Falls advice reduces further harm and cuts ambulance journeys

Main image shows: Left, Specialist Registrar Dr Alexandra Burgess and far right, Emergency Nurse Practitioner Debra Clee, who are part of the Cwtch roll out team, at work in the Older Person’s Assessment Service (OPAS) in Morriston Hospital. They are pictured with patient Sheila Oldroyd, 93, from Port Talbot.

Around 10% fewer elderly people who fall in nursing homes across Swansea and Neath Port Talbot are being taken to hospital by ambulance, thanks to better staff education.

The unique training rolled out by Morriston Hospital clinicians to 177 nursing home staff has also dramatically reduced the number of people who have fallen having to stay where they fell because staff were afraid to move them.

Now, because of the training, there has been a 99% reduction in fallers staying on the floor until an ambulance arrives. Instead, staff feel confident to move many people who have taken a tumble to somewhere more comfortable.

That has drastically reduced the chances of further harm such as pressure sores, hyperthermia, pneumonia, dehydration and even kidney failure, caused by pressure from a hard surface breaking down muscle fibres.

Unfortunately, this process starts quickly in the elderly, with the muscle fibre fragments flowing through the bloodstream to the kidneys, which stops them working properly.

The Cwtch project – the name means hug in Welsh - has turned traditional wisdom on its head. The team behind it has now reported the progress of the last 18 months in the official journal of the Academy of Gerontology in Higher Education and at the conference of the British Geriatrics Society, where it also won a prize.

“We are massively reducing the harm caused by falls through a simple, common sense intervention,” said Emergency Nurse Practitioner Debra Clee, who came up with the idea and led the training.

Specialist Registrar Dr Alexandra Burgess, who has supported the development of the service and published the work based on data gathered by colleague Alice Pritchberg, said: “We have seen a cultural shift and month-on-month reductions. On average around 10% fewer people who fall in nursing homes need an ambulance transfer to hospital, but one month that reduction was 15%.

“And we previously saw 30 to 50 long liers per month – those who had been on the floor for hours following a fall before being brought into hospital. We have seen one since Cwtch began.”

The Welsh word Cwtch, as well as meaning hug, is an acronym for nursing home staff to remember simple steps which will not only make the patient more comfortable, but could help them avoid an ambulance transfer altogether:

C - Can you move them? Research supports moving elderly fallers carefully because it’s unlikely to cause further harm, even if they have broken a bone.

W – Will it harm them? Nursing homes have registered clinicians who can check it’s safe to move fallers. Most of the time it is.

T – Treat. Treat open wounds and give pain relief such as paracetamol.

C – Cup of tea. Most patients can eat, drink and take routine medication as normal, halting further deterioration and potentially reducing the length of any hospital stay.

H – Help. What further help do they need?

Some patients will still require an ambulance and will be taken to the Emergency Department after a fall.

But following the roll-out of Cwtch, some less serious calls to the ambulance service can be diverted straight to Debra, Alexandra and their colleagues in the Older Person’s Assessment Service (OPAS) at Morriston Hospital, who can either go out to see the patient or ask nursing home staff to bring them in for assessment and treatment.

Debra said this might include stitching up a wound or arranging X rays.

Emergency Nurse Practitioner Debra Clee, of the Older Person's Assessment Service in Morriston Hospital, offers advice to a nursing home, potentially saving a resident an ambulance journey and a trip to the Emergency Department. Credit: SBUHB

Sammyjo Morgan, a registered mental health nurse and nurse manager at Burrows Hall residential and nursing home in Llangennith, Gower, said the “fantastic” programme supports residents’ physical and mental wellbeing.

“Feedback from health care staff and nurses within the home is that they feel more supported and less anxious that residents now do not need to remain on the floor waiting for the ambulance service.

“A fallen resident who lives with dementia would not understand why they need to lie on the floor and would want to get up, causing them more anxiety. However, Cwtch has enabled us to ensure the individual feels safe and relaxed in their own bed.”

She added: “We have also used OPAS on several occasions, which allows us to bring residents with dementia to a calmer environment, as A&E can be very loud and busy.”

Dr Elizabeth Davies, a consultant in elderly care at Morriston Hospital, praised the “hard work and ingenuity” that has gone into the project, which is driving further developments around improving access for nursing home patients.

“Unscheduled care at Morriston has been under considerable pressure over recent years and this project has taken a great deal of personal commitment and time,” said Dr Davies.

“It is immensely rewarding to be part of a dedicated team which is genuinely committed to patient wellbeing and quality improvement.

“I am heartened to see the team recognised in this way. I know that with their dedication and simple enthusiasm for the work we do, there will be more success in line for them in the future and I look forward to it.”