Implementing the new Falls Quality Standard - assessment and secondary prevention in older people
Professor Cameron Swift, Emeritus Professor and Consultant Physician, King’s College London discussed Implementing the new Falls Quality Standard Falls - assessment and secondary prevention in older people at today’s conference. Professor Cameron Swift discussed in-depth:
- implementing the new quality standard for falls assessment and secondary prevention in older people
- implementation challenges and quick wins
- meeting the Quality Statements
Professor Cameron Swift’s full presentation is available for download at the end of this page.
The NICE Quality Standard on Falls Assessment and Prevention in Older People (QS 86) provides an opportunity for those with expertise in this age-associated syndrome to provide leadership and make progress in the development and structure of professional practice and service configuration. A Quality Standard is not comprehensive guidance, but is intended to be a “smart” audit tool comprising selected sensitive measurable statements of structure, process and/or outcome to support improvement. QS 86 draws on three NHS approved evidence sources, including NICE Clinical Guideline 161. Falls in later life are of twofold significance – (1) the risk of injury and its consequences and (2) as a signal of underlying diagnostic and therapeutic need. There is reasonable evidence that multidisciplinary management of both elements in parallel is remarkably cost-effective, although this is less so for either element alone. QS 86, comprising 6 statements – 3 each on inpatient and community-based falls respectively - is available as a potentially effective “blunt” instrument in the right professional hands and as an opportunity to achieve change for the better.
Professor Cameron Swift’s States:
- Not fixed targets
- High level audit measures of local quality in structure, process or outcome
- Expressed as measurable proportions – not necessarily 100% norm
- Maximally evidence-based
- Where possible, set in the context of national data collection
- Falls QS published March 2015
QS 86 Statements
- INPATIENT SETTING
- Older people who fall during a hospital stay are checked for signs or symptoms of fracture and potential for spinal injury before they are moved.
- Older people who fall during a hospital stay and have signs or symptoms of fracture or potential for spinal injury are moved using safe manual handling methods.
- Older people who fall during a hospital stay have a medical examination (“to see if they are injured”)
- COMMUNITY SETTING
- Older people who present for medical attention because of a fall have a multifactorial falls risk assessment.
- Older people living in the community who have a known history of recurrent falls are referred for strength and balance training.
- Older people who are admitted to hospital after having a fall are offered a home hazard assessment and safety interventions.
“30% >65: 50%>80 fall at least once yearly…Injury, disability, dependency, mortality…NHS annual cost >£2.3bn”
FALLS DIAGNOSIS, MANAGEMENT AND PREVENTION IS:
- VITAL, EFFECTIVE AND COST-EFFECTIVE
- SPECIALISED – INTEGRAL TO CLINICAL GERONTOLOGY
- MULTIFACTORIAL AND MULTIDISCIPLINARY
- COORDINATED, FOCUSED & COMMISSIONED
- INSUFFICIENTLY IMPLEMENTED
Professor Cameron Swift’s Biography:
Cameron Swift is a physician and clinical pharmacologist, Emeritus Professor of Health Care of the Elderly at King’s College School of Medicine, London, and a past President of the British Geriatrics Society. He was a member of the UK Medicines Commission from 2001-5. As Physician to the DOH External Reference Group for the England National Service Framework for Older People, he chaired the Working Party for Standard 6 (Falls & Fractures). Subsequently he has served on the NICE Clinical Guideline Development Groups (GDG’s) for Falls Prevention and Osteoporosis, and has been Chairman of the NICE GDG, subsequent Quality Standard Topic Expert Group, and Evidence Update for Hip Fracture.