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ADHB’s cluster model becomes contagious

10 October 12
Falls are a major health issue for older people. Those living in residential care are at higher risk of injury than those living in their own homes.Mercy Parklands Helen Catherine

Research undertaken by The University of Auckland’s Professor Ngaire Kerse and published on behalf of the Tu Pakari research group in June 2009, highlighted the following statistics:

  • Falls are three times higher for people in residential care than those living in their own homes.
  • Up to 61 per cent of all residents fall.
  • Hip fractures are 10 times higher for people in residential care than for those living in their own homes.
  • ACC spent $187 million on falls over two years and two-thirds of the cost of these came from residential care residents.

It is statistics such as these that have made reduction of harm from falls a major goal of the First, Do No Harm campaign. The Northern Region district health boards are working to assist in improvement efforts across the hospital and age-related residential care (ARRC) sectors.

The Auckland DHB has adopted a cluster approach in working with the ARRC sector and is now seeing spin-offs not just in terms of falls reduction but also wider benefits as it engages with ARRC more closely.

An annual audit into falls injuries undertaken in March 2012 at Auckland DHB showed falls in older adults residing in ARRC were a considerable issue. Clearly improvements could be made by working more closely together with the ARRC sector that would benefit everyone.

In response ADHB’s Falls and Pressure Injuries Prevention Project Steering Group invited two rest home managers - Jill Woodward from Elizabeth Knox and Josephine Comrie from Waimarie - to join the team. The result was the formation of a sub-group and a decision to engage with the whole of the ARRC sector on reducing falls and pressure injuries followed.

An initial road show attracted more than 40 representatives from the 68 ARRCs in the Auckland DHB boundary. At that scene-setting meeting information about First, Do No Harm and the Health of Older People framework was presented along with details about the impact of falls in the Auckland area. Importantly at the meeting attendees agreed that a ‘hub and spoke’ approach was needed. This later became known as a cluster approach. Volunteers to host the cluster meetings were called for and 13 ARRC representatives put their hands up.

With facilitation and guidance from Auckland DHB, a series of staged meetings for each cluster is now underway. Each cluster has already agreed on its own terms of reference and surveys on how each ARRC facility is collecting its falls and pressure injuries data have been carried out. Discussions around definitions and data collection are being held and, within some clusters, decision-making on the way forward is being progressed.

While the emphasis is very much on localised plans, questions arising from individual cluster meetings are being captured. These, along with the answers, are being shared among clusters as FAQs so they can be learnt from. Storyboards have become a feature of cluster meetings, with several of these being shared regionally at First, Do No Harm mini-learning sessions.

Auckland DHB Acting Nurse Director Jane Lees says their approach took some effort to gain momentum, but that has now been achieved and they are seeing benefits that extend beyond the initial goal of reduction in falls and pressure injuries.

“We believe the most important thing is the sector engagement which we believe will be very beneficial. For many of the people who work in the ARRC sector this is the first time they have had the opportunity to network with their peers, share experiences and learn together.

“When we started out there was no consistent method in collecting or categorising data. There was no idea where pressure injuries were occurring, or where to focus on improvement.

“Now processes are being defined and many of our ARRCs are looking at other areas where they can apply the principles learned. At an August meeting Mercy Parklands, on their own initiative, turned up with a storyboard so they could share their experiences with others in their cluster. The enthusiasm blew me away.”

“We believe the collaborative process has provided excellent opportunities for shared learning and clear points of focus for achieving steps towards the ultimate objective,” says Catherine Heaney, Clinical Allied Health, Mercy Parklands. “The recommended tools for improved data collection and analysis will enable meaningful conclusions to be drawn and acted upon. Already, we have found that the use of the recommended graphs and Plan, Do, Study, Act (PDSA) trials help provide staff with a clearer understanding and promote active involvement in the progression towards a common goal.”  

Auckland’s cluster model is proving contagious, with Northland DHB investigating a similar model during September.