I Fell Down: A Post-Fall Decision Support Tool


Ed O’Brian, Clinical Support Team, Welsh Ambulance Services NHS Trust

Sue West-Jones, Emergency Medicine Consultant, Swansea Bay University Health Board

Peter Lee, Quality Assurance, Pobl Group

With thanks to Andrew Macphail, Mangar Health


Welsh Ambulance Services NHS Trust


This Bevan Exemplar project introduced a decision tool to support care home staff to identify if a person can be safely assisted up following a fall, minimising their time spent on the floor.


Background


A high volume of 999 calls relating to falls are received by the Welsh Ambulance Services NHS Trust every year. In 2017/18 over 62,000 calls were to people that have fallen, many of these calls were to an older adult in a care home.


A ‘long lie’ can result when a person spends an hour or more on the floor, complications include pressure ulcers, dehydration, hypothermia and rhabdomyolysis; a breakdown in skeletal muscle that can lead to kidney failure.


Aims


To empower care home staff to make a safe judgement call as to whether a resident can be assisted up following a fall, either eliminating the need for an ambulance or minimising the time a resident spends on the floor whilst awaiting an ambulance.


Four care homes were selected to test the use of I FELL DOWN using a Plan Do Study Act (PDSA) approach. Approval was gained from the Local Authority Commissioning Officer, Safeguarding Team and Health and Safety Team. Care home staff were given guidance on how to use I FELL DOWN by a health care professional, supplied with a Manager Camel Lifting Cushion and given training in its use.


At the start of the PDSA, the study was concentrated on one home. For all residents that were lifted following a fall, if following assessment using I FELL DOWN they were deemed by the care staff to not need an ambulance, or deemed suitable for a referral to an alternate health care provider such as a GP or District Nurse, the Trust Project Lead was contacted to attend the home and review the decision making.


All referrals, non-referrals and 999 calls during phase one were considered appropriate with no adverse incidents. The remaining three homes were then introduced.



I FELL DOWN

Injury to head
Fracture
Exhibiting unusual behaviour
Loss of consciousness
Losing blood
Difficulty in breathing or chest pain
Observed or suspected collapse
Warfarin or anticoagulant medication (head injury)
New pain since fall


Challenges


Other assessment tools such as ISTUMBLE, supported by ambulance services and used by care homes, are useful in identifying a non-injury faller. For a faller with an injury or illness, other assessment tools advise leaving a person on the floor to await a 999 response, a hospital admission following a fall may then result due to complications of long lie. I FELL DOWN allows for the injured or ill faller to be moved where appropriate, eliminating long lie whilst awaiting a 999 response.


Outcomes


Data was analysed for the four care homes involved in the PDSA, outcomes during the 9 month PDSA were compared to outcomes for the same date period the previous year.

  • 186 residents were assessed using I FELL DOWN over a 9 month period.

  • 18 residents had an ambulance requested for them following assessment using I FELL DOWN, down from 131 ambulance requests in the same date period the previous year.

  • 11 of the 18 residents that had an ambulance requested for them were lifted from the floor whilst awaiting ambulance arrival to prevent long lie.

  • Ambulance hours involved in attending a falls call for the 4 homes reduced from 132 hours the previous year to 36 hours during the PDSA.



Part of cohort Bevan Exemplar Projects 2018-19