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The Carmarthenshire Falls Project
Canllaw has been involved in the Carmarthenshire Falls Project. A
PowerPoint presentation is available to download HERE. However much
information is available below.
The events have enabled a large number of
people across Carmarthenshire to live at home independently and safer.
HERE is
the risk assessment used by Canllaw as a screening tool.
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1,
Multi agency falls and fracture strategy
Falls and
Fractures has been identified as a key area within The National
Service Framework for Older People in Wales, National Institute of
Clinical Excellence guidelines on the assessment and prevention of
falls in older people and has been identified as a Partnership priority
as stated in the Joint Commissioning Strategy for Older People in
Carmarthenshire.
As such falls and fracture strategy within
Carmarthenshire is to reduce the number of older people falling by establishing
an integrated falls care-pathway where any person who is “at
risk” of falling, or has fallen, is able to access appropriate
and standardised assessment, high-quality treatment and support from a
wide range of service providers in order to promote a better quality of
life.
The strategy therefore proposes a future model of service
provision with an emphasis on falls prevention and ensuring those who
would benefit most from a comprehensive assessment and specialist input
are identified and able to access the service they require based on
their individual needs.
The strategy has been
accepted by the Older Peoples planning team and is to be presented to
Management Executive Committee and Partnership Executive Group shortly
2,
Nantgaredig Pilot
The work
undertaken by the Carmarthenshire Community Service Review
highlighted
the requirement of a clinical pathway for falls and fractures. A
multi-agency
group was formed to undertake this task, and initiated a
subgroup
to undertake a pilot project with a GP practice.
At the beginning of 2007 agreed
to pilot a falls project in Nantgaredig a discrete area of
Carmarthenshire. This falls project was to provide a holistic proactive
assessment and response to individuals who were at risk of falling. It
was hoped that this service would reduce the numbers of hospital
admissions because of falls.
In the
initial review of the Nantgaredig project there was a 64% reduction in
the number of people over 75 years presenting at A&E with falls. Of
the 4 individuals who attended A&E during the months following the
falls pilot, 3 of these individual had neither attended the event nor
been referred by the GP practice. The numbers of individuals over
the age of 75 who attended Accident and Emergency (A&E) due to
falls from Nantgaredig surgery continues to maintain low with only 4
attendances between October 2007 and January 2008.
A full
evaluation has been completed for this project
3,
Falls events
The falls pilot in
Nantgaredig was a success with a significant decrease in the number of
individuals attending A&E because of falls from the pilot client
group (full evaluation available). As such the pilot was rolled out to
Llandeilo, Llandovery & Margaret Street GP practices.
This, in total, means that
the falls project has invited 2,700 individuals over the age of 75,
with 657 people attending and 181 people at risk of falling being
referred to Canllaw.
|
Venue
|
Date
|
Approx. Invitations
|
Attendances
|
Identified at risk of
falling – referred to Canllaw
|
Nantgaredig
|
29.3.07
|
250
|
75
|
22
|
|
Llandeilo 1
|
31.7.07
|
250
|
76
|
11
|
|
Llandeilo 2
|
28.8.07
|
250
|
58
|
15
|
|
Llandeilo 3
|
25.9.07
|
250
|
96
|
23
|
|
Llandovery 1
|
1.11.07
|
538
|
133
|
18
|
|
Llandovery 2
|
28.11.07
|
400
|
38
|
10
|
|
Margaret Street Practice
Llandybie event
|
24.1.08
|
400
|
90
|
17
|
|
Margaret Street Practice
|
26.2.08
|
400
|
91
|
15
|
|
Total
|
8
|
2738
|
657
|
181
|
The
falls event has the commitment on a monthly basis of a number of
organisation which include Canllaw, Age Concern, Care and Repair, Care Line +,Chronic
Disease Management Team, CHC , CAVS, District Nursing, Expert Patient
Programme, Foothold, Fire Service, Housing Services, Low Vision Scheme
, Pharmacy, Social Care, The Carers’ Project, Pensions Agency.
Further events are
planned for GP practices in St Clares, Burry
Port and Carmarthen
town.
4,
Sustainability of events
It was agreed by the Older
Peoples Planning team to give their unanimous support of the falls
programme and felt that support of this initiative would be beneficial
in supporting the reduction of falls among older people but also a
proactive approach in reducing the numbers of delayed transfer of care.
A submission has been made
to the director of Social Services for funds from the Promoting Independence and
Wellbeing grant scheme 2008-11 to create a specific team within Canllaw
dedicated to falls consisting of a nurse, occupational therapist and
physiotherapist. This multidisciplinary team would work with existing
services, leading and coordinating events, linking with primary and
secondary care, and developing new falls projects.
5,
Pharmacy
The Community
pharmacist attends the Camu ‘Mlaen /Step Forward and offers
medication reviews for all on more than 4 medications. As a pilot the
pharmasit will be following up non attendees with the practice and
offering domiciliary visits for those
people on multiple medications, as well as identifying potential people
at risk.
6,
Branding and logo
The success of the
events has also brought about the branding and logo of the event
7,
Welsh Language in Healthcare Conference and Awards 2008
Camu ‘Mlaen /Step
Forward was awarded the prize in May 2008 for
joint agency working in provision of excellent bilingual services.
8,
Falls Clinic
It has been
identified that a falls clinic would enhance the service provision from
primary care. This work is to be taken forward within secondary
care.
9,
Documentation
A group has been
formed to consider ways in which the home assessments undertaken by all
agencies can signpost people who are at risk of or who have fallen.
Initial work is underway in collating and reviewing assessment forms.
10,
NHS information
The NHS trust
regularly produces information in the attendance of older people at
Accident and Emergency departments, these figures are one of the
factors on which the success of the falls event is based.
11,
Links with ambulance service
Initial
discussions are underway in developing opportunities with the
ambulance service in identify fallers at an early stage in the
falls pathway by utilising the documentation provided by the ambulance
service when called out to older faller who do not require accident and
emergency admission and developing pathways to other services
12,
Care Home project
This pilot was commissioned
by the multi-agency task and finish group falls and fractures the aim
of project was to raise awareness of falls prevention strategies
amongst care home staff by introducing a training package as well as
undertaking individual and environmental assessment and encouraging the
use of Assistive Technology.
The training programme
identified has been adopted throughout local authority care homes
A full
evaluation has been completed for this project
13,
Vitality scheme
Additional funding
has been identified to develop a team of exercise coordinators and
include older adults fall prevention within the remit of the Specialist
Exercise Coordinator for COPD. This development is expected to start
early summer 2008.
14,
Assistive Technology
Care line + have introduced
technology relating to falls in a significant number of older peoples home. Work is on going in
linking this work with the care
Line and the Canllaw service.
15,
Move more often
Initial discussions underway
in developing this initiative
16,
Nintendo Wii
There
have been many anecdotal reports, since the launce of the Nintendo Wii,
that tell the story of older people embracing the opportunity that the
Wii proposes. This technology has recently been introduced
into day centre’s and residential homes in Flintshire and Neath
Port Talbot and seems to encourage participation, team work, physical
and mental stimulation and intergenerational working, however, the
sustainability of this activity as well as the benefits in terms of
physical improvements in balance, gait and flexibility have not been
measured.
The main aim of the
research is to determine if regular access to the Nintendo Wii over an
extended period of time (8 weeks) results in improvement in physical
ability, mood and wellbeing. The effectiveness of the
intervention will be assessed by an occupational therapist using a pre
and post intervention method to determine if using this equipment has a
positive impact on physical health.
17,
Publicity
The press office have been extremenly helpful in publicising
the Camu ‘Mlaen /Step Forward events and case studies of people
who have benefitted from.
Community First
18,
Basic footcare
Based on the Happy Feet
Pilot within Llanelli a low-level toenail cutting service people aged
50+ living in Carmarthenshire has been commissioned in specific areas
of Carmarthenshire. The service is provided to people who have
undertaken a podiatry from the NHS Podiatry Department, or other
primary care health professionals in the area. Initially the service is
being provided in Llanelli and Cwmamman areas and will be extended to
other areas throughout 2008
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