DEVELOPMENT AND INTRODUCTION OF A FALLS SCREENING TOOL FOR

OUTPATIENT DIALYSIS: THE FRAMP DIALYSIS

BEVERLEY DE SOUZA, SIR CHARLES GAIRDNER HOSPITAL

MARJORIE SO, SIR CHARLES GAIRDNER HOSPITAL

NICOLE SCHLATTER, SIR CHARLES GAIRDNER HOSPITAL

HAEMODIALYSIS

REMOVES FLUID FROM THE BLOOD

CORRECTS ELECTROLYTE

IMBALANCES IN ESRF AND

AKI

HAEMODIALYSIS

MAY INDUCE

• DIZZINESS

• HYPOTENSION

• ARRHYTHMIAS

• MUSCLE WEAKNESS

• SYNCOPE

HAEMODIALYSIS

AUSTRALIAN POPULATION

5.3% RECEIVING DIALYSIS (ANZDATA)

DIALYSIS PATIENTS

47.9% AGED > 65YRS (ANZDATA)

40% IN OUR UNIT > 65 YRS

80% FALLS OCCUR HOME (COOK, DESMET)

RISK FACTORS

Related to aging Related CKD co-morbidities ESRD/HD

• Gait deficit• Decreased mobility• Cognitive impairment• Postural hypotension• Multiple medications• Inner ear impairments• Visual impairments• Cardio-vascular diseases• Neurologic diseases• Impaired posture control• Impaired muscle strength and

tone• Balance deficits• Arthritis• Impaired ADL• Depression

• Diabetes mellitus, with microvascular and macrovascular sequelae

• Peripheral vascular disease• Cardiovascular problems• Hypertension with hypotensive

episode

• Dialysis-related hypotension• CKD-bone and mineral Disease• Myopathy• Anaemia• Metabolic acidosis• Dialysis disequilibrium• Dialysis encephalopathy• Catheter-related

infection/sepsis• Dialysis-related arrhythmias• Post-dialysis fatigue

Source: Abdel-Rahman, Turgent, Balogun 2011

FRAMP (WA HEALTH)

FRAMP DIALYSISWHY ?

OUR PATIENT POPULATION HAS A HIGHER RISK OF MORTALITY POST FALLS (COOK)

PATIENT

SAFETY

COLLABORATE

ON

INTERVENTIONS

EDUCATION

FOR PATIENTS

AND CARERS

INCREASE

STAFF

CONFIDENCE

AND SO THE JOURNEY BEGAN ….

DESIGN OF FRAMP DIALYSIS

MOOTED QI PROJECT

REQUIREMENTS

- SCREEN AND ASSESS RISK

- PROVIDE SUITABLE INTERVENTIONS

- UTILISE QUICKLY

- INDIVUALISE INTERVENTIONS

- IMPROVE PATIENT SATISFACTION

Planning

DESIGN OF FRAMP DIALYSIS

CONTACTED OTHER DIALYSIS UNITS

ONLINE SEARCH FOR FALLS TOOLS

LITERATURE SEARCH FOR RELATED ARTICLES

REQUIREMENTS FROM RESEARCH

• COMMUNICATION TO HEALTH PROFESSIONALS (SA HEALTH, VIC HEALTH)

• CULTURALLY ACCEPTABLE INFORMATION (QLD HEALTH, SOYF)

Planning Research

DESIGN OF FRAMP DIALYSIS

CONCEPTUAL DESIGN

TRIAL OF PROTOTYPE TOOL

INCORPORATE FEEDBACK

Planning Research Design

SIMPLE

INTERVENTIONS

THAT CAN BE

USED

SPACE FOR

INDIVIDUAL

INTERVENTIONS

SATISIFIED

WITH MY

INDIVIDUAL

INTERVENTIONS

GOOD GUIDE

TO HEALTH

PROFESSIONALS

VERY

COMPREHENSIVE

FRAMP DIALYSIS

FRAMP DIALYSIS

FRAMP DIALYSIS

FRAMP DIALYSIS

THIS HAS BEEN APPROVED BY THE S.C.G.H. HEALTH INFORMATION

MANAGEMENT COMMITTEE AND WILL BE INTRODUCED IN 2019.

THIS COULD BE EASILY IMPLEMENTED IN HAEMODIALYSIS UNITS. IT

MAY ACT AS A TEMPLATE IN OTHER AREAS. WE ARE HAPPY TO SHARE

OUR FRAMP.

SPECIAL THANK YOU TO SU KITCHEN AND CHLOE CHARLESWORTH

IN ASSISTING US TO CREATE THE FRAMP DIALYSIS.

EXTRA SPECIAL THANK YOU TO OUR PATIENT, MARILYN CRISAFULLI.

THANK YOU

ANY QUESTIONS?

CONTACT DETAILS

SU KITCHEN, FALLS CNC, SIR CHARLES

GAIRDNER HOSPITAL

SU.KITCHEN@HEALTH.WA.GOV.AU

ENJOY LUNCH!!

BIBLIOGRAPHY

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