Northwest Prevention & Management of Inpatient Falls … · PREVENTION & MANAGEMENT OF INPATIENT...

NORTHWEST PREVENTION & MANAGEMENT OF

INPATIENT FALLS AUDIT

APPENDICES, PART I THIS FILE CONTAINS ONLY FOUR APPENDICES.

PLEASE SEE THE PART II FOR MORE INFORMATION.

THE PAGE NUMBERING CONTINUES FROM THE MAIN REPORT.

Appendices, part I

82

Appendices, part I

This section provides data and pro formas from the case note audit as well as Trust presentations

from the June 25th network event for reference. Data and pro formas from the service evaluation are

provided in Appendix, Part II.

LIST OF APPENDICES IN PART I

PAGE

83 Summary Data Tables

104 Case Note Review Instructions & Pro forma

107 Post-Fall Audit Instructions & Pro forma

111 Trust Presentations from the June 25th Network Event

NOTE: All pro formas or questionnaires are available on request. Please contact Deborah Kenyon on

0161 419 5984 or [email protected].

Summary Data Tables

83

Summary Data Tables

This section will present audit results in tables, giving counts or percentages by Trust.

LIST OF TABLES

PAGE

85 TABLE 1 - 2011 AUDIT SAMPLE BY TRUST

86 TABLE 2 - SEX AND SPECIALITY BY TRUST

87 TABLE 3 - PATIENT MOBILITY ON ADMISSION BY TRUST

88 TABLE 4 - FIRST REVIEW OF HISTORY OF FALLS BY TRUST

89 TABLE 5 - FIRST REVIEW OF GAIT/MOBILITY BY TRUST

90 TABLE 6 - FIRST REVIEW OF COGNITION BY TRUST

91 TABLE 7 - FIRST REVIEW OF PATIENT ANXIETY ABOUT FALLS BY TRUST

92 TABLE 8 - FIRST ASSESSMENT OF FALLS RISK BY TRUST

93 TABLE 9 - PATIENT’S HIGHEST RISK LEVEL DURING HOSPITAL STAY BY TRUST

94 TABLE 10 - FALLS CARE PLAN AGREED WITH PATIENT BY TRUST

95 TABLE 11 - NUMBER OF WARD TRANSFERS BY TRUST

96 TABLE 12 - RISK FACTOR BY TRUST: EYESIGHT

97 TABLE 13 - RISK FACTOR BY TRUST: HEARING

98 TABLE 14 - RISK FACTOR BY TRUST: MEDICATION

99 TABLE 15 - RISK FACTOR BY TRUST: URINALYSIS

100 TABLE 16 - RISK FACTOR BY TRUST: CONTINENCE

101 TABLE 17 - RISK FACTORS BY TRUST: MOBILITY, COGNITION

102 TABLE 18 - RISK FACTORS BY TRUST: POSTURAL HYPOTENSION, OSTEOPOROSIS

103 TABLE 19 - RISK FACTORS BY TRUST: ALTERNATIVE BEDS, BED RAILS

HOW TO READ THE TABLES

Each question is reported in a table as PERCENTAGE OF PATIENTS. Note that the sample for each ques-

tion may vary insignificantly from the final sample for each Trust as blanks were excluded by ques-

tion only.

Percentages are reported in cells which may vary in tone/colour, with darker tones/colours indicating

a higher percentage (approaching 100%) and lighter tones/colours indicating a lower percentage (ap-

proaching 0%).

Summary Data Tables

84

Example table:

NUMBER OF SMILES

NO SMILES ONE SMILE TWO

SMILES

THREE OR

MORE

SMILES

TOTAL 42% 41% 13% 4%

TRUST 1 83% 12% 5% 0%

Each question on a risk factor is categorised as ASSESSMENT, EVIDENCE, or INTERVENTION.

A Assessment of risk factor is being noted.

E Evidence of risk factor is being noted.

I Intervention for risk factor is being noted.

Whether or not a patient receives an ASSESSMENT for a risk factor depends on a Trust’s policy (and

falls intervention tool). Most Trusts stratify patients according to risk level, with the higher risk lev-

els receiving a more comprehensive list of further ASSESSMENTS.

Sometimes, a Trust provides INTERVENTIONS without doing an ASSESSMENT. If most patients

have EVIDENCE of a condition, it may be more efficient to provide INTERVENTIONS to everyone.

Most of the time, however, a Trust assesses for a risk factor, finds evidence of the risk factor, and

then provides an intervention to reduce that risk factor:

HOW TO INTERPRET THE TABLES

This data is provided in table format by Trust for reference only. Best practice guidance suggests

that Trusts should not compare falls rates against each other, as populations and incident reporting

differs significantly between Trusts. It is more meaningful to compare years for a single Trust, which

is now possible by referring to the previous falls audit reports from 2004, 2006 and 2009.

Please review this data in context of the Trust’s presentations and action plans. Please also note that

the data reported is from May 2011 and therefore may differ from current Trust practice.

Assessment of risk factor

Evidence of risk factor

Intervention for risk factor

Summary Data Tables

85

TABLE 1 - 2011 AUDIT SAMPLE BY TRUST

Trusts were asked to sample 60 patients.

A minimum sample of 40 was accepted for inclusion in the final sample.

2011 AUDIT SAMPLE

TOTAL 844

AINTREE 59

CHESTER 60

LANC TEACH 60

LEIGHTON 60

STHK 60

STOCKPORT 60

TAMESIDE 61

UHSM 60

WIRRAL 59

BOLTON 55

EAST LANC 47

SOUTHPORT 63

PENNINE 59

WIGAN 41

MACC 40

2011 AUDIT SAMPLE

Unless otherwise stated, the percentage for each question is out of the above sample for each Trust.

Note that there may be valid clinical reasons for why certain assessments or interventions are not

provided. As such, there are no standards set for the provision of assessments and care for modifia-

ble risk factors. Only ‘YES’ percentages are provided, to give some indication of provision. It is up to

individual Trusts to monitor and investigate these trends through local, topic-specific audits.

Summary Data Tables

86

TABLE 2 - SEX AND SPECIALITY BY TRUST

SEX

SPECIALITY

FEMALE MALE

MEDICINE ELDERLY ORTHOPAEDICS SURGERY

TOTAL 58% 42% TOTAL 38% 20% 21% 20%

AINTREE 58% 42% AINTREE 27% 24% 22% 27%

CHESTER 50% 50% CHESTER 48% 32% 3% 17%

LANC TEACH 57% 43% LANC TEACH 28% 8% 35% 28%

LEIGHTON 60% 40% LEIGHTON 53% 0% 23% 23%

STHK 58% 42% STHK 33% 35% 12% 20%

STOCKPORT 52% 48% STOCKPORT 23% 27% 25% 25%

TAMESIDE 59% 41% TAMESIDE 33% 0% 33% 34%

UHSM 40% 60% UHSM 25% 25% 25% 25%

WIRRAL 61% 39% WIRRAL 19% 51% 15% 15%

BOLTON 56% 44% BOLTON 36% 27% 27% 9%

EAST LANC 64% 36% EAST LANC 15% 17% 32% 36%

SOUTHPORT 58% 42% SOUTHPORT 75% 0% 12% 14%

PENNINE 65% 35% PENNINE 67% 0% 14% 19%

WIGAN 73% 27% WIGAN 12% 68% 20% 0%

MACC 70% 30% MACC 73% 5% 18% 5%

FEMALE MALE

MEDICINE ELDERLY ORTHOPAEDICS SURGERY

SEX SPECIALITY

Summary Data Tables

87

TABLE 3 - PATIENT MOBILITY ON ADMISSION BY TRUST

PATIENT MOBILITY ON ADMISSION

UNKNOWN IMMOBILE BED MOBILE WHEELCHAIR

MOBILE

RESTRICTED

(WITH AID)

RESTRICTED

(NO AID)

INDEPENDENTLY

MOBILE

TOTAL 7% 7% 5% 2% 34% 9% 37%

AINTREE 2% 0% 7% 2% 46% 5% 39%

CHESTER 2% 17% 3% 0% 18% 10% 50%

LANC TEACH 23% 7% 2% 0% 27% 12% 30%

LEIGHTON 10% 17% 15% 0% 27% 2% 30%

STHK 3% 5% 10% 2% 38% 20% 22%

STOCKPORT 0% 3% 2% 2% 40% 13% 40%

TAMESIDE 11% 2% 2% 3% 25% 10% 48%

UHSM 0% 12% 8% 0% 20% 7% 53%

WIRRAL 3% 3% 2% 2% 54% 3% 32%

BOLTON 0% 2% 5% 4% 35% 15% 40%

EAST LANC 17% 6% 0% 0% 38% 13% 26%

SOUTHPORT 17% 12% 0% 5% 29% 7% 31%

PENNINE 6% 8% 3% 0% 35% 6% 41%

WIGAN 5% 5% 2% 7% 41% 2% 37%

MACC 5% 10% 5% 0% 35% 10% 35%

UNKNOWN IMMOBILE BED MOBILE WHEELCHAIR

MOBILE

RESTRICTED

(WITH AID)

RESTRICTED

(NO AID)

INDEPENDENTLY

MOBILE

PATIENT MOBILITY ON ADMISSION

Summary Data Tables

88

TABLE 4 - FIRST REVIEW OF HISTORY OF FALLS BY TRUST

FIRST REVIEW OF HISTORY OF FALLS (DD/MM/YYYY)

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

TOTAL 1% 11% 72% 12% 3% 1%

AINTREE 2% 4% 70% 21% 2% 2%

CHESTER 2% 2% 82% 15% 0% 0%

LANC TEACH 0% 2% 80% 13% 3% 2%

LEIGHTON 0% 0% 79% 16% 5% 0%

STHK 0% 10% 69% 21% 0% 0%

STOCKPORT 0% 7% 90% 3% 0% 0%

TAMESIDE 14% 28% 28% 19% 7% 4%

UHSM 0% 0% 82% 12% 3% 3%

WIRRAL 0% 22% 65% 7% 5% 0%

BOLTON 0% 4% 93% 0% 2% 2%

EAST LANC 0% 29% 54% 7% 10% 0%

SOUTHPORT 2% 22% 66% 10% 0% 0%

PENNINE 0% 25% 56% 14% 2% 3%

WIGAN 0% 0% 90% 10% 0% 0%

MACC 0% 16% 74% 8% 3% 0%

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

FIRST REVIEW OF HISTORY OF FALLS (DD/MM/YYYY)

Summary Data Tables

89

TABLE 5 - FIRST REVIEW OF GAIT/MOBILITY BY TRUST

FIRST REVIEW OF GAIT/MOBILITY (DD/MM/YYYY)

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

TOTAL 1% 7% 69% 13% 4% 6%

AINTREE 0% 3% 63% 22% 5% 7%

CHESTER 2% 2% 82% 15% 0% 0%

LANC TEACH 0% 0% 82% 12% 5% 2%

LEIGHTON 0% 0% 77% 15% 5% 3%

STHK 2% 18% 53% 22% 3% 2%

STOCKPORT 0% 2% 93% 3% 0% 2%

TAMESIDE 10% 23% 28% 16% 7% 16%

UHSM 0% 0% 92% 5% 2% 2%

WIRRAL 0% 17% 49% 12% 5% 17%

BOLTON 0% 2% 75% 13% 9% 2%

EAST LANC 0% 11% 55% 9% 9% 17%

SOUTHPORT 0% 17% 71% 8% 0% 3%

PENNINE 0% 6% 67% 14% 2% 11%

WIGAN 0% 0% 88% 10% 0% 2%

MACC 0% 10% 65% 10% 5% 10%

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

FIRST REVIEW OF GAIT/MOBILITY (DD/MM/YYYY)

Summary Data Tables

90

TABLE 6 - FIRST REVIEW OF COGNITION BY TRUST

FIRST REVIEW OF COGNITIVE/MENTAL STATES (DD/MM/YYYY)

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

TOTAL 2% 13% 70% 10% 2% 3%

AINTREE 2% 5% 69% 17% 3% 3%

CHESTER 2% 2% 82% 15% 0% 0%

LANC TEACH 2% 0% 82% 12% 3% 2%

LEIGHTON 0% 0% 85% 8% 5% 2%

STHK 2% 33% 52% 12% 2% 0%

STOCKPORT 3% 35% 58% 0% 0% 3%

TAMESIDE 10% 30% 28% 20% 5% 8%

UHSM 0% 2% 83% 10% 3% 2%

WIRRAL 0% 32% 58% 5% 0% 5%

BOLTON 0% 2% 96% 0% 2% 0%

EAST LANC 2% 9% 68% 9% 4% 9%

SOUTHPORT 2% 19% 71% 7% 0% 2%

PENNINE 0% 6% 73% 14% 0% 6%

WIGAN 0% 2% 85% 10% 0% 2%

MACC 0% 20% 58% 8% 5% 10%

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

FIRST REVIEW OF COGNITIVE/MENTAL STATES (DD/MM/YYYY)

Summary Data Tables

91

TABLE 7 - FIRST REVIEW OF PATIENT ANXIETY ABOUT FALLS BY

TRUST

FIRST REVIEW OF ANXIOUS ABOUT FALLS (DD/MM/YYYY)

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

TOTAL 0% 74% 19% 3% 1% 2%

AINTREE 0% 93% 0% 0% 2% 5%

CHESTER 2% 77% 10% 3% 2% 7%

LANC TEACH 0% 23% 62% 10% 3% 2%

LEIGHTON 0% 100% 0% 0% 0% 0%

STHK 0% 67% 30% 2% 0% 2%

STOCKPORT 0% 78% 20% 2% 0% 0%

TAMESIDE 0% 93% 2% 2% 2% 2%

UHSM 0% 22% 62% 12% 3% 2%

WIRRAL 0% 63% 27% 2% 5% 3%

BOLTON 0% 96% 4% 0% 0% 0%

EAST LANC 0% 81% 9% 2% 2% 6%

SOUTHPORT 2% 90% 7% 0% 0% 2%

PENNINE 0% 98% 0% 0% 2% 0%

WIGAN 0% 61% 32% 5% 0% 2%

MACC 0% 60% 30% 8% 0% 3%

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

FIRST REVIEW OF ANXIOUS ABOUT FALLS (DD/MM/YYYY)

Summary Data Tables

92

TABLE 8 - FIRST ASSESSMENT OF FALLS RISK BY TRUST

FIRST ASSESSMENT OF FALLS RISK (DD/MM/YYYY)

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

TOTAL 1% 10% 67% 13% 3% 6%

AINTREE 2% 3% 54% 31% 5% 5%

CHESTER 0% 2% 82% 17% 0% 0%

LANC TEACH 0% 2% 80% 13% 3% 2%

LEIGHTON 0% 2% 70% 15% 7% 7%

STHK 0% 13% 58% 25% 0% 3%

STOCKPORT 0% 3% 92% 3% 0% 2%

TAMESIDE 11% 21% 21% 20% 8% 18%

UHSM 0% 0% 85% 10% 2% 3%

WIRRAL 0% 19% 59% 7% 5% 10%

BOLTON 0% 5% 91% 0% 2% 2%

EAST LANC 0% 43% 32% 6% 6% 13%

SOUTHPORT 0% 7% 78% 10% 2% 3%

PENNINE 0% 21% 56% 11% 2% 11%

WIGAN 0% 0% 88% 7% 0% 5%

MACC 0% 10% 65% 13% 3% 10%

UNKNOWN NO ON

ADMISSION

ON FIRST

FULL DAY

FOLLOWING

ADMISSION

ON SECOND

FULL DAY

FOLLOWING

ADMISSION

ON THE

THIRD FULL

DAY

FOLLOWING

ADMISSION

(OR LATER)

FIRST ASSESSMENT OF FALLS RISK (DD/MM/YYYY)

Summary Data Tables

93

TABLE 9 - PATIENT’S HIGHEST RISK LEVEL DURING HOSPITAL STAY

BY TRUST

PATIENT’S HIGHEST RISK LEVEL DURING THEIR HOSPITAL STAY

(BY RISK CATEGORY)

UNKNOWN NOT AT

RISK

TOTAL

AT RISK AT RISK LOW RISK

MEDIUM

RISK

HIGH

RISK

TOTAL 7% 9% 42% 5% 15% 11% 11%

AINTREE 3% 0% 97% 0% 36% 32% 29%

CHESTER 3% 5% 92% 0% 25% 28% 38%

LANC TEACH 3% 8% 88% 2% 25% 40% 22%

LEIGHTON 2% 0% 98% 0% 53% 33% 12%

STHK 10% 12% 78% 0% 25% 0% 53%

STOCKPORT 3% 0% 97% 0% 33% 23% 40%

TAMESIDE 23% 16% 61% 0% 33% 16% 11%

UHSM 12% 47% 41% 32% 7% 2% 0%

WIRRAL 24% 27% 49% 3% 19% 22% 5%

BOLTON 0% 40% 60% 60% 0% 0% 0%

EAST LANC 43% 4% 53% 0% 13% 21% 19%

SOUTHPORT 22% 0% 78% 0% 41% 30% 6%

PENNINE 7% 49% 44% 31% 2% 0% 12%

WIGAN 2% 0% 98% 0% 39% 32% 27%

MACC 18% 20% 63% 15% 25% 18% 5%

UNKNOWN NOT AT

RISK

AT RISK

(ALL) AT RISK LOW RISK

MEDIUM

RISK

HIGH

RISK

PATIENT’S HIGHEST RISK LEVEL DURING THEIR HOSPITAL STAY

(BY RISK CATEGORY)

Summary Data Tables

94

TABLE 10 - FALLS CARE PLAN AGREED WITH PATIENT BY TRUST

FALLS CARE PLAN AGREED WITH PATIENT, FAMILY OR CARER

TOTAL

YES

YES,

WRITTEN YES, VERBAL NO N/A

TOTAL 35% 18% 16% 65% 0%

AINTREE 69% 2% 68% 31% 0%

CHESTER 63% 53% 10% 37% 0%

LANC TEACH 3% 0% 3% 97% 0%

LEIGHTON 18% 2% 17% 82% 0%

STHK 35% 35% 0% 65% 0%

STOCKPORT 75% 33% 42% 25% 0%

TAMESIDE 21% 20% 2% 79% 0%

UHSM 68% 8% 60% 32% 0%

WIRRAL 17% 12% 5% 83% 0%

BOLTON 0% 0% 0% 100% 0%

EAST LANC 32% 13% 19% 68% 0%

SOUTHPORT 11% 11% 0% 89% 0%

PENNINE 27% 22% 5% 71% 2%

WIGAN 51% 44% 7% 49% 0%

MACC 33% 33% 0% 68% 0%

TOTAL

YES

YES,

WRITTEN YES, VERBAL NO N/A

FALLS CARE PLAN AGREED WITH PATIENT, FAMILY OR CARER

Summary Data Tables

95

TABLE 11 - NUMBER OF WARD TRANSFERS BY TRUST

NUMBER OF WARD TRANSFERS

NO WARD

TRANSFERS

ONE

WARD

TRANSFER

TWO

WARD

TRANSFERS

THREE

OR MORE

WARD

TRANSFERS

TOTAL 42% 41% 13% 4%

AINTREE 83% 12% 5% 0%

CHESTER 58% 32% 7% 3%

LANC TEACH 48% 32% 17% 3%

LEIGHTON 20% 60% 18% 2%

STHK 36% 44% 17% 3%

STOCKPORT 22% 43% 25% 10%

TAMESIDE 31% 31% 23% 15%

UHSM 50% 47% 3% 0%

WIRRAL 32% 59% 9% 0%

BOLTON 33% 56% 9% 2%

EAST LANC 55% 38% 6% 0%

SOUTHPORT 63% 20% 15% 2%

PENNINE 31% 52% 15% 3%

WIGAN 24% 62% 10% 3%

MACC 43% 33% 20% 5%

NO WARD

TRANSFERS

ONE

WARD

TRANSFER

TWO

WARD

TRANSFERS

THREE

OR MORE

WARD

TRANSFERS

NUMBER OF WARD TRANSFERS

Summary Data Tables

96

TABLE 12 - RISK FACTOR BY TRUST: EYESIGHT

A E I I I

WA

S EY

ESIG

HT C

HEC

KED

?

(OB

JEC

TS A

T A

DIS

TA

NCE,

EYES

IGH

T C

HA

RT)

WA

S TH

ERE

EVID

ENCE

OF

PO

OR

EY

ESIG

HT?

(WIT

H C

UR

REN

T E

YEW

EAR

)

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

SIG

HT A

ID?

WA

S TH

E P

ATIE

NT R

EFER

RED

FOR

A V

ISIO

N T

EST?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N I

NTER

VEN

TIO

N F

OR

EYES

IGH

T?

YES YES YES YES YES

TOTAL 25% 22% 13% 1% 13%

AINTREE 17% 14% 8% 3% 10%

CHESTER 32% 12% 0% 0% 0%

LANC TEACH 2% 13% 5% 0% 5%

LEIGHTON 0% 13% 7% 0% 7%

STHK 10% 3% 17% 0% 17%

STOCKPORT 10% 17% 0% 0% 0%

TAMESIDE 16% 13% 5% 0% 5%

UHSM 83% 17% 7% 0% 7%

WIRRAL 22% 37% 23% 0% 22%

BOLTON 62% 18% 2% 2% 2%

EAST LANC 28% 22% 15% 0% 15%

SOUTHPORT 27% 41% 40% 0% 39%

PENNINE 0% 55% 43% 0% 41%

WIGAN 59% 37% 5% 0% 5%

MACC 25% 25% 10% 5% 10%

YES YES YES YES YES

WA

S EY

ESIG

HT C

HEC

KED

?

(OB

JEC

TS A

T A

DIS

TA

NCE,

EYES

IGH

T C

HA

RT)

WA

S TH

ERE

EVID

ENCE

OF

PO

OR

EY

ESIG

HT?

(WIT

H C

UR

REN

T E

YEW

EAR

)

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

SIG

HT A

ID?

WA

S TH

E P

ATIE

NT R

EFER

RED

FOR

A V

ISIO

N T

EST?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N I

NTER

VEN

TIO

N F

OR

EYES

IGH

T?

A E I I I

Summary Data Tables

97

TABLE 13 - RISK FACTOR BY TRUST: HEARING

A E I I I

WA

S H

EAR

ING

CH

ECK

ED?

WA

S TH

ERE

EVID

ENCE

OF

PO

OR

HEA

RIN

G?

(WIT

H A

ID

IN W

OR

KIN

G O

RD

ER)

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

HEA

RIN

G A

ID?

WA

S TH

E P

ATIE

NT R

EFER

RED

FOR

A H

EAR

ING

TES

T/A

ID?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N I

NTER

VEN

TIO

N F

OR

HEA

RIN

G?

YES YES YES YES YES

TOTAL 30% 15% 6% 0% 6%

AINTREE 93% 14% 7% 0% 7%

CHESTER 15% 17% 2% 0% 2%

LANC TEACH 3% 10% 2% 0% 2%

LEIGHTON 2% 13% 5% 0% 5%

STHK 8% 3% 2% 0% 2%

STOCKPORT 7% 3% 0% 0% 0%

TAMESIDE 28% 10% 5% 0% 5%

UHSM 72% 10% 3% 0% 3%

WIRRAL 19% 17% 7% 0% 7%

BOLTON 65% 31% 13% 0% 13%

EAST LANC 26% 15% 9% 0% 9%

SOUTHPORT 31% 19% 15% 0% 15%

PENNINE 2% 23% 6% 0% 6%

WIGAN 59% 24% 2% 0% 2%

MACC 33% 15% 10% 5% 10%

YES YES YES YES YES

WA

S H

EAR

ING

CH

ECK

ED?

WA

S TH

ERE

EVID

ENCE

OF

PO

OR

HEA

RIN

G?

(WIT

H A

ID

IN W

OR

KIN

G O

RD

ER)

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

HEA

RIN

G A

ID?

WA

S TH

E P

ATIE

NT R

EFER

RED

FOR

A H

EAR

ING

TES

T/A

ID?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N I

NTER

VEN

TIO

N F

OR

HEA

RIN

G?

A E I I I

Summary Data Tables

98

TABLE 14 - RISK FACTOR BY TRUST: MEDICATION

E E E E E E A I

WA

S TH

E P

ATIE

NT O

N

PSY

CH

OTR

OP

IC

MED

ICA

TIO

NS?

WA

S TH

E P

ATIE

NT O

N

SED

ATIV

E M

EDIC

ATIO

NS?

WA

S TH

E P

ATIE

NT O

N

CA

RD

IAC M

EDIC

ATIO

NS?

WA

S TH

E P

ATIE

NT O

N

BO

NE-

STR

ENG

TH

ENIN

G

MED

ICA

TIO

NS?

WA

S TH

E P

ATIE

NT O

N

AN

TIB

IOTI

CS?

WA

S TH

E P

ATIE

NT O

N

FOU

R O

R M

OR

E

MED

ICA

TIO

NS?

WA

S TH

ERE

A R

ISK

/BEN

EFIT

REV

IEW

OF

ALL

MED

ICA

TIO

N?

IF Y

ES,

DID

TH

IS R

ESU

LT I

N A

CH

AN

GE

IN M

EDIC

ATIO

NS?

YES YES YES YES YES YES YES YES

TOTAL 26% 25% 66% 24% 50% 88% 44% 30%

AINTREE 39% 32% 59% 27% 44% 88% 15% 12%

CHESTER 40% 17% 30% 32% 58% 95% 98% 92%

LANC TEACH 23% 42% 52% 10% 48% 73% 45% 35%

LEIGHTON 40% 13% 83% 18% 38% 87% 93% 25%

STHK 17% 20% 75% 30% 62% 98% 75% 40%

STOCKPORT 27% 25% 62% 15% 28% 83% 45% 34%

TAMESIDE 28% 25% 66% 33% 59% 92% 31% 31%

UHSM 33% 50% 75% 27% 50% 85% 33% 27%

WIRRAL 20% 24% 75% 32% 39% 88% 53% 35%

BOLTON 31% 15% 76% 31% 49% 87% 2% 2%

EAST LANC 30% 32% 66% 9% 34% 85% 23% 17%

SOUTHPORT 15% 3% 68% 14% 51% 83% 31% 14%

PENNINE 6% 32% 49% 27% 57% 87% 5% 5%

WIGAN 27% 10% 83% 30% 71% 95% 56% 48%

MACC 13% 25% 83% 23% 70% 95% 58% 32%

YES YES YES YES YES YES YES YES

WA

S TH

E P

ATIE

NT O

N

PSY

CH

OTR

OP

IC

MED

ICA

TIO

NS?

WA

S TH

E P

ATIE

NT O

N

SED

ATIV

E M

EDIC

ATIO

NS?

WA

S TH

E P

ATIE

NT O

N

CA

RD

IAC M

EDIC

ATIO

NS?

WA

S TH

E P

ATIE

NT O

N

BO

NE-

STR

ENG

TH

ENIN

G

MED

ICA

TIO

NS?

WA

S TH

E P

ATIE

NT O

N

AN

TIB

IOTI

CS?

WA

S TH

E P

ATIE

NT O

N

FOU

R O

R M

OR

E

MED

ICA

TIO

NS?

WA

S TH

ERE

A R

ISK

/BEN

EFIT

REV

IEW

OF

ALL

MED

ICA

TIO

N?

IF Y

ES,

DID

TH

IS R

ESU

LT I

N A

CH

AN

GE

IN M

EDIC

ATIO

NS?

E E E E E E A I

Summary Data Tables

99

TABLE 15 - RISK FACTOR BY TRUST: URINALYSIS

A E A I

WA

S A

UR

INA

LYSI

S

PER

FOR

MED

?

WA

S A

N I

NFE

CTIO

N

CO

NFI

RM

ED?

WER

E FU

RTH

ER

INV

ESTIG

ATIO

NS

PER

FOR

MED

?

WA

S TH

E P

ATIE

NT T

REA

TED

FOR

TH

E IN

FECTIO

N?

YES YES YES YES

TOTAL 49% 15% 14% 16%

AINTREE 49% 12% 8% 10%

CHESTER 63% 19% 25% 14%

LANC TEACH 32% 8% 3% 7%

LEIGHTON 43% 23% 5% 23%

STHK 65% 15% 30% 25%

STOCKPORT 23% 7% 10% 7%

TAMESIDE 61% 10% 10% 10%

UHSM 33% 7% 5% 7%

WIRRAL 63% 19% 26% 18%

BOLTON 62% 15% 2% 17%

EAST LANC 43% 13% 9% 19%

SOUTHPORT 47% 12% 7% 12%

PENNINE 48% 18% 26% 21%

WIGAN 44% 29% 12% 29%

MACC 66% 37% 32% 37%

YES YES YES YES

WA

S A

UR

INA

LYSI

S

PER

FOR

MED

?

WA

S A

N I

NFE

CTIO

N

CO

NFI

RM

ED?

WER

E FU

RTH

ER

INV

ESTIG

ATIO

NS

PER

FOR

MED

?

WA

S TH

E P

ATIE

NT T

REA

TED

FOR

TH

E IN

FECTIO

N?

A E A I

Summary Data Tables

100

TABLE 16 - RISK FACTOR BY TRUST: CONTINENCE

A E I E I

WA

S TH

E P

ATIE

NT A

SSES

SED

FOR

CO

NTI

NEN

CE?

DID

TH

E P

ATIE

NT H

AV

E A

NY

CO

NTI

NEN

CE

PR

OB

LEM

S?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

DV

ICE

ON

TO

ILET

PLA

NN

ING

?

WA

S TH

E P

ATIE

NT

CA

TH

ETER

ISED

?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N I

NTER

VEN

TIO

N F

OR

CO

NTI

NEN

CE?

YES YES YES YES YES

TOTAL 82% 27% 14% 23% 31%

AINTREE 97% 22% 10% 25% 34%

CHESTER 85% 46% 19% 29% 43%

LANC TEACH 80% 15% 17% 10% 20%

LEIGHTON 78% 30% 5% 22% 25%

STHK 30% 32% 3% 18% 22%

STOCKPORT 83% 35% 5% 20% 22%

TAMESIDE 56% 10% 13% 26% 31%

UHSM 100% 20% 7% 23% 28%

WIRRAL 91% 27% 9% 18% 25%

BOLTON 96% 29% 0% 29% 29%

EAST LANC 70% 17% 15% 28% 36%

SOUTHPORT 90% 32% 24% 19% 27%

PENNINE 94% 29% 13% 29% 40%

WIGAN 100% 34% 56% 27% 63%

MACC 90% 23% 25% 18% 38%

YES YES YES YES YES

WA

S TH

E P

ATIE

NT A

SSES

SED

FOR

CO

NTI

NEN

CE?

DID

TH

E P

ATIE

NT H

AV

E A

NY

CO

NTI

NEN

CE

PR

OB

LEM

S?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

DV

ICE

ON

TO

ILET

PLA

NN

ING

?

WA

S TH

E P

ATIE

NT

CA

TH

ETER

ISED

?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N I

NTER

VEN

TIO

N F

OR

CO

NTI

NEN

CE?

A E I E I

Summary Data Tables

101

TABLE 17 - RISK FACTORS BY TRUST: MOBILITY, COGNITION

A I

E E

WA

S TH

E P

ATIE

NT R

EVIE

WED

BY

A P

HY

SIO

THER

AP

IST?

WA

S TH

E P

ATIE

NT*

PR

OV

IDED

WIT

H A

MO

VIN

G/H

AN

DLI

NG

PLA

N?

DID

TH

E P

ATIE

NT H

AV

E

DEM

ENTIA

?

WA

S TH

E P

ATIE

NT D

ELIR

IOU

S

OR

CO

NFU

SED

?

YES YES YES YES

TOTAL 65% 59% TOTAL 13% 26%

AINTREE 71% 17% AINTREE 24% 24%

CHESTER 62% 60% CHESTER 5% 20%

LANC TEACH 73% 72% LANC TEACH 8% 12%

LEIGHTON 58% 65% LEIGHTON 10% 22%

STHK 49% 70% STHK 10% 36%

STOCKPORT 63% 77% STOCKPORT 8% 22%

TAMESIDE 75% 72% TAMESIDE 15% 18%

UHSM 58% 97% UHSM 10% 18%

WIRRAL 66% 46% WIRRAL 9% 24%

BOLTON 78% 0% BOLTON 20% 45%

EAST LANC 74% 79% EAST LANC 17% 23%

SOUTHPORT 47% 56% SOUTHPORT 20% 20%

PENNINE 73% 42% PENNINE 10% 32%

WIGAN 59% 71% WIGAN 18% 37%

MACC 73% 78% MACC 18% 43%

YES YES YES YES

WA

S TH

E P

ATIE

NT R

EVIE

WED

BY

A P

HY

SIO

THER

AP

IST?

WA

S TH

E P

ATIE

NT*

PR

OV

IDED

WIT

H A

MO

VIN

G/H

AN

DLI

NG

PLA

N?

DID

TH

E P

ATIE

NT H

AV

E

DEM

ENTIA

?

WA

S TH

E P

ATIE

NT D

ELIR

IOU

S

OR

CO

NFU

SED

?

A I

E E

Summary Data Tables

102

TABLE 18 - RISK FACTORS BY TRUST: POSTURAL HYPOTENSION, OS-

TEOPOROSIS

A E I

A

WA

S LY

ING

AN

D S

TAN

DIN

G

BLO

OD

PR

ESSU

RE

TA

KEN

?

WA

S TH

ERE

EVID

ENCE

OF

PO

STU

RA

L H

YP

OTEN

SIO

N?

WA

S TH

E P

ATIE

NT*

PR

OV

IDED

WIT

H A

DV

ICE

ON

HO

W T

O

PR

EVEN

T S

YM

PTO

MS

OF

PO

STU

RA

L H

YP

OTEN

SIO

N?

WA

S TH

E P

ATIE

NT A

SSES

SED

FOR

OST

EOP

OR

OSI

S?

(IN

CLU

DIN

G R

EFER

RA

LS)

YES YES YES YES

TOTAL 8% 4% 2% TOTAL 6%

AINTREE 8% 0% 0% AINTREE 7%

CHESTER 9% 5% 4% CHESTER 5%

LANC TEACH 0% 0% 0% LANC TEACH 3%

LEIGHTON 5% 5% 0% LEIGHTON 2%

STHK 15% 7% 3% STHK 0%

STOCKPORT 13% 2% 0% STOCKPORT 8%

TAMESIDE 7% 2% 2% TAMESIDE 10%

UHSM 8% 6% 4% UHSM 12%

WIRRAL 8% 3% 2% WIRRAL 8%

BOLTON 0% 4% 0% BOLTON 13%

EAST LANC 13% 6% 4% EAST LANC 2%

SOUTHPORT 2% 0% 0% SOUTHPORT 0%

PENNINE 2% 10% 0% PENNINE 0%

WIGAN 7% 0% 2% WIGAN 15%

MACC 30% 10% 5% MACC 15%

YES YES YES YES

WA

S LY

ING

AN

D S

TAN

DIN

G

BLO

OD

PR

ESSU

RE

TA

KEN

?

WA

S TH

ERE

EVID

ENCE

OF

PO

STU

RA

L H

YP

OTEN

SIO

N?

WA

S TH

E P

ATIE

NT*

PR

OV

IDED

WIT

H A

DV

ICE

ON

HO

W T

O

PR

EVEN

T S

YM

PTO

MS

OF

PO

STU

RA

L H

YP

OTEN

SIO

N?

WA

S TH

E P

ATIE

NT A

SSES

SED

FOR

OST

EOP

OR

OSI

S?

(IN

CLU

DIN

G R

EFER

RA

LS)

A E I

A

Summary Data Tables

103

TABLE 19 - RISK FACTORS BY TRUST: ALTERNATIVE BEDS, BED

RAILS

A I

A I

WA

S TH

E P

ATIE

NT A

SSES

SED

FOR

ALT

ERN

ATIV

E B

EDS?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N A

LTER

NA

TIV

E B

ED?

WA

S TH

E P

ATIE

NT’S

NEE

D

FOR

BED

RA

ILS

ASS

ESSE

D?

WA

S TH

E P

ATIE

NT*

PR

OV

IDED

WIT

H A

BED

RA

IL P

LAN

?

YES YES YES YES

TOTAL 33% 14% TOTAL 55% 32%

AINTREE 5% 2% AINTREE 29% 12%

CHESTER 45% 28% CHESTER 80% 54%

LANC TEACH 68% 27% LANC TEACH 77% 37%

LEIGHTON 12% 3% LEIGHTON 63% 58%

STHK 2% NA* STHK 93% 63%

STOCKPORT 35% 10% STOCKPORT 43% 32%

TAMESIDE 13% 0% TAMESIDE 43% 21%

UHSM 43% 17% UHSM 85% 50%

WIRRAL 47% 3% WIRRAL 54% 17%

BOLTON 69% 24% BOLTON 25% 7%

EAST LANC 13% 4% EAST LANC 28% 13%

SOUTHPORT 3% 2% SOUTHPORT 17% 8%

PENNINE 25% 23% PENNINE 25% 17%

WIGAN 61% 29% WIGAN 98% 68%

MACC 65% 43% MACC 68% 28%

YES YES YES YES

WA

S TH

E P

ATIE

NT A

SSES

SED

FOR

ALT

ERN

ATIV

E B

EDS?

WA

S TH

E P

ATIE

NT P

RO

VID

ED

WIT

H A

N A

LTER

NA

TIV

E B

ED?

WA

S TH

E P

ATIE

NT’S

NEE

D

FOR

BED

RA

ILS

ASS

ESSE

D?

WA

S TH

E P

ATIE

NT*

PR

OV

IDED

WIT

H A

BED

RA

IL P

LAN

?

A I

A I

Key: PURPLE indicates that a question was not applicable to this Trust.

* STHK provides alternative beds to all patients.

Case Note Review Instructions & Pro forma

104


CASE NOTE REVIEW - PRO FORMA INSTRUCTIONS


105

CASE NOTE REVIEW - PRO FORMA PAGE 1 OF 2


106

CASE NOTE REVIEW - PRO FORMA PAGE 2 OF 2

Post-Fall Audit Instructions & Pro forma

107


POST-FALL AUDIT - PRO FORMA INSTRUCTIONS


108

POST FALL AUDIT – PRO FORMA PAGE 1 OF 3


109



110


Trust Presentations from the June 25th Network Event

111

Trust Presentations from the June 25th Network Event

Acute Trusts were invited to present a summary of their results and either a SWOT analysis

(strengths, weaknesses, opportunities, threats) or an action plan as part of the network event on

June 25th (2011). These presentations are provided for reference.

LIST OF PRESENTATIONS

PAGE

112 PRESENTATION 1 - AINTREE UNIVERSITY HOSPITALS NHS FT

113 PRESENTATION 2 - EAST LANCASHIRE HOSPITALS NHS TRUST

114 PRESENTATION 3 - LANCASHIRE TEACHING HOSPITALS NHS FT

115 PRESENTATION 4 - EAST CHESHIRE NHS TRUST

116 PRESENTATION 5 - MID-CHESHIRE HOSPITALS NHS FT

118 PRESENTATION 6 - ST HELENS & KNOWSLEY HOSPITALS NHS TRUST

119 PRESENTATION 7 - STOCKPORT NHS FT

120 PRESENTATION 8 - UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FT

123 PRESENTATION 9 - TAMESIDE HOSPITAL NHS FT

124 PRESENTATION 10 - WRIGHTINGTON, WIGAN AND LEIGH NHS FT

112

PRESENTATION 1 - AINTREE UNIVERSITY HOSPITALS NHS FT

113

PRESENTATION 2 - EAST LANCASHIRE HOSPITALS NHS TRUST

114

PRESENTATION 3 - LANCASHIRE TEACHING HOSPITALS NHS FT

115

PRESENTATION 4 - EAST CHESHIRE NHS TRUST

116

PRESENTATION 5 - MID-CHESHIRE HOSPITALS NHS FT

118

PRESENTATION 6 - ST HELENS & KNOWSLEY HOSPITALS NHS TRUST

119

PRESENTATION 7 - STOCKPORT NHS FT

120

PRESENTATION 8 - UNIVERSITY HOSPITAL OF SOUTH MANCHESTER

NHS FT

123

PRESENTATION 9 - TAMESIDE HOSPITAL NHS FT

124

PRESENTATION 10 - WRIGHTINGTON, WIGAN AND LEIGH NHS FT

125

NORTHWEST PREVENTION & MANAGEMENT OF

INPATIENT FALLS AUDIT

END OF

APPENDICES, PART I THIS FILE CONTAINS ONLY FOUR APPENDICES.

PLEASE SEE THE PART II FOR MORE INFORMATION.

THE PAGE NUMBERING CONTINUES FROM THE MAIN REPORT.

Northwest Prevention & Management of Inpatient Falls … · PREVENTION & MANAGEMENT OF INPATIENT...

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