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Falls and Frailty response service - An Advanced Specialist Occupational Therapist from Royal Berkshire Hospital (UK), working with a Specialist Practitioner from South Central Ambulance Service, combining their skills.
The criteria
We see patients who have fallen in their own homes, who are over 65 and are frail. The service aims to avoid admissions for patients who would usually be admitted to the Royal Berkshire Hospital. The service is currently available 7am - 7pm, on Saturday, Sunday and Monday. We would be dispatched from either 111 calls or 999 calls, to patients fitting the above criteria.
The assessment
The specialist practitioner will review the patient from a medical perspective and perhaps liaise with the patient's GP, if required. On the van, we have specialist equipment to assist with moving and handling and to lift the patient from the floor. The occupational therapist will then gather information and complete an initial assessment. They will complete further functional assessments within the patient’s home. In addition to this, the occupational therapist can prescribe equipment, either from the van or order it to the patient’s property.
The team will also carry out a falls risk assessment, to reduce risk of further falls. This assessment involves:
taking lying and standing blood pressure
reviewing existing medical conditions and medications (sometimes discussing with GP)
reviewing trip hazards in the environment
a mobility review
looking at footwear
The team has access to a variety of different services within Berkshire, specifically looking at admission avoidance. This consists of community hospital admission avoidance beds, rapid response services and other support services. If the patient does need to be admitted, completed assessments will be handed over to the Frailty Practitioner or Occupational Therapist in Royal Berkshire Hospital Emergency Department, to reduce the patient’s length of stay.
Case Study
(No actual names or personal details used).
'Christine' pressed her pendent alarm, which alerted the emergency services that she had fallen within the last hour. She had attempted to stand up several times, but was unsuccessful. She therefore pressed this alarm, which was used to contact the emergency services. Christine was identified as a patient who would benefit from Falls and Frailty response team input. Her daughter arrived at the scene - as the pendent alarm service contacted her as next of kin. However, she was unsuccessful in assisting Christine off the floor.
Christine had fallen on her way to the bathroom, from the lounge. The Specialist Practitioner did a medical review, to establish if Christine had an injury or was unwell. Christine stated she was not in pain and reported that she had slipped in her bathroom, as she was rushing to the toilet. A lifting cushion (Mangar Elk) was used to lift the patient off the floor.
Christine and her daughter were able to give further information on how she usually functions.
Christine usually mobilises with her stick and has no further support at home, other than friends and family that come to see her. Further functional assessments of Christine’s mobility and transfers were completed, alongside further assessment from the specialist practitioner. Christine was then given falls advice (such a removing the rug that she slipped on) and given written falls guidance.
During the assessment, Christine and her daughter reported that she had been struggling with her washing and dressing recently, as she was being treated for a chest infection. A referral was completed to the rapid response team, who were able to come out and assess that day. Christine’s daughter stated that she will also try and visit daily, to support with Christine’s evening meal.
Christine was able to remain at home, without having to be admitted to hospital. The Specialist Practitioner’s paperwork was then sent to Christine’s GP, to alert them of today’s events and interventions.