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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Issue Date: Jan 2013 Review Date: May 2015

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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors

Preventing falls is a particular challenge in a Community setting because safety has to be balanced against an individual’s right to make their own decisions about the risks they are prepared to take, and their dignity and privacy.

1. Aims of the Procedure

This procedure has been developed to ensure Future Directions CIC is compliant with guidance from the National Institute for Health and Clinical Excellence (NICE), and ensuring compliance with the minimum requirements specified by the National Health Service Litigation Authority (NHSLA): Risk Management Standards for Mental Health and Learning Disability Trusts (April 2008) to undertake appropriate risk assessments for the management of slips, trips and falls involving service users, staff and visitors.

The aim of this procedure is to have safe systems in place that will minimise the number of and consequences of slips, trips and falls. This will be achieved by:-

Providing a safe working environment which, as far as is reasonably practicable, is free from hazards which contribute to falls.

Ensuring all potential slip and trip hazards in the workplace are identified.

Ensuring, where necessary, appropriate risk assessments and risk reduction action plans are in place to reduce falls.

Provides guidance through supporting procedures for all health care professionals using the best available evidence to reduce the risk to all service users, staff and visitors.

Ensuring staff are aware of their responsibilities in the prevention and management of slips, trips and falls.

2. Definitions

When someone falls, it is rarely easy to be sure if it was a simple trip, or whether they were dizzy and fainted or collapsed. Falls are therefore defined as ‘an event whereby an individual comes to rest on the ground or another level, with or without loss of consciousness’ (NPSA 2007).

Slips are defined as ‘to slide accidentally, causing an individual to lose their balance, this is either corrected or causes a person to fall’.

Trips are defined as ‘to stumble accidentally, often over an obstacle, causing an individual to lose their balance’.


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3. Main Duties and Responsibilities

Examine any resource implications that need to be addressed across to Future Directions CIC reduce or prevent falls. Receive and examine incident reports which detail the incidents of falls.

The Director of Operations is responsible for ensuring that Future Directions CIC meet their obligations under the relevant Health and Safety Legislation (Health and Safety at Work Act 1974).

The Operational Network Managers/Team Manager and Operations Managers are responsible for ensuring the health, safety and welfare of all who are employed within their areas and in so doing ensuring the health, safety and welfare of visitors, service users and contractors

All staff must take responsibility to work in a safe and effective manner to eliminate or minimise the risks of slips, trips and falls.

(See also Health and Safety at Work Procedure – Home Areas and Risk Management Incorporating Workplace Risk Assessment.

4. Management of Slips, Trips and Falls Involving Staff and Others

All members of staff have a duty to take reasonable care for the health and safety of themselves and other persons who may be affected by their acts or omissions. All safety rules documented in the Health and Safety at Work Procedure must be observed. The Management of Health and Safety at Work Regulations 1999 require that Future Directions CIC assess all risks to the health and safety of their staff and others who may be affected by their acts or omissions (e.g. service users, visitors and contractors).

Department Managers will ensure that suitable and sufficient risk assessments are undertaken to ensure that the risks which their staff may be exposed to in undertaking their duties are adequate and controlled to reduce risk to the reasonably practicable minimum (see also Workplace Risk Assessment).

Appendix A outlines the relevant information for staff.

5. Causes and Circumstances of Falls Service Users

Over 400 risk factors for falls have been identified, and many different risk classifications exist. Falls can sometimes happen because of a single factor, for example, tripping or fainting, however, most falls are due to a combination of several factors and the interaction between factors is crucial.

Intrinsic factors linked to falls are:-

Personality and lifestyle (activities, attitudes to risk, independence and receptiveness to advice).


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Age related changes (changes in mobility, strength, flexibility and eyesight that occur in healthy old age).

Illness or injury (stroke, arthritis, dementia, cardiac disease, acquired brain injury, delirium, Parkinson’s disease, dehydration, disordered blood chemistry and hypoglycaemic episodes in diabetes).

Extrinsic Factors

Medication (sleeping tablets, sedation, pain killers, medication lowering blood pressure, alcohol and street drugs).

Environment (lighting, wet floors, loose carpets, cables, steps, footwear, distances and spaces).

Those most vulnerable to falls

Older people are more vulnerable to falls; also people who have fallen once are at a higher risk of falling again. People taking medicines, people with epilepsy and other neurological conditions, people with dementia are also

Why people fall: What people were doing when they fell:

Most falls are a result of a combination of factors

Poor mobility

Environmental hazards such as wet floors or steps are identified in only a small number of falls

Most falls occur whilst people are walking

People are particularly likely to fall whilst using the toilet or commode

Falls from trolleys/beds may be more likely to lead to serious injury or litigation

People most vulnerable to falls: When people are more likely to fall:

Older people, particularly those aged over 80

Men are more likely to fall in Acute Hospital settings than women

Weekdays when there are more people around

Mid-morning when they are more likely to be active

Fewer falls occur at mealtimes


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6. The Prevention of Falls to Reduce Injury for Service Users: The Evidence

The reasons why people fall are complex and can be influenced by physical illness, mental health problems, medication and age-related issues, as well as the environment.

Consequently, efforts to reduce falls and injury will need to involve a wide range of staff and, in particular, those working in Nursing, Medical, Social Care,Therapy, Pharmacy, Management and Facilities Services.

6.1 Observation

One to one observation may not always be feasible or effective in preventing falls.

6.2 Using Multifaceted Interventions

The literature found reasonable evidence that using multifaceted interventions was an effective way to reduce the number of falls.

These are interventions linked to the risk factors that can be modified in individuals and should include:

Review of medication which could be associated with falls.

Detecting and treating delirium and cardiovascular disease.

Detecting and treating or managing incontinence and urgency.

Detecting and treating osteoporosis.

Detecting and treating eyesight problems.

Providing safer and/or appropriate footwear.

Physiotherapy, exercise and access to walking aids.

Increasing the range of beds and chairs to suit different needs.

Using bedrails if the benefits outweigh the risks.

Good nutrition and hydration

It is less clear in the literature whether they are as effective for people with dementia.

6.3 Service Users Views on Interventions to Prevent Falls

The complex interplay or risk factors that result in service users falling, means interventions should be tailored to the needs of the individual.

It is important to consider peoples wishes particularly because those most vulnerable to falls may be too ill or confused to be able to discuss, understand and consent to interventions that could prevent them from falling:-

Service users must be taken into account in planning interventions to reduce harm from falls in order to balance dignity and independence with risk of harm.

6.4 The Environment


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Around 5% of falls reported to the NRLS were thought to have been caused by environmental factors, with 1% of reports involving wet floors, usually due to the person’s urine rather than cleaning. Many aspects of the environment may have an impact on the risk of falls or injury including floor surfaces being uneven, slippery, floor density (how soft or hard the surface is to land on, floor pattern can create the illusion of slopes or steps with impaired vision), lighting (sudden changes from light to dim), clutter and cables and furniture.

Improvement to lighting, flooring, trip hazards, ward design and furniture may reduce the risk of falls.

There is no clear evidence that a particular type of flooring reduces injuries.

6.5 Technology to Prevent Falls and Injury

Technological interventions include movement alarms and hip protectors.

There is not enough evidence to recommend the use of hip protectors.

There is not enough evidence to recommend the use of alarm devices.

6.6 After a Fall

After a service user has fallen there is still an opportunity to reduce the degree of harm by promptly detecting and effectively treating injuries, considering why they fell, and applying measures that could reduce the risks of further falls or injury. Falls can be a symptom of underlying illness, early detection and treatment of injuries is needed. Unless a first fall leads to a review, including medical assessment, the person is likely to fall again.

7. Implementing a Multi-faceted Individually Targeted Intervention and Support Plan

All service users at risk of falling or who have had a fall in the last 12 months will have an assessment undertaken. It is the responsibility of the Team Manager and/or Operational Network Manager to action this, following the Slips, Trips and Falls General Assessment and Intervention Process identified at Appendix C

The assessment will include:

History of falls, before and after admission.

Assessment of gait, balance, mobility and muscle weakness/strength – in Community Service the M & H Risk Assessment Appendix A and B, H & S 5 Manual Handling Procedure and Personal Health Record Section 13 will be updated and used to inform the assessment.

Assessment of visual impairment

Assessment of cognitive impairment

Footwear examination/check


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Assessment of home/environment hazards

Cardiovascular examination and medication review

Nutrition/Dehydration

See DOAS (DO Once and Share Pathway for Individuals who have Fallen) Guidance (Appendix B). This will be recorded in the individual’s personal records.

Within Future Directions CIC staff will utilise Community Slips, Trips and Falls General Assessment (Appendix D) to carry out the service users Assessment and Health and Safety Assessment (Appendix A Health & Safety at work) to inform of any home hazards. The completed assessment will be stored in the service user’s personal file.

They will continue to monitor service users falls in an attempt to identify factors utilising Service User Record of Fall and Contributing Factors (Appendix E).

8. Staff Training

All staff new to Future Directions CIC will receive awareness training regarding slips, trips and falls. A record of training attendance will be maintained by the secretarial support team at Marle House.

Risk management awareness will form part of the initial induction for staff, supported by the Risk Management. Risk management training will be a component of personal development plans and monitored through the appraisal and personal development programme.

Future Directions CIC will on a monthly basis, identify the number of slips, trips and falls for service users from the incident management data. This will be disseminated to Managers on a monthly basis.

9. Monitoring and Review

Trends in slips, trips and falls incidents involving service users are monitored through Operational Network Manager weekly meetings. Analysis of trends data relating to falls from incident reporting will provide a measurement of the effectiveness of the falls assessments and support plans.

Staff and visitors slips, trips and falls statistics will be monitored by the Management Team and directors and reported on a quarterly basis.


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors

Appendix A

Guidance for Staff Outlining Likely Causes and Suggested Action

Future Directions CIC recognises its responsibilities under Health and Safety Legislation and the importance of providing a working environment that is safe and healthy for all employees, contractors, voluntary workers, visitors and members of the public.

Future Directions CIC will endeavour to protect staff and other persons, to whom it has third party liability at law, from the effects of slips, trips and fall hazards, by good management and risk assessment.

Employees Responsibilities

STEP 1 – Identify the Hazards Look around the ward/workplace (including outdoor area) for anything that may be a slip or trip hazard, such as poor floor surfaces etc.

STEP 2 – Decide who might be Harmed and How Consider who will come into the ward/workplace and whether they are at risk.

STEP 3 – Evaluate the Risk Consider the precautions already taken and assess whether they adequately deal with the risks.

STEP 4 – Record Your Findings

STEP 5 – Review Assessment from Time to Time If there is any significant change, you should review the risk assessment to make sure that precautions are still adequate.

Slips and Trips – Likely Causes

Slip and trip accidents may have different causes, but often have the same result. By looking at the contributing factors separately, it is possible to work out more accurately the cause of the slip or trip accident.

A) Slip Hazards

Spills and splashes of liquids and solids Wet floors (following cleaning) Unsuitable footwear Change from a wet to dry surface (footwear still wet) Unsuitable floor surface/covering Dusty floors

Sloping surfaces


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B) Trip Hazards

Loose floorboards/tiles Uneven outdoor surfaces Holes/cracks Changes in surface level – ramps, steps and stairs Cable across walking areas Obstructions Bumps, ridges and protruding nails etc. Low wall and floor fixtures – door catches, door steps Electrical and telephone socket outlets

C) Fall Hazards

Staff not trained in moving and handling service users Over reaching Climbing on furniture Rushing down steps/stairs, ladders and faulty equipments

D) Factors which Increase Risk

Risk assessments not carried out regularly Poor or unsuitable lighting Wrong cleaning regime/materials Moving goods/carrying/pushing or pulling a load Rushing around Distractions/fatigue Drugs and medications


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MANAGING RISK

There are many simple measures that can be taken to reduce or eliminate risks. The following table gives some suggestions.

Hazard Suggestion Action

Spillage of wet and dry substances - bodily fluids

Clean up spills immediately. If a liquid is greasy, ensure a suitable cleaning agent is used.

After cleaning, the floor may be wet for some time. Use appropriate signs to tell people the floor is still wet and arrange alternative bypass routes.

Untrained staff or lack of continuous training of staff

Trained staff must be used to carry out the required duty, i.e. moving and handling of service users.

No risk assessments Risk assessments should be done at regular intervals, also incidents must be reported and control measures put in place.

Miscellaneous rubbish, for example plastic bags

Keep area clear, remove rubbish and do not allow to build up.

Slippery surfaces Access the cause and treat accordingly, with appropriate cleaning method, regime/material.

Poor lighting Improve lighting levels and placement of light fittings to ensure more even lighting of all floor areas.

Changes of level Improve lighting, add apparent tread nosings.

Slopes Improve visibility, provide handrails, and use floor markings.

Unsuitable footwear Ensure service users and workers choose suitable footwear, particularly with the correct type of sole.


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Appendix B

MULTIFACTORIAL ASSESSMENT DOAS GUIDANCE (2006)

Medical Component of a Multifactorial Assessment

(Minimum requirement, other parts will be directed by clinical findings) Past medical history including history of

stroke, Parkinson’s Disease, Epilepsy, Fracture, Arthritis.

Falls History Description including by a witness, activity

at the time of falls, frequency, when and where.

Any loss of consciousness. Prodromal symptoms – light-headed,

dizziness, palpitations, chest pain. Medication History Smoking and alcohol Urinary incontinence or urgency Visual impairment or change in vision Hearing impairment Pulse rate and rhythm Lying and standing blood pressure Auscultate for aortic stenosis Visual acuity and fundoscopy Sensory and motor neurological

assessment especially power in hip and foot flexors, proprioception loss

Assess gait Tests for cognitive function, anxiety and

depression Note:

If the cause of fall remains unexplained or

blackouts suspected, refer to Medical

problem/unexplained falls pathway

Falls History

Activity at the time of fall When and where Frequency of falls Ability to get up from the floor unassisted

(unassisted, not requiring help from another person)

How many falls in the past 12 months Changes to lifestyle as a result of falling, e.g. not

going out alone, now uses walking aid, not getting to the bath etc.

What footwear was worn at time of fall

Fear of Falling Ask Are you frightened of falling? What frightens you (e.g. lying there all night,

fractures) Assess Ability to summon help Ability to prepare for a long lie Use appropriate assessment tool Tinetti fear of falling – falls efficacy scale (FES) FES-1 (Yardley) ConfBal ABC – UK

Recommendation Teach strategies to get up from floor Provide info regarding summoning help Teach coping strategies to prepare for long lie Consider Referral for stress and anxiety management Referral to mental health services

Assessment of Gait, Balance, Joint Range of Movement and Muscle Strength

Assess gait, balance, joint range of movement and muscle strength Assessment tools may include: Timed ‘get up and go’ test Timed Unsupported Steady Stand (TUSS) Timed sit to stand from standard 18” chair Berg Balance Test Check use of and/or provide appropriate mobility aid (Guidelines for collaborative management of elderly people who have fallen: CSP and College of Occupational Therapists 2000) Functional Ability Subjective questioning of ability to manage

personal and domestic activities of daily living. Choose appropriate treatment

Urinary and Faecal Continence

Assessment Is there urgency of micturition? Is person taking diuretics? Does s/he have problems at night? Does s/he have access to commode at night? Is s/he wearing appropriate aids? Recommendation If continence problems persist refer for specialist continence assessment


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Assessment of Hearing

Check for ear wax

Check hearing aid working/batteries fitted and working

Ensure correct use of hearing aid

Advise about having hearing tested and

corrected

Recommendation Refer to Audiologist if appropriate

Osteoporosis Risk

History of fragility fractures (any fracture caused by a fall from standing height)

Taking long term corticosteroids

Parental hip fracture

Body mass index less than 19

Medical conditions independently

associated with bone loss, such as rheumatoid arthritis

Assessment of Visual Impairment

Has there been any change in vision?

Has the individual visited Optician during the last 12 months?

Is the individual wearing their glasses and are they clean?

Recommendation Visit the Optometrist annually if there is a history of:- - Diabetes - Glaucoma or immediate family member with

Glaucoma - Early cataracts that need monitoring - Over 70 years of age Visit Optometrist every 2 years if no

problems

Pain Assessment

Assess pain using appropriate assessment tool

Recommendation Review analgesia using WHO guidelines

Assessment of Home Hazards

Poor lighting, particularly on stairs Stairs Loose carpets or rugs Trailing bed clothes Slippery floors Need for safety equipment such as grab rails Poor heating Trailing wires Cluttered rooms Pets Recommendation Identify need and refer for equipment, aids and adaptations and minor repairs

Assessment of Cognitive Impairment

Abbreviated mini mental test

MMSE – Mini Mental State Examination

MEAMS – Middlesex Elderly Assessment of Mental State

HADS – Hospital Anxiety and Depression Scale


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Medication Review

4 or more drugs including medicines bought ‘over the counter’ and herbal medicines

Recent change in medication

Compliance/ability to take medication

Taking drugs that may increase the risk of falls:

Benzodiazepines and sleeping tablets Psychiatric drugs Antidepressants Sedating Antihistamines Anticholinergic drugs Drugs for dizziness and nausea Analgesics/Opiates Drugs for Parkinson’s disease Anticonvulsants Hypertension drugs Cardiac/angina medication (this list is not exhaustive)

Review Alcohol Intake

Determine units of alcohol consumed per week Recommendation Advise about risks of taking alcohol with

medications

Give sensible drinking advice

Advise about immediate and long term risks of falling due to dulling of neurological capacity from alcohol

Footwear Examination/Check

Toes able to wiggle freely within shoe/depth of toe box

Width and depth of shoe should be adequate for the individual

Sole does not interfere with normal foot function Shoe upper and lining should be made of soft

material Shoe construction should be of reasonable

quality Whether fits snugly around heel Heel height low or moderate Shoe should not have sharp protusions or edges

internally Shoe covering over instep Shoe must not noticeably slip on the foot –

through the presence of a strap, lace or buckle The level of sole grip must be safe for the

individual Recommendation Provide information regarding suitable shoes Refer if appropriate to Orthotist

Nutrition/Dehydration

Nutrition

Nutritional screening to identify if at risk of malnutrition/or nutritional support required. Ask if:

Difficulties with eating, e.g. badly fitting dentures.

Difficulties with handling meals/drinks, e.g. arthritic condition, visually impaired.

Problems with digestion/absorption, e.g. constipation

Reduced appetite/intake

Special dietary needs

Unintentional weight loss (3kg/12 months)

Nutritional screening tools may be used, either a local one or Malnutrition Universal Screening Tool (MUST) devised by BAPEN

Recommendation If no dietary problem(s) identified No dietary intervention required but explain importance of:-

A well balanced diet for good health and wellbeing

Calcium, Vitamin D, sunlight for bone health If problems identified refer as appropriate to:-

Dietetic Services for full nutritional assessment, intervention monitoring

Therapy/Dental Services for physical problems handling food

Speech and Language Therapy for problems with Dysphagia

CPN/Psychological Service for mental health/psychological problems Dehydration

Signs of thirst, sunken eyes, loss of strength

Dry skin (loss of turgor)

Dry mouth/clarity of speech (which may be affected)

Dizziness on sitting or standing

Decrease in urine output, confusion, constipation

UTI

Vomiting/diarrhoea

Fever

Recent changes/additions of diuretics Recommendation A minimum of 8 glasses of 250mls daily will improve these symptoms and postural hypotension


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Appendix C

SLIPS, TRIPS AND FALLS GENERAL ASSESSMENT AND INTERVENTION PROCESS

Risk Identification: 1. Older people reporting a fall or considered at risk of falling, or

who have balance and gait problems.

2. Any individual service user considered at risk of falling, or who have balance and gait problems or falls have been reported at Network Management Team Meeting.

e.g.: Balance and gait assessment should be used to identify Balance and Gait problems in the adult population (this can be identified via the service user manual handling risk assessment and the individual’s personal health section 13).

Management Team Assessment recommended: 1. Slips, trips and falls general assessment (Access via

Community Service Form G Drive).

2. Complete general home hazards assessment (Utilising Community Services Health and Safety Assessment, Appendix A Health & Safety in one name - access via Community Services Form G Drive).

Referral: 1. Following slips, trips and falls

assessment, any areas identified for further investigation will be referred to the individuals GP or other identified health professional. This could include further multidisciplinary assessments.

2. Following home hazards assessment,

any hazards which cannot resolved will be referred to Housing Provider and/or Commissioner and reported to Senior Management via NWM Team meeting.

Monitoring: 1. Any further falls should be recorded via

the slips, trips and falls – Record of falls and contributing factors (Access via Community Service forms G drive).

2. Any observed change or deterioration of balance or gait should be recorded via balance and gait assessment or in individual’s personal records and follow referral section.

NB: Information to be discussed at NW

management team and actions,

interventions or referrals recommended

Interventions identified, health action plan and health care plan developed or updated and support implemented. (Please utilise Appendix F as a checklist to reduce the risk of falls).


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Appendix D

Please write clearly, in black ink, initial amendment and do not use tippex

SLIPS, TRIPS AND FALLS GENERAL ASSESSMENT

Name: Address: Tel No:

GP: Address: Tel No:

Person Completing Form: Designation/Relationship to Service User: Date Completed:

Operational Network Manager: Scheme:

Fall History (last 12 months) Date Inside/Outside Activity Medical Attention


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Service User History

1. Does the service user have a history of epilepsy/blackouts or other neurological conditions, i.e. MS, Motor Neuron Disease, Huntington’s etc.

Y N If yes was this a contributory factor in the fall?

2. Is the service user unsteady on their feet? Y N If yes was this a contributory factor in the fall?

3. Are there any issues with footwear (see Appendix B for further information)


4. Does the service user have poor balance, i.e. needs to hold on to furniture when walking?


5. Is the service user diabetic?

When was blood glucose levels last tested?


6. Does the service user suffer from any form of sensory impairment, i.e. inner ear infections/hearing difficulties and/or visual impairment etc.


7. Does the service user have a history of cardiovascular problems?

Y N If yes, when was last cardiovascular assessment?

8. Is the service user currently receiving prescription medication (consider side effects of medication and refer to Appendix B for further information)

When did the service user last have their medication reviewed by the GP?


9. Does the service user have a diagnosis of osteoporosis or have they been tested for it in last 12 months?

Y N If yes please give details

10. Does the service user drink alcohol?

What is their alcohol intake?


11. Does the service user have any eating and drinking issues?

Could they be dehydrated or lacking in nutrition?



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Add any additional information which may be of relevance

NB: Please refer to Appendix B for further information and Appendix C to identify next steps to take


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Appendix E Please write clearly, in black ink, initial amendment and do not use tippex

COMMUNITY SERVICE USER RECORD OF FALL AND CONTRIBUTING FACTORS

1. Time and date the fall occurred

2. Where exactly did the fall occur?

3. Was the fall witnessed?

If so, by whom?

4. Describe what the service user was doing immediately prior to the fall

5. Describe the fall, did the service user appear to lose consciousness?

6. What happened immediately after the fall, was there any impairment to the service user’s mobility or level of consciousness or change in behaviour?

7. Did the service user sustain an injury as a result of the fall. Did they require medical attention?

Please describe

8. Was there any contributing factor to the fall, i.e. uneven surface, lose fitting footwear, trailing leads etc?

9. What impact has the fall had on the service user’s life?


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10. Did factors in the environment contribute to the fall?

Y N If yes, what action has been taken to minimise a reoccurrence of the fall?

11. Was anyone else involved or injured as a result of the fall?

Y

N If yes, who and how?

12. Anything else you would like to add? Y N

Completed by: ___________________________________________________

Date Completed: ___________________________________________________


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Appendix F

Goal: To provide and maintain a safe environment and reduce the risk of falls

Intervention Resulting Action/ Person Responsible

1. Check footwear is supportive and well fitting, has non slip sole, no trailing laces

2. Assess the environment for safety hazards

3. Eyesight: Ensure eyesight is checked, wearing glasses if worn. If eyesight is poor ask GP/Optician for review. Ensure glasses are worn and within reach

4. Bed and Bedrails: Assess the need for bedrails (refer to Procedure H & S 22). If likely to fall from bed, ensure the bed is at the lowest possible height unless this would reduce mobility or independence. Consider the use of a special low bed.

5. Medication: Check for medication associated with falls risk. MO to review, do not stop abruptly.

6. MDT: Ensure the Physiotherapist/Occupational Therapist is aware of the service users risk, frequency, nature, seriousness of falls.

7. Lighting: Consider lighting that is best for the service user. Bedside light left on overnight, night light in toilet.

8. Assessment of nutrition/dehydration

9. Safety Aids: Use slip mat to prevent slipping off chairs, wheelchairs must have safety straps use of personal safety alarms. Ensure the service user has the correct aids for mobilising.

10. Involve and Inform the service user in their prevention care plan and educate in safe practices. Provide leaflets.

11. Toilet: Does the risk of falls appear to be associated with the need for the toilet? Assess continence/use of continence aids. If used keep urinals and commodes close.

12. Health: Check for any medical reason associated with falls.


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Prevention and Management of Slips, Trips and Falls for Service Users, Staff and Visitors Appendix G

POST FALL PROTOCOL GUIDANCE 1 DO NOT MOVE SERVICE USER.

2 IMMEDIATE RESPONSE

2.1 Basic Life Support and Reassurance

Check for ongoing danger, e.g. wet floors, electricity, obstructions Check if service user is responsive Check service user’s airways, breathing and circulation

2.2 Check for Injuries

If no apparent injury, assist service users to bed/chair via appropriate means. If the service user can get off the floor independently, then allow them to.

If head trauma and/or fracture is apparent or suspected contact on call, NHS Direct or GP - Signs of head trauma: conduct neurological observations – transfer to A & E via Ambulance - Suspected lower limb fracture – call for Ambulance, make service user comfortable on floor.

Do not move service user.

- Suspected upper limb fracture – immobilise limb, return service user to bed/chair, transfer to A & E.

Check signs of other injuries, e.g. bruising, laceration, swelling, abrasion and record

2.3 Baseline Observations

Check and record any symptoms of nausea, confusion, drowsiness, delirium, agitation Perform appropriate measurements, e.g. pulse, blood pressure, temperature, oxygen saturation

2.4 Make Safe any Environmental Hazards

Remove or minimise environmental hazard(s) if any contributed to the fall If the hazard can’t be removed directly ensure necessary warning is implemented that no other

person will be at risk

2.5 Monitor the Service User

Observe the service user and record observations in their personal records any concerns. Contact on call and or emergency services for advice.

Some injuries may not be apparent at the time of the fall – ensure service user is checked regularly

3 INCIDENT FORM PRISM

Complete the Incident Form Determine how and why the service user fell and record the circumstances

- Date, time and location, e.g. ward, treatment room, outside - Cause of fall, e.g. slip/trip, blackout and activity at time of fall, e.g. walking, transferring - Where service user fell, e.g. from bed, chair, toilet, corridor - Other contributing factors, e.g. toileting related, mobility aids, restrains, team, call bell in use

4 INFORM RELEVANT CONTACTS

4.1 Inform the service user relatives where appropriate, and inform and involve them in any actions planned to reduce the risk of further falls

4.2 Inform local teams as relevant/appropriate

5 REVIEW FALLS RISK ASSESSMENT AND CARE PLAN

ADDITIONAL RECOMMENDATIONS

When service user is falling or sliding from bed or chair. - If possible, position yourself in such a manner that you support the service user’s weight as you

assist them to floor. - Do not try to prevent the fall by grabbing the service user - Do not grab the service user by the arm to lift them back into the bed or chair.

Call for assistance where possible. Ask for advice from other areas if service users are recurrent fallers or situations are difficult to

manage. Share successful interventions with other areas. At the start of each shift, always find out which service users have had a fall or who are most likely


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to fall. Find out where the Support Plan says.

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