Winter, Spring, Summer and Falls in NSW Ambulance

NSW Ambulance introduced a falls package to address the year-round problem of falls in people aged 65 and over in the community. It incorporated a new falls risk assessment, protocol, clinical pathway and screening tool for paramedics, as well as education materials for consumers and general practitioners (GPs).

Aim

To ensure all people aged 65 and over who are not transported to hospital for ongoing care are assessed for falls risk, educated and appropriately referred by a paramedic.

Benefits

• Reduces the risk of falls among older people in the community.
• Improves education and awareness of falls by older people.
• Reduces unnecessary transfers to hospital and hospital admissions.
• Increases appropriate referrals and falls education to GPs .
• Provides a clear screening tool, clinical pathway and protocol for falls.

Background

Falls are a major problem around the world, with approximately 35 per cent of people aged 65 and over falling each year1. This figure increases to over 40 per cent for those over 70 years of age.¹ In NSW, people who injure themselves from a fall account for 44 per cent of all hospitalisations and more than 400 deaths per year, with older people accounting for 57 per cent of those hospitalisations.²

In NSW, there are more than 100,000 falls recorded by NSW Ambulance each year. Falls are the most common job paramedics are called to, with numbers increasing each year.³ People who have fallen and are not significantly injured are assessed and treated by paramedics, and may be left at home for self care. There are around 30,000 people each year who are left at home for self care, representing approximately 30 per cent of the non-transport rate by NSW Ambulance.³

Prior to the project, people left at home were not provided with a formal falls risk assessment, prevention education or a targeted referral. Having a single fall places a person at significant risk of having another fall, so without these prevention strategies, the risk of another fall is increased.⁴ As such, NSW Ambulance determined that a falls package was required, to address the year-round problem of falls, particularly in people aged 65 and over in the community.

Implementation

NSW Ambulance introduced a falls package, incorporating a falls risk assessment, education and appropriate referral of all patients seen by paramedics who were not transported to hospital. The package incorporated the following elements.

• Falls Education Package: an extensive document designed as a self-guided learning package for paramedics, which describes the problem of falls, common causes of falls, falls assessments and falls risk testing, falls prevention and how to use each component of the falls package.
• Falls Protocol: a clinical practice guideline for use by NSW Ambulance paramedics.
• Elderly at Risk Protocol: an existing NSW Ambulance clinical practice protocol for use with all patients aged 65 and over.
• ECP Falls Pathway: a clinical practice guideline for use by NSW Ambulance extended care paramedics.
• Falls Screening Tool: a screening tool based on the Falls Risk in Older People in the Community (FROP-Com) with associated scoring for falls risk.
• Falls FULL Assessment Tool: a comprehensive tool based on the Falls Risk in Older People in the Community (FROP-Com) with associated scoring for falls risk.
• Exercises: simple exercises for falls prevention, to enhance balance and lower limb strength.
• GP information sheet: a brief document describing the project and scoring system, based on the FROP-Com falls risk assessments and circulated via Primary Health Networks through the paramedic-initiated referral.
• Patient information brochure: developed to educate patients about how to reduce the risk of another fall. It is provided to patients following their risk assessment by paramedics.

Following the evaluation of the pilot project, the components of the falls package  deemed suitable for use by paramedics will be rolled out in June 2018 with the release of the NSW Ambulance clinical practice protocols. They will be incorporated into standard practice for all paramedics and extended care paramedics from June 2018.

Status

Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.

Dates

• Project start: March 2017
• Implementation: 1 June 2017 - 31 August 2017
• Project evaluation: June 2018
• Rollout across NSW Ambulance: June 2018

Implementation sites

• NSW Ambulance Blacktown Superstation
• NSW Ambulance Harden Station
• All stations with a dedicated extended care paramedic module

Partnerships

• Clinical Excellence Commision. Clinical Leadership Program
• GPs of pilot participants
• Primary Health Networks (Western Sydney, Murrumbidgee, Hunter New England and Central Coast, Nepean Blue Mountains, Central and Eastern Sydney, Northern Sydney)

Results

The following results were collected in April 2018.

• 32 consumers enrolled in the pilot.
• Of those 32, 90 per cent did not have a repeat fall.
• 91 per cent referred to the education materials provided and used it for ongoing falls prevention education.
• 100 per cent used the home safety check list, which allow them to assess their own home for falls risks and make adjustments where appropriate.
• 100 per cent attended a follow-up appointment with their GP for ongoing care after being assessed, educated and referred by the paramedic.

A full evaluation will be undertaken in June 2018, measuring the following outcomes.

• Using the names and addresses in NSW Ambulance data, the number of repeat falls from program participants will be monitored.
• Using NSW Ambulance data and follow-up phone calls, the number of people who use the education materials provided by paramedics for falls prevention will be recorded.
• Using NSW Ambulance data and follow-up phone calls, the number of consumers who follow up with their GP for ongoing care will be recorded.
• Using NSW Ambulance data, the number of people who were assessed for falls risk, educated and referred will be compared to all people aged 65 or over seen by paramedics.

Lessons learnt

• Keep it simple when identifying problem and try not to make assumptions or jump straight to solutions.
• Consider multiple perspectives when developing solutions, as what seems simple may not be to others.
• Communication and listening to stakeholders is critical to the success of the project.
• It was challenging to balance the workload of the project and competing priorities.
• To maintain momentum, it is important to motivate others involved in the project and change the mindset of people whose role is affected.
• The leadership and management style of the project leader has a significant impact on the success of the project.

References

1. World Health Organisation (WHO). WHO Global Report on Falls Prevention in Older Age. Geneva Switzerland: WHO; 2007.
2. NSW Government. Acute and other services’ indicators: falls-related injury hospitalisation. Sydney NSW: Clinical Excellence Commission; 2013.
3. NSW Government. Falls Report 2011. Rozelle NSW: NSW Ambulance; 2011.
4. Australian Commission on Safety and Quality in Health Care (ACSQHC). Safety and Quality Improvement Guide Standard 10: Preventing Falls and Harm from Falls. Sydney NSW: ACSQHC; 2012.

Further reading

• Falls prevention, Clinical Excellence Commission

Contact

Michelle Price
Coordinator - Falls Strategy
NSW Ambulance
Phone: 02 9320 7820