3rd September 2019 Proactively Preventing Harm from Falls
Western NSW Forum in Dubbo Flyer
1st November 2019 Northern NSW Forum in Ballina
Featured Topic: Osteoarthritis
A clinical snapshot from South Western Sydney Local Area Health District - by Julia Gaudin
The Osteoporosis Refracture Prevention (ORP) service is a proactive, preventative health service providing comprehensive case management for patients who have sustained a minimal trauma fracture.
In 2017, South Western Sydney Local Health District conducted an audit to indicate there was no mechanism for identification and treatment of patients who have sustained a minimal trauma fracture (MTF). Left untreated, patients with a MTF have a high rate of refracture with associated mortality and morbidity .
Consequently, like other hospitals across New South Wales, Liverpool Hospital implemented an Osteoporosis Refracture Prevention (ORP) service in 2018 to address the unmet need of identifying patients sustaining a MTF, assessing fracture risk and providing treatment for fracture prevention.
Successful implementation required collaboration between inpatient, outpatient and primary care services. These included orthopaedics, geriatrics, rehabilitation teams, and the general practitioner. Innovative approaches were developed to tailor the service to the diverse multicultural population of South West Sydney.
In addition to assessing fracture risk through a Bone Mineral Density Scan and blood tests, our service addresses the non-pharmacological strategies such as dietary calcium intake, vitamin D and appropriate exercise. While osteoporosis medications can be effective in reducing a patient’s fracture risk by half , it is vital that our patient’s falls risk is assessed and addressed with the appropriate falls prevention strategies. Even with improved bone strength, our patients may be likely to refracture, if they continue to fall.
Our Osteoporosis Refracture Prevention Service provides an initial falls risk screen, educates and provides the appropriate falls prevention resources, and refers the patient to Falls Clinic and Falls Prevention Groups in the local area where necessary.
 Agency for Clinical Innovation. Model of care for osteoporotic re-fracture prevention. 2nd Edition, October 2017.
 The Royal Australian College of General Practitioners and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd Edition. East Melbourne, Vic: RACGP, 2017.
By Stacy Thomas, Senior Media Adviser, South Western Sydney Local Health District.
From left to right : Dr Carlos El-Haddad (Rheumatologist), Julia Gaudin (A/Fracture Liaison Coordinator/Physiotherapist) and Anna Augustynowicz (a patient identified post minimal trauma fracture)
An award winning research program from Illawarra Shoalhaven LHD- by Vani David , J. McLoughlin, M. Nonu, D. Edgar, V. Wilson, V, Traynor
‘Let’s Reflect on the Fall’
Hospitals are places where one comes for treatment and, a place where people should feel safe. Health care professionals have a vital role as patient's advocates, providing a safe environment for our clients. Nonetheless, the hospital can be a risky place for older people. Falls-related injury is one of the leading causes of morbidity and mortality in older Australians, with 40% of injuries in acute care attributed to falls . Reflection is a concept, which is beneficial but not used in falls prevention .
The aim of this mixed method study was to minimise falls by involving staff and patients in taking action through critical reflection of what has occurred (leading up to and during the fall), developing ideas about how things could be safer, implementing a number of these ideas and evaluating them to see what works in reducing falls. This study also aimed more broadly at culture change for which an action orientated approach through use of evidence is best suited as it engages people in looking at their own practices and enables them to create potential solutions for ‘real problems’- in this case: falls.
Three wards at Wollongong hospital are participating in the project. These wards had high incidence of falls and were keen to decrease their falls rate. The study is conducted in 3 phases. Phase 1 is initial data collection, engagement sessions; phase 2 is giving staff and patients an opportunity to reflect on their falls incident, and Phase 3 focus on feedback from phase 2 and co designing the solutions with the staff on the individual pilot wards. We are currently in Phase 3 working towards exploring the solutions and looking at opportunities to implement these solutions to prevent falls on the pilot wards.
 Oliver D (2004). Prevention of falls in hospital inpatients: agendas for research and practice. Age and Ageing, Vol. 33, Iss. 4, pp- 328–330.
 Somerville, M and Keeling, J.2004 A practical approach to promote reflective practice within nursing, Nursing times, Vol.100, Iss. 12, PP. 42
This project won the the best Nursing and Midwifery Research award for 2018 awarded by Illawarra Area Health
Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative
Smith TO, Higson E, Pearson M, Mansfield M. Int J Rheum Dis. 2018; June 21(6):1193-1201. doi:10.1111/1756-185X.12871 AimsTo assess the probability of individuals with early-diagnosed hip or knee osteoarthritis experiencing a fall and/or fracture compared to a cohort without osteoarthritis. Methods: Data were analyzed from the Osteoarthritis Initiative dataset. We identified all people who were diagnosed with hip or knee osteoarthritis within a 12 month period, compared to those without osteoarthritis. We determined whether there was a difference in the occurrence of falls, with or without consequential fractures, between people newly diagnosed with hip or knee osteoarthritis compared to those who had not, using odd ratios (OR) and 95% confidence intervals (95% CI). Results:Five hundred and fifty-two individuals with hip osteoarthritis were compared to 4244 individuals without hip osteoarthritis; 1350 individuals with knee osteoarthritis were compared to 3445 individuals without knee osteoarthritis. People with knee osteoarthritis had a 54% greater chance of experiencing a fall compared to those without (OR: 1.54; 95% CI: 1.35-1.77). People with hip osteoarthritis had a 52% greater chance of experiencing a fall compared to those without hip osteoarthritis (OR: 1.52; 95% CI: 1.26-1.84). People with knee and hip osteoarthritis demonstrated over an 80% greater chance of experiencing a fracture in the first 12 months of their diagnosis compared to those without hip or knee osteoarthritis (total knee arthroplasty: OR 1.81; total hip arthroplasty: OR 1.84). Conclusions: There is an increased risk of falls and fractures in early-diagnosed knee and hip osteoarthritis compared to those without osteoarthritis. International guidelines on the management of hip and knee osteoarthritis should consider the management of falls risk.
New Order information for the Staying active and on your feet booklet
New order limits have been applied. The order form on the NSW Active and Healthy website has been updated with a maximum order limit of 5 books per order (these are free in NSW only).This booklet can be downloaded and ordered (limit of 5 books per order) at: https://www.activeandhealthy.nsw.gov.au/preventing-falls/staying-active-and-on-your-feet/ For larger numbers Local Health Districts can order the book from the state forms catalogue, product code NH700472, $81.38 per packet of 25.
Ladder Safety from Institute of Trauma and Injury Management, Agency for Clinical Innovation (ACI)
The 2013 NSW Trauma Report found that falls were the major cause of injury and deaths across NSW, particularly for those aged 55 and over. An analysis of state-wide data from the past five years (2010-2014) found 372 ladder falls, predominantly in males, resulted in major trauma in this older age group.
Falls from just 1-2 metres can cause serious injury, such as spinal cord damage, broken limbs, severe brain injury or even death. Seventy percent of ladder falls result in a head injury which can lead to death or a permanent disability.
The Agency for Clinical Innovation’s Institute of Trauma and Injury Management have launched the Steps to home ladder safety web resource and associated community awareness program. It featuring videos, checklists and step by step instructions to keep you and your loved ones safe when using a ladder.
Our annual forum was held on Friday 31st May 2019, in Sydney. Over 400 people attended and it was a very successful day!
Head over to our website to:
- view the recording of the Plenary Sessions presentations and the Exercise for falls prevention workshop and Panel Discussion Session
- look at the slides again from all our presenters
- read the additional Q&A with Prof Stephen Lord, A/Prof Kim Delbaere, Dr. Morag Taylor, Dr Jennie Hewitt, Ms Mandy Meehan and Dr Mark Yates
Website News New sections have been added and updated on the NSW Falls Prevention Network website these include: Updated:
Do you have any news on Falls Prevention you want to share with others on the network, or report on a project that is happening in your area. We also welcome suggestions for articles and information you would like to see in this newsletter.
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