By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland
On 5th December I went along to the Argyll and Bute Care Homes Quality Improvement for Falls Prevention event. It was a really interesting day, and it was great to hear about the work that care home staff are doing to reduce falls and improve quality of life for their residents.
PDSAs and data
Dr Christine McArthur, Project Lead, introduced the day and Sheila Morris, Occupational Therapy Care Home Lead, gave an overview of Plan Do Study Act cycles and the role of data in improvement. She emphasised the importance of carrying out small tests of change and having a clear plan.
The project participants then had the opportunity to discuss a case study of a 72-year-old lady who had had a number of falls, considering risk factors such as polypharmacy and multiple complex conditions, and reviewing the data in the falls diary to identify whether there was a pattern to her falls.
The care home staff observed that people are increasingly coming in to care homes with more mobility problems and multiple conditions and co-morbidities. Sheila commented that everyone in the care home sector is at risk of falling and should have a multifactorial falls assessment.
A personal account
Donna Wilson described how team work is helping reduce falls in the hospital ward where she works. Where previously information on falls used to get lost in the system, improved documentation and reporting is helping the team to identify the reasons why patients fall. She recommended tools such as measles charts (floor plans for identifying falls hot spots) and stressed the importance of not having a blame culture: it’s important to record all falls, and to learn from them.
Care home staff then had the opportunity to share their successes and pitch their ideas for tackling falls in a Dragon’s Den-style session, with some rather familiar-looking celebrity judges…
It was interesting to see how small changes have made a big difference for residents, such as reducing medication, encouraging residents to walk at different times of the day, introducing new falls documentation and putting a mattress on the floor for a resident with dementia who didn’t always sleep in his bed.
How the care home environment can make a difference
There was then some discussion about the importance of the care home environment, and taking account of residents’ visual problems and cognitive impairment. Contrasting cutlery can help to encourage people to eat, while providing seating areas to rest encourages residents to be mobile. Sheila Morris highlighted the importance of chair height: if a residents are sitting in chairs that are not the correct height for them, this can prevent them from getting enough food and drink, and they will not get enough muscle challenge, which can lead to them falling.
It was good to see innovative practice in this area from elsewhere: we learned about the ‘Pimp my Zimmer’ campaign from Chalkney House care home in Essex, in which residents were encouraged to decorate their zimmer frames, which helped them to remember use them and led to a 60% reduction in falls.
A strong theme from the day was supporting residents to do as much as they can for themselves. Nicola Grainger, physiotherapist, gave advice on maintaining walking aids and ensuring that they’re at the right height – and that residents use them appropriately. Given that one week of bed rest is the equivalent of ten years of ageing on the body, it’s vitally important for staff to support residents to be as active as they can be.
Supporting people through technology
Technology can also play an important part in supporting people’s health and wellbeing. Elaine Booth, Community Engagement Officer at Living It Up, discussed home health monitoring and the potential of tools such as Skype, and highlighted useful resources which are available on the Living It Up website, such as the falls assistant, interactive games and community challenges, which could be used to promote exercise in care homes.
Care home staff were then prompted to list the activities that they do to keep residents active. It was great to see the sheer variety of what was on offer at the different homes: knitting, Christmas tree decorating, dementia gardens, corridor marathons, theatre trips and teaming up with the local nursery for painting and vegetable planting are just a few of the activities that staff are doing to encourage physical activity and enhance residents’ quality of life.
This was an action-packed day with a lot of learning on different approaches to reducing falls and promoting physical activity in care homes. It was inspiring to see staff’s commitment to the project and difference that it is making to the health and wellbeing of older people in care homes in Argyll and Bute.
For some background information on the Care Homes Quality Improvement for Falls Prevention project, have a look at this blog post on a care home quality improvement workshop from earlier in the year.