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Falls Prevention Planning in Champlain: Article 7

CME Certified Fall Prevention module

In a cross Canada review, there were few certified Fall Prevention programs targeted towards Primary Care physicians and their healthcare professional teams. Dr. Frank Molnar, Geriatrician, and his team have changed that! The Champlain Fall Prevention Steering Committee, Dr. Molnar and the Regional Geriatric Program of Eastern Ontario have worked together to deliver an interactive Fall Prevention module which utilizes the Champlain Fall Prevention tools. This online group learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by the University of Ottawa’s Office of Continuing Professional Development for up to 2 MainPro+ credits.

The sequential modules focus on education, client self-screening using the Staying Independent Checklist, and delivery of the appropriate and evidence-based follow up assessment and diagnosis to determine the root cause of the fall. Selecting the right intervention and referral is also covered in the module.

A complement to this CME program includes access for non-registered health care workers to an online PSW Fall Prevention module. It can be useful for volunteers, receptionists and other non-registered team members as it provides information to enable them to act as a coach and guide for their older clients and to understand the importance of self-screening and the use of the Staying Independent  Checklist as part of the Champlain Fall Prevention Algorithm.

These two modules are components of the Fall Prevention education framework to reinforce the delivery of the best practices in Fall Prevention across the continuum. Work is now being undertaken to provide other registered healthcare professionals with similar support,

All of these resources and the link to sign up for the CME module can be found through the www.stopfalls.ca website

Falls Prevention Planning in Champlain: The Work Plan for 2015-16

In this fourth article about the Champlain Falls Prevention Strategy, we look at the 2015-2016 work plan for implementation and current initiatives.

Having established a strong foundational Falls Prevention clinical pathway for seniors to receive the appropriate Falls screening, assessment and intervention in the appropriate setting, work is now being done to promote and support use of the standardized tools in community and primary care settings.

EMR Integration

Feedback from clinicians testing the Champlain Falls Prevention algorithm and Staying Independent Checklist told us that it was essential to make them a part of the EMR. A great deal of work has been done with the Practice Solutions group to make this possible on the PS platform – with a go-live date in the near future – followed usage support with Nightingale on Demand. Other clinicians wanted a method of communicating their assessment findings and interventions with other agencies to avoid duplication or gaps in the process. A multifactorial draft work sheet based on the algorithm will be trialed with some community agencies in the fall of 2015 to gather their input.

Training Health Care Providers

Ensuring that health care providers have access to information about best practices in falls prevention is a key part of the work required to make this strategy successful. The Personal Support Worker (PSW) training module is now widely used by Public Health to train staff in Retirement Homes, community agencies, and community colleges in the region. An online accredited CME module for physicians is currently in the final stages of development. A framework that will help organizations to support staff in delivering high-quality falls prevention assessment and intervention to their clients is the focus for this year.

To enable health care providers and their clients to find the right exercise and/or falls prevention classes for their needs in their area, ongoing work is focusing on classes funded through the Champlain LHIN, and providing information and clear steps to assist in the selection of the appropriate class.

Reducing ED visits and hospital admissions

Provincially the Champlain region ranks poorly in regards to numbers of falls related visits to ED and admissions to hospital. Drilling into this data this year will clarify where to focus the next stages of work now that the tools to support teams across health care sectors have been developed and are ready for use. Savings of $1.72 million can be realized across the system with only a 10% reduction in falls related admissions to hospital in Champlain.

This concludes our series of four articles providing background and progress updates about the development and delivery of a Champlain Falls Prevention Strategy. There is a dedicated and enthusiastic group of representatives from many health care sectors in the region, all of whom have made this an excellent example of successful collaboration and achievement. We look forward to bringing you an update in about six months.

Article written by: Christine Bidmead (cbidmead@toh.on.ca), Project Manager, Champlain Falls Prevention Strategy

Supporting Regional Excellence in Falls Prevention: A Progress Update

In this third article focusing on the Champlain Falls Prevention Strategy, we look at the six foundational pillars of the strategy and what progress was made towards advancing each one in 2014-2015.

The Champlain Regional Falls Prevention Strategy was planned with a system change approach in mind. Composed of six foundational pillars, the strategy was developed by a Steering committee made up of members from across health care sectors. During the 2014-2015 fiscal year work was undertaken to advance each pillar, with support to ensure that the plans were linked together strategically.

Pillar 1 – Public awareness and engagement

Increase awareness of the risk factors associated with falls and promote preventive measures to reduce the number and impact of falls on seniors in Champlain.

2014-15 progress:

Public health units in the region have adopted the use of the Staying Independent Checklist as a self-screening tool for older adults in the community. This is being aligned with the Champlain Falls Prevention algorithm. Working in conjunction with the Champlain LHIN, the units are implementing a communications plan from February to June 2015. Primary Care physicians received communications in the initial stages that included the Staying Independent Checklist and the Champlain Falls Prevention algorithm.

Pillar 2 – Detection, diagnosis and intervention

Ensure that robust, reliable tools and leading practices are used for the detection and diagnosis of falls- related conditions and risk factors. Ensure comprehensive identification of seniors across the aging continuum and tailored interventions that respond to the psychosocial, cognitive, environmental and behavioural needs of the patient.

2014-15 progress:

The Champlain Falls Prevention algorithm and Staying Independent Checklist were refined based on feedback received from December 2013 to March 2014. These tools are now available in French and English on the RGPEO and Champlain Healthline websites, and on the stopfalls.ca and arretonsleschutes.ca domains. They are now ready for use in the following nine community and primary care sites with education support for community teams provided by Public Health.

Over the past six months the following sites have received training and have begun using the tools in their health care practice settings.

  • Barry’s Bay Home Support services
  • Seven retirement homes in Ottawa, Renfrew and Eastern Counties
  • Primary Care Outreach teams at Seaway Valley CHC and Pinecrest Queensway CHC
  • Geriatric Assessment Clinic in Primary Care
  • EMS services in Eastern Counties
  • Renfrew County GEM Program

The Practice Solutions group has also completed work to integrate the Falls Prevention algorithm into the Electronic Medical Record.

Pillar 3 – Provider Best Practice

Ensure seniors receive coordinated care, based on evidence and leading practices around falls prevention and injury reduction.

2014-15 progress:

A Falls Prevention module for training Personal Support Workers (PSW) has been developed for use by Public Health Units. The module was used during the training of PSWs in the community and Retirement Homes in January and early February 2015. It may require further refinement based on feedback from these sessions. Public Health will be driving this initiative.

Registered health care professionals will receive education on the Checklist and algorithm as usage rolls out across the region.  An accredited online education module is in the early stages of development in conjunction with the University of Ottawa. This module will initially focus on the needs of physicians but will be developed with other health professionals in mind for the future.

Pillar 4 – Performance monitoring and evaluation

Support a Champlain fall prevention structure to implement, monitor and sustain quality practices and services across all sectors.

2014-15 progress and outcome:

A Logic Model for the Champlain Falls Prevention strategy has been developed with specific outcome measures to inform future directions for the Steering Committee. This tool supports the LHIN Scorecard targets for reducing Emergency Department visits and hospitalizations for falls-related conditions in seniors over 65 years old and for residents of Long-Term Care. A local marker to understand admissions to hospital for seniors with hip fracture will be included in the data to be collected.

Pillar 5 – System integration and navigation

Provide better system integration across sectors that deliver detection, diagnosis, interventions and supports related to falls prevention for seniors in Champlain. Coordinate care related to falls prevention that will simplify and allow better navigation of patients throughout the system.

2014-15 progress and outcome:

System navigation is a very complex and critical factor in ensuring that seniors access the programs and services that will best meet their needs. For the Falls Prevention Strategy, the Committee agreed to focus on the ability to navigate into and between the various exercise classes that are funded through the Champlain LHIN / MOHLTC and design a navigation process to facilitate access.

Pillar 6 – Advocacy

Ensure a voice at the patient, family, community and system level that will address systemic issues related to falls prevention.

2014-15 progress and outcome:

The issues and challenges related to falls and falls prevention that have been identified by the Committee were shared with the Champlain LHIN Board and Medical Officers of Health from the Public Health Units. In addition, presentations on falls prevention and the work of the Committee have been made to various other groups.

Article written by: Christine Bidmead (cbidmead@toh.on.ca), Project Manager, Champlain Falls Prevention Strategy

A System Change Approach to Falls Prevention in Champlain

In this second article about the Champlain Falls Prevention Strategy, we look at what’s been done so far to respond to regional issues around falls prevention.

Responding to feedback from a survey held in early 2013, the Champlain Falls Prevention Steering Committee identified the establishment of a suitable Falls Prevention pathway and process for use across the region as a priority. Focusing on the primary and community care sectors, this systemic approach would support practitioners in the management of falls prevention in their daily practice.

Throughout 2013, the Steering Committee developed a strategic framework of six foundational pillars to guide the work required to bring about a system change in the way that Falls Prevention is managed regionally across all care sectors.

The six pillars are:

  • Public Awareness and Engagement
  • Detection, Diagnosis and Intervention
  • Best Practices for Health Care Professionals
  • System Navigation
  • Performance Management
  • Advocacy

With funding support from the Champlain LHIN, a clinical working group composed of Community and Primary Care practitioners met in the summer of 2013. Based on current evidence the working group determined that it was imperative to have a tool that would provide screening, assessment and intervention capabilities, and which could assist clinicians and health care providers in identifying and ameliorating fall risk. It also had to be viable in a variety of settings.

The development of standardized screening tools which could be widely used in the community was seen as a valuable component in building consistency throughout the region. Following a literature review the working group identified a model that would be practical and relevant, evidence-based and would promote and support the use of standardized assessment tools. The American Geriatric Society/ British Geriatric Society algorithm was the best match but required some adjustments to make it suitable for local needs. The pathway included the Staying Independent Checklist / Demeurer autonome as a screening tool that could be used by older adults with their families, caregivers or health care providers.

By December 2013 the algorithm and checklist were ready to be tested in the field. Seaway Valley CHC, Pinecrest Queensway CHC (Nepean site), Dr. Helen O’Connor at the Montfort Academic FHT and Dr. Charles Adamson in South Mountain provided invaluable feedback during the trail period when they used the Falls Prevention tools with a total of 108 older adults.

A community information sharing session was held for Renfrew County, and North Lanark, Leeds and Grenville practitioners. A thorough evaluation of the trial took place and informed the refinement and finalization of the algorithm which was completed in the fall of 2014. The documents were translated into French and resources were loaded onto the Champlainhealthline.ca and the Regional Geriatric Program of Eastern Ontario (RGPEO) websites. The website domains stopfalls.ca and arretonsleschutes.ca were linked to the website for ease of access. Work is now being done with the Primary Care Network subgroup, Practice Solutions, to include the algorithm in the EMR.

The Champlain Falls Prevention Algorithm and Staying Independent Checklist are available on the Champlainhealthline.ca Falls Prevention page.

Article written by: Jane Adams (janadams@toh.on.ca) and Christine Bidmead (cbidmead@toh.on.ca), Project Managers, Champlain Falls Prevention Strategy

Why It Is Important to Have a Falls Prevention Plan in Champlain

Falls have a significant impact on individuals, families, society, and health care systems. Find out about what’s being done provincially and locally to prevent falls among the older adult population.

Falls facts

  • 1 in 3 seniors fall every year
    • Half of seniors who fall do so repeatedly
    • 1 in 4 falls result in injuries including sprains, fractures, and death
  • Falls are the leading contributor to overall injury costs in Canada and account for $6.2 billion or 31 per cent of total costs of all injuries (Smartrisk, 2009)
  • Falls cause more than 90 per cent of all hip fractures in the elderly and 20 per cent of seniors who suffer a hip fracture die within a year
  • A single hip fracture adds between $24,600 to $28,000 in direct health costs to the system. Almost half of people who sustain a hip fracture never recover fully
  • The mean length of stay for a falls-related injury is approximately 15 days (Scott, Wagar & Elliott, 2010)
  • In the Champlain region this is can be translated as:
    • 2,765 admissions of seniors from Emergency Department for falls in 2013
    • The equivalent of 41,475 bed days at a cost of $17.2 million
    • Average length of stay for a falls-related admission = 15 days
    • Cost per bed / day = $415 (50th percentile)
  • Falls are directly accountable for 40 per cent of all elderly admissions to nursing homes or long-term care facilities

What is being done to prevent falls?

Provincially

Many jurisdictions internationally have developed approaches to reduce the number of falls and research tells us that a reduction of between 6% and 33% of fall-related injuries can be achieved through coordinated, community-wide, multi-strategy fall prevention initiatives (McClure et al., 2005).

In Ontario a task force was convened and developed the Provincial Integrated Falls Prevention Framework and Tool kit which was introduced in 2011.

Locally

In 2012 the Champlain LHIN began to invest in the development of a regional Falls Prevention Strategy. This initiative is a partnership between the LHIN, the region’s four Public Health Units, the Regional Geriatric Program of Eastern Ontario (RGPEO), and primary and community health care providers. Primary Care and Public Health leaders co-chair the Champlain Falls Prevention Steering Committee, which draws membership from across all health care sectors.

The objective of the strategy is: To effectively reduce falls and the impact of falls on Champlain older adults through a coordinated, evidence-informed approach to falls prevention that builds on community-wide, inter-sectoral collaboration.

The feedback from an early 2013 survey of primary and community care providers made it clear that a standardized approach was wanted and required to support teams in these sectors to provide screening, assessment, and intervention in order to prevent falls in their senior populations. Coordination, use of standardized tools and communication, and access to up-to-date resources that are relevant and useful were all issues that were raised in the survey.

Next month’s article: Responding to the issues: What have we done so far?

Article written by: Jane Adams (janadams@toh.on.ca) and Christine Bidmead (cbidmead@toh.on.ca), Project Managers, Champlain Falls Prevention Strategy