Perth & Kinross Community Alarm/

Telecare Project

Wednesday 18th May 2011

Carolyn WilsonFalls Service Manager

P&K CHP

Liz AdamsCommunity Alarm Falls Screener

P&K Council

P&K Aims for National Pilot

• To develop a pathway for community alarm clients who fall repeatedly to be identified early and considered for falls assessment/ intervention to reduce future falls risk

• To further enhance the role of Telecare in developing falls prevention/management pathways at a local level

• To consider options around potential service models, outlining the implications of each

Previous System prior to March 2009

• Five specialised multi-disciplinary falls clinic bases within Perth & Kinross

• Community Alarm Service identified as a referring agency to falls clinic however system needed refined to enable this.

Specialised Falls ClinicsProvide specialised multi-disciplinary falls

assessment/interventions following evidenced based guidelines

•Blairgowrie

•Aberfeldy

•Perth

•Crieff

•Auchterarder

Identified by•Community Nursing•Community AHP•SSA Trigger•Home Care alert system•Community Alarm•Community Pharmacists•Sheltered Housing Wardens•Opticians

Older Person Falls

Pathway for Community Fallers requiring Falls Clinic Services

A+E

Ambulance GPFracture Clinic/ Orthopaedic O/P

Medical/ Elderly In-patients

Orthopaedic In-patients

One-point entry system with gate-keeping/screening of referrals by Perth Falls

Clinic and allocation to appropriate falls clinics

ICAHS

Phase 1 PilotClient falls and activates

community alarm

CAT prepare and send standard letter to client inviting them to contact the Simpson Day Clinic

Client does NOT contact SDC

No further action

Swift provides detailed monthly report to falls service of repeat fallers

SDC Falls Service staff screen report, identify potential clients and advice CAT

Key Holder attends/contact community alarm to advice outcome

CAT Mobile Response Team completes post falls screening and issues falls literature

Client contacts SDC

Perth City - SDC arrange appointment

Rural – SDC advice client they will notify locality falls clinic

SDC notify appropriate falls clinic

Info recorded on SWIFT

All new Community Alarm clients are issued the P&K Falls booklet and all fallers are offered another booklet

Post Falls Screening QuestionnaireCompleted by the Community Alarm Response Team

Outcomes from Phase I

• From July to September 2009, 36 letters sent to repeat community alarm fallers

• 4 contacted/attended the Falls Clinic

• Therefore only 1 in 9 responded (11%)

• Poor uptake probably due to “cold” letter arriving and

requesting client responds.

Proposal - Phase II -

• Employ a dedicated “CA Falls Screener” 14 hours/week

• Undertake follow up home visit (anticipate 4/week) to repeat fallers (Perth/Crieff/Auchterarder clinic areas) to complete falls screening/assessment to identify causes of falls.

• Identify and rectify any remedial interventions

• Consider referral pathways to Health or Social Care Service.

• If appropriate – discuss/encourage referral to Falls Clinic

• Telephone screening to clients in Blairgowrie/Aberfeldy clinic areas with follow on referral to falls clinic if appropriate.

• Compare the above two systems

Pathway

Aspects developed

• Community Alarm Falls Screener started 9th August 2010

• Induction/Preparation/Training/Falls Clinic

• Documentation developed including– Falls screening/assessment form – Com alarm response team post fall screening – GP letter– Client letter– Client/relative action plan– Telephone screening questionnaire

• Database developed

Outcomes Phase 2 at 6 month

• 62 clients seen at end of 6 months (Feb 28th 2011)

• 34 clients on service > 3 months - reduction of 41 falls compared to 3 months prior. i.e. 89 falls to 48 falls (46%)

• 5 clients on service > 6 months - reduction of 8 falls compared to 6 months prior. 41 falls to 33 falls (20%)

(figures include one client whose falls (alcohol related) increased from 14 falls 6-month before service to 19 falls 6 months after service. If this client is removed comparing 6-months prior to the service for the other 4 clients and 6 months after the service, the falls rate have reduced from 27 to 14 1.e. by 13 (48%))

• Of 62 clients seen by the Community Alarm Falls Screener by the end of February 2011, 19 have been referred on to a Falls Clinic i.e. 31%.

Possible Causes of Falls (6 month data)

Possible Causes of Falls Identified

0

16

3

59

1 2

15

3 4

0

10

20

30

40

50

60

70

Faint

Dizzine

ss

Med

icatio

n

Mob

ility I

ssue

s

Visual

Footw

ear/F

ootca

re

Enviro

nmen

tal

Alcoho

l Rela

ted

Not K

nown

Causes

Nu

mb

er o

f C

lien

ts

Interventions Required (6 month data)Intervention Required

19

0 0 0

12

10

25

00

5

10

15

20

25

30

Falls Clinic CommunityPharmacist

Reablement communityNursing

OP or DomPhysio

CRT OT SWOTEquipment

MentalHealth

Services

Sources

Nu

mb

er o

f C

lien

ts

Referrals for Telecare Equipment (6 month data)

Telecare Equipment

3

31

3

1

Smoke/Heat Alarm Bed Exit Monitor Flood Detector Falls Detector Wrist Com Alarm

Outcomes Phase 2 at 8 month

• 87 clients seen at end of 8 months (April 30th 2011)

• Average client age = 81.6

• 52 clients on service > 3months - reduction of 64 falls compared to 3 months prior i.e. 124 falls to 60 falls (48% reduction)

• Of the 24 clients on service > 6 months - an overall reduction of 30 falls compared to the 6-months prior to the service i.e. 94 falls to 64 falls. (32% reduction)

(figures include one client whose falls (alcohol related) increased from 14 falls 6-month prior to the service to 19 falls 6 months after the service. If this client is removed comparing 6-months prior to the service for the other 23 clients and 6 months after the service, the falls rate have reduced from 80 to 45 i.e. 35 (43%))

• Of 87 clients seen by the Community Alarm Falls Screener by the end of April 2011, 30 have been referred on to a Falls Clinic i.e. (34%)

• To increase number of specialist falls assessment in 2010/2011 by 25%

30/87 referred to falls clinic i.e. 34% clients referred to falls clinic

• To reduce falls in target group by 20%. Reduction at 8 months – 3month pre and 3-month post = 48% Reduction at 8 months – 6 month pre and 6 months post = 32%

• To identify number receiving community falls screening and numbers– client referred onto alternative health and social care services - 43/87– referred to a specialist falls clinic. – 30/87

• To identify numbers referred/attended falls clinic from telephone screening - 2 telephone screenings carried out. 0 referrals made

• To measure impact of falls assessment/remedial solutions in terms of cost saved from reduced call outs. Ave callout = 3/4hr. 75% double crew. At approx £26/hr. 94 falls less (24 X £19.50 = £468) (70 X £39 = £2730) (£2730 + £468 = £3354)

• To measure impact on service user through direct interview and/or questionnaire

Outcomes to be Measured

Developments since February 2011

• To expand the service to include new clients referred for a community alarm who have fallen - 7 visits to date

• 1 ambulance referral to falls clinic however patient refused to attend. Community Alarm Falls Screening carried out. (client had Community Alarm)

• Home Care Managers to record fallers using Swift profile note ‘Falls Incident’ code

• One referral received specifically from home care

Further future developments

• To continue to promote with reablement and home care services need to specifically record fallers

• Consider expansion of this service to Scottish Ambulance Service, Sheltered Housing and Care Homes.

• To ensure the Community Alarm Falls Screening Service feeds into the work of the Integrated Resource Framework.

• Identify funding to allow the pilot to continue through permanent or change fund resources.