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Current services in relation to need

Adults :: Falls :: Current services in relation to need

Medway Foundation Trust Falls Emergency Department Pilot

The Falls Emergency Department pilot commenced following identification of the need for a clear pathway for fallers presenting at Medway Foundation Trust (MFT) Emergency Department (ED). The pilot initially ran for one and a half months from January 2012 and then resumed for 6 months from October 2012 following agreement from the Urgent Care Programme Management Group and MFT.
The objectives of the pilot were to:
• Identify the numbers of fallers presenting to ED
• Establish the percentage of patients already known to the MCH Community Falls Service
• Understand the impact of the enhanced falls assessment process and new fast track clinic

The project scope comprised:
• Mapping the desired ED Falls pathway
• Developing assessment criteria and tools for use in ED to identify fallers for triage
• Triage process in place to refer patients to most appropriate service — GP, MCH Community Falls Service or MFT Fast Track Clinic
• Undertaking of comprehensive medical review at the fast track clinic on appropriate patients to reduce the risk of recurrent falling and prevent further ED attendance and emergency admissions. Once seen within the fast track clinic, a patient may be referred by the Consultant Geriatrician to Medway's Community Falls Service if required.

Presentations were given to GPs during GP Protected Learning Times, clarifying the GP pathway and assessment tool for fallers. Prompts are currently being considered for GP clinical IT systems to help identify existing and potential new fallers in primary care, who can then be assessed using the Falls Assessment Tool and managed appropriately thereby reducing further ED attendances and non–elective admissions.

Evaluation of the pilot demonstrated that the proposed pathway change yields significant improvements in patient care, providing rapid access for complex patients to be reviewed and prevents avoidable re–attendance to ED. The Falls ED pilot review has been presented to the Urgent Care Programme Management Group (UCPMG) and the Medway Clinical Commissioning Group Commissioning Committee who supported a permanent pathway change.

Fracture Liaison Service (Medway Foundation Trust)

A Fracture Liaison Service (FLS) is a multidisciplinary service which ensures that every person over the age of 50 who suffers a fragility fracture is identified, recorded and given an assessment for their future fracture risk. The fracture liaison nurse then helps to ensure that patients are prescribed bone protecting treatments where appropriate, reducing their risk of suffering further fractures later on in life. A comprehensive FLS will also ensure that high standards of post–fracture care are delivered, and that the complex range of health and social care services that patients need following a fragility fracture, including falls services, are co–ordinated.

Medway Foundation Trust provides a comprehensive FLS led by a dedicated Nurse Specialist, working under the guidance of a Specialist Consultant. The service aims to identify all patients over the age of 50 years presenting with a new fragility fracture and to offer the opportunity to have Bone Density Measurement (DXA) if considered at risk.

Fracture clinics, trauma wards, Occupational Health and Physiotherapy departments and the Emergency Department are all targeted for case finding. Outpatients are invited by letter to attend for DXA and Bone Health assessment. In–patients are visited by one of the Osteoporosis team, assessed and invited for DXA and Bone Health assessment. An individual management plan is then produced for implementation in primary care. In all cases, the GP is alerted that the patient has had a recent fracture.

Medway Community Healthcare Community Falls Service

The MCH Falls Prevention Service is provided by a multiprofessional team which can take referrals from any health professional as well as self–referrals.

On initial referral the patient is contacted by Falls Multi Professional team member, who could be either a Nurse, Occupational Therapist or, Physiotherapist. Each patient will then be triaged and assessed according to clinical need and a personalised treatment plan will be agreed with the patient. Patients can be seen in either their own home environment or in a clinical setting according to their individual circumstances.

Complex cases are referred to a secondary care geriatrics consultant.

Rapid Response

The Rapid Response Team is jointly funded by Medway Community Healthcare and Medway Council and consists of two teams: 1. Admission Avoidance (hospital– based) team 2. Community based team

The teams assists patients who have fallen or are at risk of falls and help to assemble a care package that may involve integrated working with other health and social care professionals. The care package is tailored to the individual needs of each patient, and can include:
• Social care arranged through a care manager
• Nursing care
• Rehabilitation from occupational and physiotherapists
• Group exercise programme

The Rapid Response team can be involved in patients' care for up to six weeks, in the patient's own home or place of residence. The Rapid Response service does not accept patients who have been diagnosed with dementia or who are confused– Medway Community Healthcare provides a separate dementia support service for people with dementia who live at home and their carers.

Exercise programmes

Medway Community Healthcare Falls Service

Following an initial assessment by the Medway Community Healthcare Falls Team, appropriate patients may be considered to commence a tailored programme of exercise classes which aim to build strength, balance and confidence. The course consists of 12 sessions over a 12 week period, with the opportunity to attend a further class if deemed to be required following assessment or progressed to the next level of programme if appropriate. For house bound patients a tailored programme based upon the same principles of the taught group sessions will be provided in the patient's own home.

• Chair Based Exercise
• Otago
• Postural Stability

Exercise programmes are currently held at various locations across Medway, including:

• Lordswood Healthy Living Centre
• Rochester Healthy Living Centre
• St. Bartholomew's Hospital, Rochester
• Twydall church hall

Medway Council Health Improvement Team Exercise Referral Scheme

The Health Improvement Team within Medway Council's Public Health Directorate offer an exercise referral programme to which residents of Medway with a wide rage of medical conditions can be referred by their GP, practice nurse or other health professionals (such as the MCH Falls Team). People living with a long–term health condition are eligible for the programme, which is delivered across Medway Council's leisure centres. A risk classification tool is used to determine eligibility for the programme, with individuals classified as medium or high risk being deemed suitable. Low risk clients are referred directly to a host of community activity sessions, including walking and cycling groups, exercise, sport and dance classes. The programme consists of a 12–week course of physical activity sessions. There is a small charge for each activity session, with participants offered the choice of gym or class–based sessions. Since the service was launched in 2010, 29 referrals have been received with the primary referral reason being stated as 'falls prevention', with 13 referrals coming directly from MCH's Falls Prevention Team, 7 referrals from Primary Care and the remainder from social care, physiotherapy and other public health colleagues. A large proportion of individuals referred to the programme are older people and often state falls prevention as a key reason for attending. Balance training is therefore built in, where possible, into the gym and class based programmes.