Dr Kawa Amin is a consultant Geriatrician, Consultant Lead for the Falls Service and Geriatrics Departmental Lead for Safety & Quality at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT). He also represents the BGS on the advisory group for the National Audit of Inpatient Falls (NAIF). Deborah Watkins is a Physiotherapist and the Falls Lead at BHRUT.
Falls are a major cause of disability and mortality for older people in the UK and the problem is likely to increase with an ageing population. The associated mortality and morbidity from a fall is high with individual consequences ranging from distress, pain, physical injury and loss of confidence to complete loss of independence which impacts on relatives and caregivers. Usually nurses are the first discipline to attend to a patient following a fall.
Barking, Havering and Redbridge University Hospitals NHS Trust developed simulation training for its nurses and it has been delivered bimonthly since April 2016. The day begins with a brief introduction about Simulation Training, the candidates are divided into three teams and encouraged to work in a team and to nominate a leader for each scenario. At the end of each scenario all the candidates regroup into the debrief room for discussion and peer feedback.
Aims are two fold:
- Raise awareness, knowledge and skills in falls management and give nurses confidence and competence in their practical skills in post fall assessment and management.
- Explore and promote a different way of learning to embed their skills and knowledge. Falls are traumatic and distressing for patients and the staff involved.
The use of the Simulation Centre allows people to learn and practice techniques in a safe and non-threatening environment. It supports peer learning and review to embed knowledge and experience as opposed to a traditional lecture or e-learning style approach. It also allows them to explore human factors such as attitudes and empathy, which are always associated with their work however are difficult to teach in tutorial and lectures.
The typical simulation day starts with an interactive discussion on how to assess patients for a risk of falls based on NICE guideline (CG161 June 2013). This includes a practical way to assess a patient comprehensively and includes discussion on assessing cognition, vision and lying and standing blood pressure.
The practical scenarios are:
- A fall secondary to hypoglycemia. Post-falls assessment of a head injury, assessing neurological signs & symptoms, checking vital signs & blood glucose and escalation process.
- Post-falls assessment of a fractured neck of femur, assessing nurses’ post fall management, including injury assessment, manual handling techniques, pain control considerations and escalation process. (NICE standard 86 January 2017)
- Consolidation session on manual handling, the use of equipment for safe movement of patients post fall and assessing for signs and symptoms of common injuries following a fall.
- Recognition of cardiac syncope and when to escalate.
- Duty of Candor and communication with next of kin.
- Lying and Standing blood pressure practical teaching and assessment.
Feedback so far is excellent, the nurses really enjoy the style of learning and 82% of them regarded the content and delivery of the course including aims, interest, style of learning and meeting the their expectations as very good and the remaining 12% as good. Analysis of the feedback shows the most important learning topics from the day are:
The comments about the day:
The impact of the training on day to day care can be shown in the Trust fall data recorded in 1000 bed days. It is to be noted other falls prevention activities are also in place.
The falls per thousand bed days for the Trust sit well below the national average. In 2016/17 a further 6% reduction in overall falls and an 18% reduction in falls resulting in harm were achieved.
We would encourage everyone involved in delivering training to explore new and innovative ways of engaging staff in meaningful learning. We welcome your comments or visit the training days.
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