide to Understanding and Identifying Delirium Adapted from onlinehealth.com

http://www.hospitalelderlifeprogram.org/public/prevention.php

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Appendix 3