Previous mapping of the falls pathway had demonstrated that there was no clear systematic approach to the identification and onward referral of those presenting to the A&E department at the local hospital with a fall.
A falls team was appointed for an 11 month period, using Change Fund monies. The role of the team was to accelerate the change required and also to provide some temporary capacity to carry out falls assessments and onward referrals until a sustainable model could be sought. An improvement methodology approach was adopted, using PDSA cycles of change.
Working with the National Falls lead, the team introduced a trigger screening tool into the A&E department initially. Once this model was established in A&E is was replicated at other identified sites including sheltered and very sheltered housing complexes, Scottish Ambulance service, day care, community alarm.
The assessment bundle was initially carried out by a band 4 support worker – a member of the falls team. The substantive model of delivery has been possible by enabling other staff to assess need using a standardised multifactorial risk assessment.
Previous mapping of the sector had identified that there was a good supply of evidence based falls interventions.
Monitoring had proved to be challenging. The team, in discussion with NHS Fife and the National falls lead chose to use patient experiences as a measure.
A sustainable pathway is in place, for those patients presenting at some key areas of health and social care. There are however other opportunities within the system to progress this work further.
The benefits have been measured using personal outcomes measures. The majority of patients entered into the pathway describe the interventions as having had a positive effect upon their key outcomes – feeling safer and less isolated, better able to participate socially, no further falls.
The introduction of the trigger tool within A&E, and compliance of the same, became the main focus of attention. In hind sight, better attention should have been paid to the monitoring of the project – although good data has been retrieved.