Abstract
Introduction:
Falls are common in people living in care homes (CHs). London Ambulance Service (LAS) data indicated four out of the ten London CHs with the highest conveyance to hospital were in Lambeth and Southwark. Secondary care and community services were unable to provide prompt consultation and address educational needs of staff required to prevent and manage CH falls.
Method:
The Lambeth and Southwark CH Falls Prevention group was established in 2022 by local care partnerships to explore ways to improve the approach to falls. Following an audit of falls-related service gaps, a Care Home Falls service (CHFS) was funded for a 1 year pilot. Comprising an Occupational Therapist, Physiotherapist, and two Therapy Assistants, the team's objectives are to reduce falls incidence by providing tailored interventions for residents and enhancing staff confidence through ‘Action Falls’ Checklist training, providing prompt input with complex cases, and support for non-emergency pathways. Outcome measures are calls to LAS for falls, conveyance rates and CH recorded falls. Process measurement includes numbers of staff trained and consultations provided. Feedback from stakeholders has also been sought.
Results:
The CHFS launched in October 2024,reaching full staffing by January 2025. The team has so far worked in 12/16 CHs, provided ‘Action Falls’ training for 185 staff, handled 212 referrals, and supported 189 residents with complex falls management. Falls data analysis is ongoing but feedback from stakeholders indicate a positive impact. For example, a CH team lead said ‘previously referrals took too long which was too late for our unstable residents’ and a resident reported ‘it helped me get my life back, I can walk on my own and I’m even dancing again’.
Conclusion:
It is feasible to deliver the Action Falls training and falls interventions led by a CHFS. Falls measures will be reported when data collection is complete.
Comments
Question
Hello. Thank you for presenting your work focussed on falls in care homes. How often have teaching sessions been held in each of the care homes, given that there is usually quite a high staffing turnover? What has happened in the last four months with regards ambulance calls and number of falls?
Answer
Thank you for your question. The teaching sessions (as per Action Falls protocol) are provided on several occasions in each home ensuring 50-70% of all staff are trained. The project is working in waves, providing training in each of the homes in the two boroughs. We anticipate it will take a year to cover all the homes, so we will return back to homes to repeat training for new staff once this is complete and should be able to do this with more agility in the second year of the project.
LAS stands for London Ambulance Service. The 999 (ambulance) calls and falls recorded by the care homes show a trend towards reducing. However, it is a short time period and small numbers of homes / residents. We will have more robust data after a year of data collection. What we have observed is that the first wave of homes are calling 111 more and 999 less.
Do you have a sense of…
Do you have a sense of whether the 999 calls being made remain appropriate and whether the outcomes of the calls have altered since the intervention?
Answer
Thank you for your question.
We don't have the granularity of data to fully determine appropriateness of 999 calls. We use the metric of percentage conveyance as a way of determining this (we would expect the percentage conveyed to be higher when more 999 calls are appropriate). We don't have enough data on this yet to be able to present, but will be in a position to analyse this when the project has been running for a year.
Question
Do you feel you would have had the same outcomes if you had only been delivery the Falls Action training and not seeing residents in the home?
Answer
Thank you for your question.
There are a few residents in each home who (often fall repeatedly) are very complex and need specific case management. Therefore, although there is evidence that Action Falls works at a care home population level, as we have had the capacity to see some of the residents, I think this probably did contribute to the effectiveness of the team's work.
Care Home
Thank you for the poster.
A really interesting implementation project
Following the positive 1 year pilot, is the service going to be taken forward and continue?
Answer
Thank you for your question. Yes the pilot had positive findings and it has been funded as an established service now. We will continue to evaluate and improve it.