98-659 / Organisation, implementation and evaluation of National Falls and Bone Health Strategy 2013-2015

Ireland
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Health Service Executive (HSE) in collaboration with the State Claims Agency (SCA).

Topic

Clinical guidelines or pathways
Quality improvement project
Category
Patient falls
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GOP Description
 
Implementation level
National
Regional
Local
Clinical settings
All – acute, community, residential and primary care settings.
Objectives
It aims to protect bone health throughout life and prevent falls in Ireland’s ageing population.
Population
Persons aged 65 years and older (11%) or 491,168/4,588,252 population (2011 census)
Methods
 
Methodology
Change management project methods such as continuous quality improvement (CQI) plan developed in conjunction with existing quality, safety and risk programmes; aligned to existing health reform agenda; integrated into older persons clinical care programme (national change management forum).
Timeframe implementation
3-5 years
Implementation tools available
Strategy recognises the need to collaborate with multiple stakeholders to build greater awareness, strengthen cooperation capacities, streamline clinically effective, high quality service delivery, and support innovative mechanisms to achieve safer environments. Using principles of empowering service user self-mangement, early detection of risk, and the availability of preventative interventions, the approach will optimise the opportunity to use innovative assessment and screening mechanisms, guidelines and assistive technologies to deliver seamless services. HSE also commits to participate with pan-European stakeholders in the European Innovation Partnership Framework to share best practices, strengthen monitoring and service improvement measures and to contribute to data registries alignment.
Implementation cost
Personnel resources include the National Sponsorship Group; Regional Operational Groups; Clinical Risk Adviser (SCA) and HSE Lead as National Co-ordinators; administration and liaising functions from existing resources; financial resources including operating within current constraints of cost containments, staff reductions and re-orienting existing practices to minimise overall costs of full implementation.
Results
 
Method used to measure the results
Reductions in a number of indicators such as older persons being treated for falls, hospital admissions secondary to a fall related injury, nursing home admissions secondary to a fall related injury, hip fractures (Mean DRG Cost 2005-2010 €13,346 per patient), ambulance call outs, A&E presentations, rehabilitation admission requirements, home care package requirements, mortality rates secondary to falls & complications, bed days utilised secondary to falls & fractures.
Results
Not yet applicable
Analysis of the results
Not yet applicable
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
Apart from the operational context of working within a difficult economic climate, imposing tight resource constraints and a headcount embargo, the key barriers to overcome are:
•    Resisting the dissipation and fragmentation that the strategy is designed to eliminate as it cascades from national to regional, to local level
•    Implementing within a transitional governance framework as our health system that is currently undergoing transformation
•    Shifting to a model of greater client empowerment, increased personal self-management and individual care-pathway co-design
•    Balancing central co-ordination, regional innovation and personal autonomy.
Describe the strategies used to overcome the barriers (If needed)
To overcome these, we will establish co-ordinated national guidelines to operate at all levels of service delivery, establish uniformity across awareness building channels, harmonise capacity development, and support ‘productive interaction’ between informed, activated patients and prepared, pro-active multi-disciplinary practice teams.
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
The key elements that will be progressed on implementation are:
•    New falls and fractures clinical care pathway / process, involving screening at multiple points of entry, decision algorithms, and assessment mechanisms
•    New national guidelines to support the new pathway at different entry points
•    New national standards to support information dissemination falls prevention awareness
•    Adoption and adaptation of a new ‘Single Assessment Tool’ during the further development of the project
•    The development of registers including a hip fracture registry within the HIPE database
•    The encoding of future care pathways on-line tool to provide pathways contexts to users
•    Connecting existing home-based tele-care systems and services to the falls early ‘at risk’ screening mechanisms
•    Development of a ‘falls and fractures community of practice’ within the HSELAND web portal to promote practice development
•    Support bone health promotion in schools

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Contact information
 
Name: Elaine O' Connor
Position/function: Programme Manager
Department: Safety and Quality Improvement Directorate
Organisation: Health Information and Quality Authority
City: Dublin
Country: Ireland
Region: Leinster
E-mail: eoconnor@hiqa.ie
Phone: 00 353 1 814 7435
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