Title: How does a Rapid Response Service impact a client’s experience of a fall in the community?
Background
A fall is defined as inadvertently coming to rest on the ground, floor, or lower level, this excludes intentional change in position to rest – on furniture, wall or other objects – (WHO 2007). Within Midlothian, Scotland, the Rapid Response Service (RRS) utilise specialised equipment to pick up a person who has fallen in the community. The RRS operates 24 hours per day and has a single point of contact. The RRS is an integrated health and social care service comprising of; care staff, a falls co-ordinator, a falls practitioner, occupational therapists, physiotherapists, specialised nurses and a consultant geriatrician
A fall can entail many damaging effects, including physical injuries, loss of confidence and increased anxiety. This, in turn, directly increases the risk of further falls and deterioration in both physical and mental health. A ‘long lie’ following a fall – remaining on the ground or floor for one hour or more – is associated with serious complications for an older person, including pressure ulcers, kidney damage caused by muscle breakdown, pneumonia, hypothermia, dehydration, psychological harm and even death (Scottish Government 2014). The (World Health Organisation 2007) report that 28-32% of people over 65 years and 32-42% of people over 70 years will sustain a fall each year. There is a direct correlation between increase in age and frequency of falls.
Within Scotland, it is projected that number of people over 75 years of age will increase by 25% in the next 10 years (NHS Scotland 2014). This population will be the highest users of health and social care services within Scotland. Furthermore, the number of people over 75 years of age is estimated to increase by 60% by 2033 (NHS Scotland 2014). The Scottish Government and NHS Scotland has therefore published key policy drivers which require health and social care boards to deliver services which, improve the incidence of falls.
A literature search, conducted electronically – CINAHL, Google Scholar, Sage and Ingenta Connect – to locate research pertaining to the impact of a rapid response service on a person who has sustained a fall, found current literature to be extremely limited:
1.The search failed to locate literature which investigated the effectiveness of a falls pick up service.
2. Literature searches found limited research pertaining to a persons’ experiencing of a fall in the community.
3. Investigations into the cost of falls in the UK is limited (Scuffham, Chaplin and Legood 2003).
4. There is a direct research focus on the use of exercise programmes and the incidence of falls.
Whilst it is recognised that falls prevention is pivotal, the World Health Organisation highlights the challenges of preventing falls in an increasing aging population. Therefore, it is imperative that the RRS recognises the significant challenges it faces and ensures that measures are implemented to provide a person centred and high quality falls service.
Research Question
How does a Rapid Response Service impact a client’s experience of a fall in the community?
Aims and Objectives
The research project aims to investigate services users experience of a fall. The study will investigate the impact of a rapid response team at the time of a falls pick up and follow up care. Furthermore, the study will seek to identify any gaps in service and the actions required to provide a gold standard falls provision.
Theoretical Framework and Methodology
An ethnography approach involves studying participants in a specific social setting and a grounded theory approach is used to develop a philosophy which explains a particular social phenomenon, these frameworks will not facilitate the attainment of the proposed study’s aims and objectives. A phenomenological approach has been selected for the proposed study, as the research practitioners aim to investigate personal experience. Phenomenological research attempts to describe phenomena such as caring and the wholeness of the experience (Danuta et al., 2007).
Study method
The proposed study will implement a mixed method approach to gather data. This will directly compliment the phenomenological basis, by providing a framework which advances the social good through the addition of the voiceless within the study’s development (Mertens 2011). The research practitioners will analyse Midlothian’s Rapid Response Service’s (RRS) Falls Data from April 2014 to January 2015. The 10 month time period has been selected as a new system of recording was implemented in April 2014 which provides more detail about fallers than was previously the case. The RRS records; date and time of fall, location of fall, gender of faller, age of faller, time of call out, time of care staff arrival, reason for fall, method used to summon assistance from RRS, telecare system in place (yes/no), injury sustained (yes/no), admittance to hospital (yes/no), follow up assessment conducted (yes/no) and if an emergency service was involved. Graphs and tables will be used to present analysed data and evidence any emergent themes.
Semi structured interviews will be conducted with six – eight participants. These participants will have sustained a fall and been picked up by the RRS in the previous ten months – April 2014 to January 2015. Participants will be randomly selected from RRS data. Interviews will take place at the participants’ home or another place of their choice. The interview questions will be guided by Talking Points (Cook and Miller 2012) with an aim to uncover participants’ personal experience and facilitate reflection of the experience meaning in context of goals and purposes.
Study limitations
The research practitioners acknowledge that the ability to generalise quantitative findings to a larger population, may be limited due to the ten month timeframe which will be applied. Furthermore, it may be advantageous if a comparative approach was applied, thus seeking trends over a number of years rather than months. However, due to time constraints and differing recording systems, the practitioners are unable to complete a comparison of data over a longer time period.
Ethical Considerations
A request will be made to Midlothian Council’s Directorial Team to gain ethical approval for the proposed research study. Ethical approval must be gained prior to the distribution of information packs and letters to potential research participants. Information packs will detail; the study purpose and process, participant’s voluntary status and right to withdraw at any time during the research. Furthermore, the information packs will explain that participation within the study will not prejudice future assessment or treatment (Polgar and Thomas 2008). The research practitioners will reiterate all information pack details when completing the semi structured interviews, thus aiming to provide further reassurance to participants. The proposed research study will endeavour to implement strategies to protect all participants from any potential distress during the research process. A guarantee of confidentiality will be offered. The only exception to this would arise where, in the course of research, information came to light relating to the wellbeing of the subject or a third party. Such information that would require to be reported by the researchers to the community care department.
The researcher will receive written consent from each participant within the study and in turn will ensure through the use of information packs that each participant is fully aware of his or her voluntary status in the study (Bowling 2002, Polgar and Thomas 2008). Consent is only valid if a person has capacity and is providing this voluntarily; such consent must be recorded (Department of Health 2009). Therefore the proposed study will implement exclusion criteria, ensuring that clients who do not have the capacity or understanding, due to mental illness and/or medication side effects, are protected. The sample group will exclude any person who has worked directly with either of the practitioner researchers. Such exclusion criteria will illuminate the possibility of a research bias and conflict of interest; subsequently increasing validity of collected data and protecting participants from distress.
Anonymity will be assured by using pseudonyms throughout the transcription documentation and final research report. Data in its unedited format will only be seen by the research practitioners. All quantitative data will be stored on a password protected electronic file and qualitative data will be stored within a locked drawer, within a locked room which is within a secure unit – key pad protected. It is only the research practitioners who will have access to the study’s data.
Knowledge Exchange
Research findings will be shared with the Practitioner Research Project (PROP) and the final study report will be published on the PROP blog which is hosted by IRISS. The research findings will be displayed and presented at a knowledge exchange event which will be held at the University of Edinburgh in July 2015.
The researcher will present findings to; Midlothian Council’s Joint Management Team (JMT), Health and Social Care Board, Association of Directors of Social Work (ADSW) and Joint Improvement Team (JIT). The Rapid Response Service have established and working pathways with all emergency services; therefore research findings and the final report will be presented to the Scottish Ambulance Service, Police Scotland and Scottish Fire and Rescue Service.
The final research report will be submitted to a variety of professional journals and publications. Abstracts of the research study will be submitted to relevant conferences. A copy of the research report will be sent to Ann Murray, Falls Programme Manager, who will distribute this to Falls Co-ordinators within Scotland. Allied Health Professionals (AHPs) and Social Work colleagues within acute, primary and community care will be informed of the study findings.