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The new Falls Quality Standard Falls - assessment and secondary prevention in older people

Will Carr Clinical Specialist Falls Prevention Gloucestershire Hospitals NHS Foundation Trust spoke at today’s Falls Prevention and Management in Older People conference on:

• the new quality standard for falls assessment and secondary prevention in older people
• implementation challenges and quick wins 
• meeting the Quality Statements

Will is currently working with the National Osteoporosis Soceity implementing fracture liaison services with the intention of preventing an estimated 22000 hip fractures through early identification.

On the Falls NICE quality standard Will discussed how not everything is covered only the areas deemed most important for quality improvement, and that the quality standard offers some challenges for implementation inlcuding: 

  • Statements broadly spread over both Primary and Secondary care settings
  • Exercise and home hazard assessment, interventions also likely to require involvement of Local Authority, Third Sector and private organisations
  • Agreeing consensus definition of a fall
  • Processes to accurately record the number of fallers
  • Resources

–Evidenced based strength and balance classes
–Occupational Therapy home assessment

Will said there is also opportunities that looking at the bigger picture and multiagency working is quite exciting and offers a drive to say how we can work with orther organisations including the private sectors. 

Abstract of Will's talk

Quality Standards (QS) highlight key areas for development within a defined area of health or care.  They describe the high priorities for quality improvement in this particular area.  A QS is made up of a set of succinct statements and associated measures.  These are drawn from existing NICE guidance or other accredited sources.  Consideration is also given to comments from NHS, service user and other organisations during the consultation process when creating a QS.

QS can contain up to 15 quality statements which describe an aspirational but achievable ‘enhanced’ service.  The associated measures can be used to assess the provision of the care or service as defined by the statement.  QS86 ‘Falls in older people: assessment after a fall and preventing further falls’ includes six statements:
1.    Older people who fall during a hospital stay are checked for signs or symptoms of fracture and potential spinal injury before they are moved.
2.    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.
3.    Older people who fall during a hospital stay have a medical examination.
4.    Older people who present for medical attention because of a fall have a multifactorial risk assessment.
5.    Older people living in the community who have a known history of recurrent falls are referred for strength and balance training.
6.    Older people who are admitted to hospital after having a fall are offered a home hazard assessment and safety interventions.
As with the associated NICE Clinical Guideline (CG161 Falls: assessment and prevention of falls in older people), older people are defined as those aged 65 and over.  Most of the statements relate to assessments and interventions associated with fallers in hospital care.  However, some are extrapolated out to include community dwelling older people who present to walk-in centres and attend at GP surgeries.

All QS indicate if any related national quality assured indicators, or sources of routinely collected data such as national audits, are available to be used to measure the quality statement.  Otherwise, the quality measures themselves will form the basis for the development of local audit and data collection processes.  Some measures highlighted in QS86 can be evidenced from the non-hip fracture elements of the Royal College of Physicians Falls and Fragility Fracture Audit Programme.

It is likely that some provider organisations may feel they are already achieving many aspects highlighted by the QS; and a significant proportion that will not be.  Some will also experience substantial challenges to establish which elements are relevant to their organisations and be required to forge new partnerships across the whole care pathway to work towards meeting the statement.  However, this is the aim of these aspirational drivers for enhanced quality of care.

The full QS is available on the NICE website:

Will’s full presentation is available for download at the end of this page. 

Will is a Physiotherapist by profession; qualifying with a BSc (hons) from UWE in 2003.  He completed his formative rotations in Cheltenham and Gloucester hospitals before focusing on elderly rehabilitation in the community.  He subsequently specialised into falls prevention and has helped evolve the Falls Service in Gloucestershire as a Clinical Specialist in Falls Prevention and Management for the last 5 years.  He has just completed a yearlong NICE Scholarship project based on implementing the in-patient guidance described in NICE 161.

Will has recently left the NHS to join the National Osteoporosis Society as a Project Manager in the Charity’s Service Development team; which aims to expand the provision of Fracture Liaison Services provided across the country.

Next event:

Falls Prevention and Management in Older People
Thursday 9 July 
ICO Conference Centre, London

Download: Will Carr full presentation

21 May 2015


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