Keeping People Safely At Home A joint initiative to develop a Falls & Frailty Pathway for Lanarkshire Andrew Graham, Shelly Jeffcott, Elaine Jamieson, Keith Colver, Karen Harley, Sharon Simpson, Lianne McInally, Sandra Lawler, Karen Black, Anne Armstrong and Jill O’Boyle Patients Non- dangerous taken to Aim: falls Hospital Falls and Frailty pathways will improve care, 78% experience and outcomes of patients by: 2 3 4 44,000 falls 50% • Avoiding unnecessary urgent transfer to hospital incident response • Reducing risk of an unnecessary hospital admission (SAS 2014-15) Patients • Enabling early access to community-based kept at Referred to falls Home assessment, rehabilitation & support pathway 22% 5% Figure 1: Evidence BEFORE PATHWAY to show opportunities for improvement1 Method: The first step was to identify key players from Locality Response and Piloting* Building numbers * Train the Trainer^ Spread^ Scottish Ambulance Service and to ensure that both sets of teams understood the context. Shadowing of staff on A&E ambulances brought insight into ‘work system’ challenges to consider. Work system elements interact and influence each other. 16 staff in Law 2 x Paramedics 11 x Team Leaders (10 paramedics Coatbridge station 9 x Paramedics at Coatbridge, & 6 technicians) Coatbridge & Motherwell, PERSON Staff/patient confidence in pathway Cumbernauld Kirkintilloch, Shotts, Douglas/Biggar, Law Time taken for assessment & advice 12 staff trained in Tools & Organisatio n TASK Coatbridge Technology TOOLS & TECH Form availability & transmission Person(s) 10 staff trained in *Health & Social Care Douglas/Biggar Internal ^Scottish Ambulance Environment ORG Training, feedback & management support Tasks Figure 3: Crews trained by Falls Advanced Occupational Therapist * & Team Leads ^ INTERNAL ENV Patient’s living conditions The first task was to develop Level 1 Falls Pathway, ratified by External SAS clinical governance. The next task was a training approach Environment to educate SAS staff on how and when to refer. The current EXTERNAL ENV Not a 24/7 outreach service trial operates in Coatbridge/Cumbernauld and Airdrie localities Mon to Fri between 09:00-15:00. The NHS Lanarkshire Falls Figure 2: Work System Elements that impact on development of Falls & Frailty Pathway5 Register team will record all SAS referrals. Results: Lanarkshire trial Challenges New tests of change Previous ■ Small number crews trained relative ■ Expanding the numbers of crews Lanarkshire to Lanarkshire sub-Division trained to use the referral pathway average 70% ■ The trial in limited locality areas only ■ Extending the trial to more localities ■ ■ All patients Paper forms and faxing to NHS Level 1 Assessment on electronic 23 Patients taken taken to Lanarkshire Falls Register team patient record on ambulance tablets hospital had to Hospital injuries ■ Lack of confidence by crews for ■ Providing feedback for reflective 12 changing practice and mgmt support practice and ‘Masterclass’ for updates ■ Limited patient follow-up occurring ■ 1:1 phone interviews with patients ■ Not informed by patient experience ■ Developing videos of patient stories Figure 4: Evidence AFTER PATHWAY to show reduction in uninjured patients to A&E6 Figure 5: Learning from the trial so far and next steps to increase spread & sustainability References: 1. Scottish Ambulance Service Data Warehouse 2014/15. Acknowledgement: In 2016/17, the Active and Independent Living Improvement Programme (AILIP) 2. Scottish Ambulance Service, ‘Towards 2020: Taking Care to the Patient’. are supporting spread and sustainability of Scottish Ambulance Service Falls & Frailty Pathways. 3. Health and Social Care Board. Commissioning Plan 2016/17. 4. NHS Lanarkshire. Achieving Excellence: Healthcare Strategy, August 2016. 5. Carayon P. et al. Work system design for patient safety: the SEIPS model. QSHC 2006 Dec; 15(Suppl 1): i50–i58. 6. NHS Lanarkshire Falls Register Team data, 2016/17. www.scottishambulance.com.