District nurses join forces with firefighters to prevent falls
Fire safety checks are being used to identify older people at risk of faling and refer them to appropriate services
Nurses have teamed up with West Yorkshire Fire and Rescue Service (WYFRS) as part of a falls prevention initiative
Bradford District Care NHS Foundation Trust (BDCT) is providing training to all firefighters across Bradford and Airedale as part of an 18-month falls prevention project. The training will enable firefighters to identify older people who are at risk of falling at home as part of their routine Safe and Well checks. If an older person is identified as being at risk, they will be referred to the district nursing team for an in-depth falls assessment.
More than 25,000
people age 65 and over have at least one fall in the Bradford district every year
Area manager for fire safety at WYFRS, Chris Kirby, said: 'When firefighters visit people in their homes for Safe and Well checks to discuss fire safety, they will also give basic advice on falls and see which people could be at risk of a fall. We can then identify issues at an early stage which can reduce the likelihood of people being admitted to hospital by putting preventative measures in place.'
The training is being delivered by the trust’s falls prevention nurse, Rachel Morris. 'More than 25,000 people over 65 have at least one fall each year in the Bradford district – one in three are over 65 and one in two are over 80,' Ms Morris said.
'Out of this annual number, 578 people are admitted to hospital as a result of a hip fracture and 2,600 attend hospital as a result of a fracture. By working together with WYFRS, we are able to identify vulnerable people who we might not be aware of and offer help and support to prevent falls which could result in a serious injury.'
When the firefighters carry out a Safe and Well check, a person’s falls risk is identified through four questions. These include whether the person has fallen in the past 12 months, whether they have experienced any episodes of dizziness or blackouts and whether they have any issues manoeuvring around their home. A yes answer to any of the questions triggers a referral to the district nursing team via the trust’s single point of access contact centre. For those deemed not at risk, firefighters will offer basic falls prevention advice such as keeping wires out of the way and moving furniture and rugs to avoid trip hazards. They will also discuss the importance of having regular eye tests and medication reviews.
One in three
are over 65 and one in two are over 80
The project has been introduced across the Bradford and Airedale district following a successful six-month pilot in Keighley. The fire service carried out 80 falls screening checks to identify those at risk and this resulted in 46 referrals to the district nursing team. In addition, the project is helping to identify older people who are not known to the district nurses.
'Firefighters have access to vulnerable people who would not previously have been on the radar of the trust’s district nursing team,' Ms Morris said. 'We find people do listen to the advice from firefighters and they are honest about any issues they have been having as they feel more comfortable talking to them. As an older person, you may not want a doctor or nurse coming into your home as you may be worried about where a visit could lead if you are unwell.
'Firefighters can provide reassurance that the district nurses want to help to prevent a fall happening so older people can remain independent and at home.'
As part of the training, Ms Morris discusses a case study of a woman aged 84 who was involved in the pilot to illustrate how a potential fall was prevented. The patient was not previously known to the trust’s services prior to the Safe and Well check. Following a medication review as part of the district nursing falls assessment, the patient was found to have an undiagnosed condition: postural hypertension. This was managed through medication and a referral to a local balance and exercise class.
Practical help is available
'Vulnerable people often do not know there is practical help available such as cleaning, grocery shopping or befriending services in the local community,' BDCT district nurse, Jacqueline Critchlow said.
'There was a woman who used to have regular falls when walking her two dogs, and this sometimes resulted in her being admitted to hospital. The situation was affecting her and she worried about the dogs not being walked. I referred her to the befriending service who offer dog-walking. A volunteer from the service now walks the dogs every day, and this has prevented the woman having any further falls. It is rare that a patient falls off our radar once they are on it.'
'We carry out a number of checks within the falls assessment,' said team leader for the Silsden district nursing team, Jo Corbett. 'We look at all factors that could cause or have previously caused a fall such as medication, high or low blood pressure plus any infections a person may have that could cause them to lose balance. In the over 65s, a large proportion of hospital admissions are due to urinary tract infections which do turn out to be the cause of a fall a high percentage of the time.'
are admitted to hospital annually as a result of a hip fracture
Since the project began at the end of July, training has been delivered to 40 firefighters including all members of the Keighley and Bingley fire crews. The training is receiving a positive response from the firefighters. 'WYFRS is really onboard with offering falls prevention advice and risk screening as part of their Safe and Well checks,' Ms Morris said.
'We are the gatekeepers to many local services'
'We often identify undiagnosed medical conditions through the falls assessment,' Ms Corbett said. 'Additionally, the assessment helps us to identify people who are socially isolated. We can refer vulnerable people to social groups and events in their local area or if they are nervous about going out on their own, we can arrange support from the carers resource or befriending service. As district nurses, we can offer a wide range of help and support as we are the gatekeepers to many local services.
'The referrals we receive from the fire service are excellent, they really do identify when a person is at risk. Many of the people referred to us tend to be independent and as a result, they have not previously been identified to us as having a nursing need. We do a follow-up with patients three months after our initial assessment to check the support services we referred are in place. We can also arrange any further support or equipment that is needed.
'This proactive approach is enabling us to identify the factors surrounding an older person’s falls risk and act on those before they lead to a potential hospital admission or life-threatening hip replacement surgery.'