Prevention and Management of Falls: Standard Operating Procedure

Transcription

1 Clinical Preventin and Management f Falls: Standard Operating Prcedure Dcument Cntrl Summary Status: Versin: Authrs: New v1.0 Date: 30 June 2015 Angie Brkes, Yvnne Curtney, Prfessr Tny Ellitt, Sarah Hankey, Debbie Mres, Sandra Mrtn, Jackie Owen, Ann-Marie Stkes, Denise Walker Owner/Title Apprved by: Ratified: Related Trust Strategy and/r Strategic Aims Implementatin Date: Review Date: Key Wrds: Assciated Plicy r Standard Operating Prcedures Debbie Mres - Allied Health Prfessinals Lead Plicy and Prcedures Cmmittee Date: 23 rd July 2015 Plicy and Prcedures Cmmittee Date: 23 rd July 2015 The Trust s Visin, Values, Aims and Behaviurs July 2015 July 2018 Falls management, falls preventin, falls assessment, falls risk, what t d if smene falls. Preventin and Management f Falls Plicy. Cntents Standard Operating Prcedure fr Implementing the Preventin and Management f Falls Plicy in Inpatient and Cmmunity Services.2 Annex 1: Preventin and Management f Falls Prcess Map - April Annex 2: Physitherapy Mbility Sheet 8 Leaflet 1: Preventin and Management f Falls 9

2 Change Cntrl Amendment Histry Versin Dates Amendments V th June 2015 SOP created Standard Operating Prcedure fr Implementing the Preventin and Management f Falls Plicy in Inpatient and Cmmunity Services The flw chart at Annex 1 utlines the prcess map fr staff t fllw fllwing admissin. Falls initiatives are embedded in existing clinical prcesses, eg medicatin management, physical healthcare pathway, assessment f cgnitive functin. On admissin there are 2 rutes: The Physical Healthcare Pathway is cmpleted. On admissin t wards where patients are belw the age f 65, with n cgnitive impairment, the Physical Healthcare Pathway is fllwed and if a ptential/actual risk f fall indicated, the Falls Checklist (see RiO) is cmpleted. Fr peple aged 65 years r ver r thse with cgnitive impairment the Falls Checklist is cmpleted n admissin, alng with the Physical Healthcare Pathway and Fracture Risk Assessment (FRAX) (respnsibility f medical staff nly). The FRAX is currently n pc/laptps and can be dwnladed frm: Whilst awaiting cmpletin f the Physical Health Pathway part 1 by the admitting Dctr, admitting staff, aware frm admissin infrmatin f assciated physical health r medicatin triggers that may increase the risk f falls, must cmplete the Falls Checklist n RiO. Transfer frm wards/hspital when inter ward r hspital transfers ccur, within 24 hurs f the transfer, Falls Checklist is cmpleted and the utcme dcumented in the clinical recrd. The Falls Checklist and Physical Healthcare Pathway are multidisciplinary assessments f the service users and cnsider the fllwing: Ability t mbilise. Histry f r fear f falling. Visual acuity use f spectacles fr reading, walking. Osteprsis. Cgnitive impairment. Urinary incntinence - ptential infectin. Page 2 f 11

3 Faecal incntinence. Medicatin. Cardivascular. Functinal ability mbility. Ftwear/ft care. Medicatin. Bld pressure variances with psture/mvement. Outcmes f this are dcumented in the clinical recrd and identified needs care planned. Due t tw independent risk factrs - increasing age (65 years plus) and cgnitive impairment, wards with lder age patients/cgnitive impairment, the Falls Checklist is used alngside the Physical Healthcare Pathway. Patients will be re-assessed using the Falls Checklist when: A significant change in their cnditin ccurs. Fllwing a fall. Fllwing a change in medicatin. Fllwing taking nn-prescribed drugs r excessive cnsumptin f alchl. Review f their falls management care plan. Fllwing cmpletin f the Falls Checklist, a visual recrd f the mbility r transfer equipment required by the service user, is displayed in the service users bedrm using the Physitherapy Mbility Sheet (see annex 2). Care Planning Falls Preventin and Management The Falls Checklist includes the fllwing mandatry interventins t be care planned. Evidence f cmpletin f the Falls Checklist within 24 hurs f admissin. Dcumentatin f reviews f Falls Checklist fllwing changes t medicatin regime. Dcumentatin f review f Falls Checklist fllwing physical health changes. Evidence that the service user has been referred t a Physitherapist. The referral t be generated within 72 hurs f admissin and relevant actins identified in health recrd chrnlgy and persnalised care plan. Evidence that a referral t a Psychlgist has been made if fear f falling is identified. Where indicated as an utcme f the Falls Checklist, dcumentatin that a review f eyesight and altered perceptin has been actined. Statement f cnsideratins that may increase risk f falling, eg incntinence, rientatin, agitatin. Dcumentatin f mbility aids used and transfer assistance required and visual chart f this t be displayed in the service user s bedrm. Use f bedrails is cnsidered as a cntrl measure t manage falls frm beds nly when a thrugh risk assessment has been cmpleted by the multidisciplinary team. See Clinical Risk Assessment and Management Plicy. Electrnic prfiling beds can be utilised where the team cnsider it is required fr high risk cmbinatins fllwing cmpletin f risk assessment by the ward team. Medical staff, GP s and Pharmacists t prescribe tgether the bisphsphnates regime as required. If it is suspected the patient culd be at risk f steprsis, please discuss with the multidisciplinary team, t develp an individual Falls Preventin Prgramme, including cnsideratin f FRAX Tl assessment and prescribed use f bisphsphnates. Page 3 f 11

4 It may be necessary t use interpreters, translatin services t imprve cmmunicatin. Link t the Trust Translatin and Interpreting Plicy What t d in the Event f a Fall If a service user is fund n the ward flr, r seen t fall t the flr, immediate actin is required. An immediate assessment by the Nurse in Charge then, if required, Ward Dctr r Duty Dctr identifies if any harm r injury has been dne, with actin taken by the Nurse in Charge t ensure the individual is safe frm further injury and cmfrtable. The assessment will include checking fr rtatin/shrtening f limbs and visible signs r symptms that may indicate spinal r head injury. Where a fracture is suspected a medical assessment shuld be cmpleted within 30 minutes, with findings being recrded in the patient s healthcare recrd. Where a head injury is suspected, whilst awaiting examinatin by a Dctr an assessment shuld be cmpleted by a persn with cmpetencies t use the Glasgw Cma Scale (n RiO) based n Natinal Institute fr Health and Clinical Excellence (NICE) Clinical Guideline 56: Head Injury. All patients presenting a head injury shuld be assessed immediately by a trained member f staff r paramedic team and by a member f medical staff within a maximum f 15 minutes. Part f this assessment shuld establish whether they are high risk r lw risk f brain injury and/r spinal injury. The assessment and classificatin f patients wh have sustained a head injury shuld be guided primarily by the Glasgw Cma Scale (GCS) and its derivative the Glasgw Outcme Scale (GOS). Gd practice in the use f the Glasgw Cma Scale and Outcme Scale shuld be adhered t at all times. Refer t the Physical Healthcare Pathway. Where rtatin r shrtening f limb is evident and fracture suspected, particularly n legs, the patient shuld nt be mved, call immediately fr the emergency services and keep the service user warm and cmfrtable until an apprpriate transfer is undertaken by the paramedic team. Where spinal injury is evident r rtatin r shrtening f limb suggesting fracture suspected, particularly n legs, the patient must nt be mved, but be kept warm and cmfrtable with privacy and dignity prtected until a safe and apprpriate transfer using the relevant spinal injury and/r fracture splint equipment (eg hard cllars, flat-lifting equipment, scps) is effected by the emergency services team. If n further assessment f treatment is required, the persn is accmpanied t their seat r bed using techniques taught within the Safelad Management Plicy and their immediate physical healthcare needs met, ie pain relief, pain management. Infrm the Duty Dctr. If further assessment is required, the patient is accmpanied t A&E fr assessment/and treatment. If a fracture is identified, a persnalised care plan is develped t manage immediate healthcare needs n return t the ward. Relatives are infrmed in the mst apprpriate way agreed by the team n duty. Page 4 f 11

5 Relevant dcumentatin Safeguard System is cmpleted and, where a fracture has ccurred then an Incident Frm is cmpleted and distributed t Service Manager, Clinical Directr, Risk Manager, Senir Manager n Call. When a fracture is diagnsed/evident - a diagnsis f a fracture will trigger a Serius Incident Investigatin. The team undertaking this must include an Allied Health Prfessinal - either a Physitherapist r an Occupatinal Therapist, and in line with Serius Incident reviews, a Dctr. Hw t Manage Risk f Falls in the Cmmunity When a service user in a cmmunity setting is cnsidered at risk frm falling then Trust staff are advised t link with the lcal falls teams wh can be cntacted via the service user s GP. Page 5 f 11

6 Annex 1: Preventin and Management f Falls Prcess Map April 2015 NB: All fractures are subject t the Serius Incident prcess. Use this prcess map in cnjunctin with the Trust Preventin and Management f Falls Plicy Patient admitted. Physical Health assessment/age/cgnitive impairment identifies the need fr Falls Checklist and cmplete assessment within 24 hurs f admissin. FRAX assessment as required. Patient fund n flr. Patient assessed by cmpetent practitiner t ascertain injury. Incident Frm cmpleted. Relatives infrmed. Bdy Map updated. Minr injury cntact Duty Dctr. Majr injury dial Emergency Services. N injury mnitr/review risk management. Refer t Physitherapy. Dctr requests further investigatins. Needs identified and care plan frmulated. Visual mbility plan n service user s bedrm wall. Yes See Plicy fr mandatry interventins requiring cmpletin. Refer t apprpriate healthcare prfessinals. Patient cared fr as apprpriate and care plan develped t meet current needs. Care team repeat Falls Checklist and persnalise care plan as apprpriate t meet current needs. Refer t Physitherapist. N Yes Patient accmpanied t A&E x-ray. Fracture detected N Yes Care plan reviewed at Multidisciplinary Review fr review and evaluatin. Patient treated at A&E. Persnalised care plan develped t meet current needs n return t ward. Updated incident reprt cmpleted and RIDDOR. Bdy Map updated. Evidence f care plan implementatin. Actin plan develped. SI investigatin cmpleted. Divisinal Risk Manager appints SI investigatr. distributed as per guidance t: Clinical Directr. Evidence f evaluatin f care plan in integrated clinical recrds. Feedback t relevant stakehlders, including Learning the Lessns events. Page 6 f 11 Multidisciplinary investigatin, t include Physitherapist r Occupatinal Therapist. Trust Risk Manager. Senir Manager and thers. Incident frm cmpleted. RIDDOR. Bdy Map updated

7 Page 2 f Preventin and Management f Falls Prcess Map April 2015 Patient assessed by cmpetent practitiner t ascertain injury; N injury - infrm Dctr. Obtain physical bservatins, lk at risk care management, ie assistive technlgy and refer t Physitherapist. Incident frm and family cntact as previus bx. Minr injury - cntact Dctr, but ward staff shuld already have cmpleted physical bservatins and ensure service user is cmfrtable. Update falls assessment. Incident frm and family cntact as previus bx. Majr injury - as abve d nt mve patient cntact emergency services and cmplete transfer frm (hard cpy), incident frm and family cntact as previus bx. Why d Peple Fall? NHS Evidence identifies ver 400 falls indicatrs. Fur main categries are: Envirnmental Issues eg Adverse weather cnditins. Uneven/inapprpriate surfaces, eg use f rugs. Changes t different levels fr example ascending and descending stairs. Inapprpriate ftwear. Liquid n the flr r sticky flrs. Pr lighting. Perceptually cnfusing designs f surfaces and spaces. Medical Cnditins eg Onset f strkes. Living with Parkinsn s symptms. Adapting t amputatins (lwer and upper limb cntribute t falls). Impaired sensry mtr functin fr example, diabetes. Arthritis rheumatid and stearthritis. Cgnitive Impairment. This is a strng independent risk factr arund falls. Peple with a diagnsed cgnitive impairment are 67-85% mre likely t fall withut the cntributin f frailty and debility being added int this picture. This means ur client grup aged 65 years and ver, particularly thse with a diagnsis f rganic cnditins, are at high risk f falling. Vestibular Disrders. Where dizziness and lack f balance cntrl are the main symptms eg Side effects f medicatin. Effects f steprsis putting pressure n the ascending arteries thrugh the neck t the head. Page 7 f 11

8 Annex 2: Physitherapy Mbility Sheet Patient Name Date_ Full Hist Standing Hist (Assistance f 2) (Assistance f 2) Upright sitting in bed Walking Supervisin Assistance f 1 Assistance f 2 Wheeled Frame Trilatr Supervisin Assistance f 1 Assistance f 2 Supervisin Assistance f 1 Assistance f 2 Gutter Frame Elbw Crutches Supervisin Assistance f 1 Assistance f 2 Walking stick Supervisin Assistance f 1 Assistance f 2 Wheelchair Supervisin Assistance f 1 Assistance f 2 NB: This is fr guidance nly Supervisin Assistance f 1 Assistance f 2 Page 8 f 11

9 Leaflet 1: Preventin and Management f Falls The Trust has a plicy t help reduce the harm frm falling. Assessment When yu cme int hspital the staff will ask yu sme questins t find ut if yu might fall. Yur family r carers can help t answer them. Eyes D yu have any prblems with yur eyes? D yu use glasses? Weak bnes D yu have any prblems with yur bnes s they break easily? Incntinence Can yu cntrl when yu g t the tilet? Medicatin D yu take any tablets? Page 9 f 11

10 Walking Hw well can yu walk and d yu need any help? Feet D yu need special care fr yur feet and what ftwear d yu need t walk safely. Care plans If yu are at risk f falling yur care plan will say what special care yu need t make sure yu are prperly lked after. Physitherapy A physitherapist may be asked t see yu t help yu walk safely. Safety Staff must make sure the ward is as safe as pssible fr yu. This will include lking at whether yu need ct sides r mveable highlw beds. If yu Fall If yu d fall a dctr r nurse will examine yu as sn as pssible. The nurse in charge will Page 10 f 11

11 make sure yu are safe and cmfrtable and have any medicine yu need. Brken bne If the dctr r nurse thinks yu have brken a bne yu will g t the General Hspital in an ambulance. A member f staff will g with yu and yur family will be tld what has happened. Training Ward staff are trained t assess the risk f peple falling and t write care plans t prevent falls. Preventin If smene des fall, staff will lk at why this happened s they can try and stp it happening again. Page 11 f 11