Falls and Fragility Fracture Audit Programme – RDMA20 Case Study

Published: 18 Dec 2020

FFFAP, highly commended in previous years have consistently shown a commitment to involving patients and carers within their audit programme. The patient panel are enthusiastic and engaged and throughout 2020 have remained positive as illustrated in this blog where the team describe how the PPI activities continued with the panel building on audit findings and identifying what is important to patients – producing a range of resources as a result.

Written by Elinor Davies who is a Project Manager for FFFAP. This post was initially submitted for the Richard Driscoll Memorial Award 2020.

Members of the Falls and Fragility Fracture Audit Programme (FFFAP) Patient and Carer Panel were looking forward to the April meeting. It would be an opportunity to meet face to face and share ideas (as well as fancy biscuits). However, the announcement of lockdown on 23^rd March put an end to such hopes.

It would have been easy to spend the last 6 months, ‘maintaining’ a good level of PPI activity in programme work and to put efforts towards an improved patient-centric model on the back seat. On the contrary though, we have been taken aback by the positivity and drive shown by Panel members.

A childhood memory has been playing over in my mind. Some good friends had joined our family for dinner. Dessert was a magnificent pavlova, handmade by my mother, atop with lashings of cream and fresh strawberries. The only problem, it had stuck to the baking tray. As my mother’s hopes of presenting the dessert in perfect segments quickly diminished, our friend Jim grabbed a spoon and plunged it right into the centre. We all followed his example and ate up every last morsel with glee.

In a similar vein, Panel members have ‘grabbed a spoon’, refusing to let the pandemic become a barrier against their involvement in enhancing the Programme’s impact. Of course, the April meeting took place via Microsoft teams and despite the absence of luxury shortbread, it was an enjoyable and productive session.

In fact, during this difficult period, the Patient and Carer Panel have continued to play a pioneering role in identifying the need, and co-producing content for, three new programme resources tailored to key target audiences. Each has been informed by the lived experience of Panel members alongside the expertise of members of the Programme Advisory Groups from specialties including ortho-geriatrics, orthopaedics, physiotherapy and dietetics. Our audiences can therefore have confidence in the quality and authenticity of the Programme’s outputs.

Firstly, a resource for public governors and non-executive directors at NHS trusts and health Boards, members of Health Watch and other healthcare champions. Panel chair Julia Ellis’s experience as a Hospital Governor led her to explore opportunities to influence quality improvement that had not yet been ventured into. Her idea to engage and support those whole role it is to hold NHS trusts and health boards to account was strongly supported by the Panel and welcomed by the wider FFFAP team. As such, she led the Panel to work in close collaboration, albeit virtually, with the FFFAP clinical team and wider health professionals to convert data on falls prevention and falls management into a lay-friendly video and two infographics. Both the video and the infographics encourage hospital governors and non-executive directors to check their trust or health board’s performance in falls prevention and management by accessing the National Audit of Inpatient of Falls and asking a series of challenging questions. HQIP’s Tina Strack, Associate Director for the Clinical Outcomes Review Programme and a Hospital Governor herself, was particularly complimentary about the usefulness of this resource and how it was the first of its kind and an example to be followed. This resource is available here.

Secondly, a one page guide for fragility fracture patients, their carers and families detailing the importance of ‘staying on treatment’ for osteoporosis amidst fears of the possible associated side-effects. Based on findings from the Fracture Liaison Service Database (FLS-DB), Panel members identified a lack of treatment adherence amongst fracture sufferers; a problem that they felt could be targeted and improved by a patient-focused resource providing important information about the necessity of continuing to take treatment for not just weeks or months, but years following the first occurrence of fragility fracture. Panel member Alison Smith admits that she herself was “guilty of not adhering to the treatment” but that “a timely, monitoring phone call from her local fracture liaison service {…} set me back on track”. Unfortunately, such monitoring is not experienced across the board and Panel members were determined to create a relatable resource to save thousands of fragility fracture sufferers from the serious repercussions that occur in cases where treatment is not adhered to, most notably a loss of independence.

Thirdly, a resource for family carers who will be supporting hip fracture patients during hospital admission and after discharge. Panel members’ shared experience highlighted the importance of carers having access to good quality information and advice especially when going through a stressful and worrying time. Again, HQIP’s Tina Strack was particularly enthusiastic: ‘’This is a fantastic resource. I am a carer for my mother-in-law who has advanced dementia and I wish I had access to something like this last year when she was in hospital.’’

Even before the carer’s guide has been officially published, the Panel have already accepted the next challenge; to ensure that all carers of hip fracture patients are given this information as a matter of routine. This will be the subject of our next virtual meeting via Microsoft teams.