Policy for the prevention and management of Slips, trips and falls for patients in East Cheshire NHS Trust In- patient and Community settings.

Transcription

1 Policy for the prevention and management of Slips, trips and falls for patients in East Cheshire NHS Trust In- patient and Community settings. community settings Author: Lisa Minshall Version 3: March

2 Policy Title: Policy relating to the prevention and management of slips, trips and falls for patients in inpatient and community settings Executive Summary: This policy will provide guidance for all staff regarding the prevention, assessment and management of slips, trips and falls in the Trust. The policy contains documents required for the effective assessment of patients in the Trust and incorporates the guidance. This policy should be read in conjunction with the Policy Schedule and the Policy for the safe use of bed rails. Supersedes: Policy relating to the prevention and management of slips, trips and falls for patients - Version 2 Description of Update to assessment in line with latest standards and Amendment(s): guidance on multifactorial risk assessment. Inclusion of post falls protocols hospital and community Bed rails policy now stand alone SOP Removed falls risk tool. This policy will impact on: All clinical staff and patients Financial Implications: None Policy Area: Clinical Practice Document ECT Reference: Version Number: 3 Effective Date: March 2017 Issued By: Head of Nursing. Review Date: March 2019 Authors: Lisa Minshall - Head of Nursing. Impact Assessment Date: Feb 2016 APPROVAL RECORD Consultation: Approved by: Committees / Group Harm Free Care Group Community Nursing Forum Matron KIT Senior Sister KIT Matron KIT Senior Sister KIT Harm free care group Date Dec 2016, Jan 2017 Jan 2017 Dec 2016 Feb 2017 Dec 2016 Feb 2017 Jan 2017 community settings Author: Lisa Minshall Version 3: March

3 Contents Section Topic Page 1.0 INTRODUCTION SCOPE OF POLICY DEFINITIONS DUTIES AND RESPONSIBILITIES POLICY IMPLEMENTATION PREVENTION AND MANAGEMENT OF FALLS IN THE INPATIENT (Hospital and Intermediate care bed based) SETTING Assessment of risk Multifactorial Falls Care Plan The environment and equipment Assessment and care of patients who have fallen in an inpatient setting Management of a Patient with Visible, Reported or Suspected Severe Injury following a fall. Management of a hospital patient who has fallen and who are prescribed Anticoagulants Unwitnessed falls - Hospital in patients Additional interventions required post fall PREVENTION AND MANAGEMENT OF FALLS IN THE COMMUNITY SETTING Assessment of risk Multifactorial Falls Care Plan Assessment And Management Of Patients Who Fall In The Community Setting USE OF BEDRAILS - HOSPITAL AND COMMUNITY EDUCATION AND TRAINING MONITORING AND EFFECTIVENESS EQUALITY STATEMENT 19 References 20 community settings Author: Lisa Minshall Version 3: March

4 APPENDICES 1. Prevention and Management of Falls Falls Prevention In-patient Leaflet Care Admissions Assessment Enhanced Care Risk Assessment & Care Plan ECT Post Falls Protocol 31 5a. ECT Post Falls Protocol Care Plan Community Prevention leaflet - Reducing the Risks Booklet Community Post Fall Protocol Multifactorial Falls Care Plan Equality Impact Assessment 38 community settings Author: Lisa Minshall Version 3: March

5 1.0 INTRODUCTION East Cheshire Trust recognises that minimizing the risk of falls and fall related injuries is an important safety and quality of care issue. Falls and falls related injuries are a common and serious problem for older people. People aged 65 years and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year (NICE 2013). People fall for many different reasons including physical, mental and environmental reasons. Effective falls management requires multi-professional involvement including medics, nurses, therapists, pharmacists, support staff, facilities services and management. Patients must be involved in falls management to ensure independence, dignity; privacy, rehabilitation and falls risk are all appropriately addressed (National Institute on Aging, 2016). Patient falls have both human and financial costs. For the individual patient, the consequences range from distress and loss of confidence, to injuries that cause pain and suffering, loss of independence and, occasionally, death (NPSA 2007). Patients in hospital have a greater risk of falling as they are often more vulnerable due to newly acquired risk factors such as acute illness, delirium, cardiovascular disease, side effects from medication or problems with balance, strength or mobility. Poor eyesight or poor memory can create a greater risk of falls when the patient is out of their normal environment on a hospital ward. (NICE 2014). NICE Clinical guideline 161 states that all people age 65 years or older who are admitted to hospital should be considered for a falls multi factorial risk assessment in order to identify their risk of falling during their hospital stay. In addition people ages who are admitted to hospital and are judged by a clinician to be at a higher risk of falling because of underlying co-morbidities should also be considered for a falls multi factorial assessment. Prevention of falls, and effective management of patients following a fall, is recognised as an important patient safety challenge with Falls prevention, risk assessment and effective risk reduction strategies are everyone s responsibility in order to reduce falls incidence, reduce harm to patients and create a safer environment. 2.0 SCOPE OF POLICY This policy identifies East Cheshire Trusts commitment to reducing the incidence of falls for patients in line with NICE (National Institute for Health and Care Excellence) guidance (June 2013 and January 2014). This policy applies to all permanent, locum, agency and bank staff of East Cheshire NHS Trust involved in the direct provision of care to patients. The patients covered by this policy are all adult in-patients and patients being cared for in the community settings. community settings Author: Lisa Minshall Version 3: March

6 The purpose of this policy is to provide information and standards on the prevention and management of all patient slips, trips and falls and prevention and reduction of injurious falls in adult inpatients within East Cheshire Trust Hospital. The aim of this policy is: To provide a strategy to reduce, as far as is reasonably practicable, the incidence of inpatient and community falls and fall related injuries To facilitate the continual reduction in the number of avoidable, injurious slips, trips and falls across the adult, in-patient population to support the safety of patients and promote a culture of falls management and prevention being all staff s responsibility through the appropriate identification and care of people at risk To outline key responsibilities in relation to the management of patient falls To increase staff and patient awareness of the risk and impact of falls and effective prevention strategies Standardising the approach to falls risk assessment and prevention by using the evidence based multifactorial care pathway approach in line with NICE guidance (2015) Identifying and standardise targeted interventions for at risk patients to minimise the risk of falling Develop the skills and competence of practitioners with regard to falls assessment and management 3.0 DEFINITIONS Definitions of falls are provided to support consistent descriptors to aid the standardisation of reporting falls via the incident reporting system. Slip: To slide accidentally causing the person to lose their balance. This is either corrected or causes the person to fall. Trip: To stumble accidentally, often over an obstacle causing the person to lose their balance. This is either corrected or causes the person to fall. Fall: An event which results in the person coming to rest inadvertently on the ground or other surface lower than the person, whether or not an injury is sustained. Controlled/assisted fall: For example when a staff member attempts to minimise the impact of the fall by easing the patient s descent to the floor or by breaking the patient s fall. These events may still result in injury to the patient. A near fall/near miss: A sudden loss of balance that does not result in a fall. This can include a person who slips, stumbles or trips but is able to regain control prior to falling. Fall from height: Any level above floor level must be considered a height, which, should the patient fall from, could result in serious injury. Examples would include, a patient falling out of bed/from a trolley, climbing out of a window, falling over a barrier. An un witnessed fall: This occurs when a patient is found on the floor and neither the patient nor anyone else knows how he/she got there. community settings Author: Lisa Minshall Version 3: March

7 Serious Harm Fall: Any slip, trip or fall which results in: a fracture, significant head injury, an injury which requires surgical intervention, or a prolonged stay in hospital. Bedrail: Known in the Trust as safety or bedside rails and are an integral component of a selection of the Trusts standard bed. These are a device designed to prevent patients falling out of bed. Datix: The Trust s risk management system (see Incident Reporting, Analysing, Investigating and Learning Policy and Procedures) 4.0 DUTIES AND RESPONSIBILITIES The Policy relating to the prevention and management of slips, trips and falls for patients in hospital and community settings must be implemented at all levels within the organisation to ensure a safe and consistent approach in the management of patients who are at risk and /or experience a fall. The Trust Board: The Board is ultimately responsible for fulfilling all duties assigned to them in current UK Health and Safety legislation Chief Executive: As accountable officer, the Chief Executive is responsible for making sure that appropriate policies and systems are in place to reduce the risk of slips, trips and fall for patients, staff and visitors and that the policies are implemented and monitored Director of Nursing, Quality and Performance: The Director of Nursing, Performance and Quality is responsible for: Ensuring that effective systems are in place to support appropriate risk assessment and care planning to manage those risks as far as is reasonably practicable Monitoring overall performance in relation to falls incidents ensuring that trends, themes and contributory factors are identified and reported appropriately Director of Corporate Affairs and Governance: Has Trust Board responsibility for all aspects of risk management including the management of risk register and setting the framework for the reporting and the management of incidents, ensuring the Trust complies with national, regional and local reporting arrangements Clinical Risk Manager: Is responsible for the initial processing and escalation of incident reports on datix as per the incident management policy and will provide data as requested for the analysis of patient slips, trips and falls within the Business Units. The Head of Estates Operations: Will ensure that any provisions made for the control of environmental issues related to patient slips, trips, falls and hazards are implemented in the new or refurbished premises and will monitor their upkeep to ensure ongoing control community settings Author: Lisa Minshall Version 3: March

8 All staff working within the clinical settings have a responsibility for the safety of patients, themselves and others: Medical staff must ensure: The assessment of patients on admission for any condition that may predispose the patient to a risk of falls and this should be incorporated in the clerking documentation The patients previous falls history is clearly documented in the medical notes and shared with the multidisciplinary team as appropriate The clinical review for any condition that may have caused a fall and review medications that have contributed to the patient s fall(s) Review patients following a fall Patients who are at further risk of falls in the community are considered for referral to the Intermediate Care Team/Frailty Falls Team prior to discharge where appropriate Completion of training in Falls Prevention Directorate Managers/Heads of Nursing/ Matron/Ward Sister/ Team Leader: Ensure that the policy is adhered to in the clinical setting and that all team members are aware of and implement the requirements if the Falls and related policies Ensure that there is a clear process of dissemination ensuring that the appropriate assessment and documentation relating to falls is used for all patients in their areas are aware of and implement the requirements of the Falls policy Ensure that local induction arrangements incorporate awareness of slips trips and falls and where indicated in the training needs analysis, suitable supplementary training is given Monitor compliance with mandatory Falls, Slips and Trips training and associated competencies Ensure that all patients are assessed as to their risk of falls on admission, with reassessment at frequent intervals or when there is a material change in the Patients condition. A detailed risk assessment is completed for those patients identified at risk of a fall Ensure that at risk patients are flagged and care is planned and discussed as part of the safety briefings Promote a culture of patient involvement in falls prevention and treatment care planning Ensure that staff are aware of environmental hazards e.g. cluttered environment, access to walking aids, trip hazards (TRAINING) Ensure that any incidents that occur which are linked with falling and/or falls management are reported and investigated using Datix Ensure that all falls incident reports are investigated thoroughly and escalating any possible RIDDOR reportable incidents to the Safety and Risk Team Ensure that environmental risks related to slips, trips and falls are identified and managed appropriately in their area(s) of responsibility Ensure that fall related incidents, complaints and claims are reviewed and lessons learnt are implementing locally and where appropriate shared across the organisation Assistance with the investigation of serious falls and review the management of patients that have had multiple falls (more than three) Undertaking regular audit of patient assessment, care plans and treatment regime are to ensure that they are current, valid and evaluated community settings Author: Lisa Minshall Version 3: March

9 Utilises data available (e.g. incidence, Safety thermometer) to monitor the effectiveness of fall prevention strategies in areas under their management Ensure that appropriate equipment and resources are allocated appropriately to support the management of patients assessed as being at risk of falls including resources being allocated appropriately Encourage an open and honest culture including where appropriate, open and transparent communication is held with patients and relatives in accordance with the Duty of Candour Registered Nurses: Registered nurses must ensure: They work within the standards and guidance of the Trust Falls policy for the prevention and management of patient falls Falls awareness as to the risks & impact of falls is promoted to patients/relatives, providing a patient information leaflet (Appendix 2) Patients/relatives have been advised regarding appropriateness of footwear for the hospital environment if problems have been identified on admission, so that alternatives might be provided as necessary Observation of the environment identifying and reducing environmental risks where possible e.g. lockers, call bells, drinks etc. are within patient reach to discourage over stretching Discussion at patient safety briefings during shift handovers and during referrals. The use of the falling leaf symbol on the patient Safety Boards (PSB) to be used to denote that a patient is assessed as at risk of falls That the correct care and reporting procedures are followed in the event of a patient fall using the recognised incident reporting tool (datix) and in accordance with the Trust Incident Reporting Policy They have received training and are competent in the prevention, risk assessment and management of falls Completion of the Trust mandatory programme for Falls Prevention and Management programme Referral to the Community Resource Team/Falls Service as part of discharge planning (as appropriate) Registered nurses in Hospital (in-patient) areas: A falls multifactorial risk assessment is commenced for all adult in patients within 6 hours following admission A bedrail screening assessment is commenced for all adult in patients where bed rails are being considered for use Appropriate and timely review of a multifactorial falls risk assessment on any inter hospital ward transfer, change in clinical condition or review weekly if no change observed Ensure that the multidisciplinary team are aware of patients at risk of falls or who have fallen by using handovers and Safety Briefings/huddles Falling leaves are used on hot boards to identify at risk patients Registered nurses in community nursing teams: A multifactorial falls risk assessment is commenced for all adult patients admitted to caseload as part of the initial assessment and line with local assessment timescales Appropriate and timely review of a falls risk assessment for patients on the caseload following a patient fall or change in clinical condition community settings Author: Lisa Minshall Version 3: March

10 Unregistered clinical staff: Are responsible for: Completion of mandatory Falls, Slips and Trips training Undertaking comfort rounding as prescribed in the individualised care plan Implementing the Falls Risk Care Plan as delegated to them (within the scope of their competence) Documenting the care delivered as part of the patient evaluation records Therapists: Physiotherapists are responsible for: Carrying out an assessment on all patients referred to the service with a fall/following a fall as an in-patient The assessment will include balance, gait, range of movement, strength, functional ability including transfers and the need for and provision of a walking aid The physiotherapy treatment plan will continue until the patient reaches either their pre admission level of mobility or rehabilitation potential, whichever is the greater. This will be the responsibility of the physiotherapist in charge of the patient s care Providing advice to other members of the multidisciplinary team on the best methods of movement and mobility Education of patients and carer with regards to falls prevention. Providing patients/relatives with advice of suitable footwear as appropriate Completion of training in Falls Prevention Occupational therapists are responsible for: Ongoing assessment and intervention of activities of daily living and necessary interventions throughout the patients stay, where indicated Assessment of cognitive function where appropriate. Where indicated, assessment of the patient s home environment, identifying the daily activities which place the person at risk of possible falling Completion of training in Falls Prevention Pharmacists: Pharmacists are responsible for: Medicine reconciliation Support of specific medication reviews for patients at risk of falls / who have fallen when requested by the medical or nursing staff Ensure any changes made are listed on Discharge Summary to GP Equality and diversity: The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. This policy has been appropriately assessed 5.0 POLICY IMPLEMENTATION Falls can be a symptom of underlying illness (Patient Safety First, 2009). Following a fall early detection, effective injury treatment, and consideration of why the patient fell and application of measures to reduce the risk of further falls or injury is required to reduce the degree of harm (NPSA, 2007). community settings Author: Lisa Minshall Version 3: March

11 There is evidence that multifactorial risk assessments followed by a targeted multidisciplinary intervention can prevent 20-30% of in-hospital falls (NICE 2014). Identifying those at risk is the first stage in falls prevention. A multifactorial assessment must be undertaken for each patient and aims to identify the patient s individual falls risk factors that can be improved and managed. A multifactorial falls assessment will include: Cognitive assessment Continence assessment Falls history assessment including causes and consequences such as injuries and fear of falling Footwear assessment Assessment of physical and mental health issues that may increase falls risk Medication review Physiotherapy assessment regarding mobility and balance Postural instability assessment possibly including lying and standing blood pressure and physiotherapy assessment. Syncope assessment for those who have had unexplained falls. Visual assessment Assessing for the risk of falling must include discussions with the patient and, where appropriate relatives and carers. In line with consent requirements the patient s next of kin/carers must be made aware of the findings of the Patient Falls Risk Assessment, and advised of any issues that require attention while the patient is an in-patient e.g. the provision of suitable footwear, availability of spectacles etc. 6.0 PREVENTION AND MANAGEMENT OF FALLS IN THE INPATIENT (Hospital and Intermediate care bed based) SETTING 6.1 Assessment of risk All adult patients attending the Emergency Department (ED) must have a risk assessment screen undertaken within 2 hours of entering the department and if in the department for longer than 6 hours a full multifactorial risk assessment must be undertaken Patients admitted to hospital following a fall should where possible, be nursed in an easy observation part of the ward until all assessments have been completed On admission, all adult in-patients must have a holistic inpatient care assessment which incorporates a multifactorial falls assessment commenced - Appendix 3 community settings Author: Lisa Minshall Version 3: March

12 6.1.4 The multifactorial assessment must be completed within 6 hours of the patient being admitted to hospital (including patients staying longer than 6 hours in A&E and MAU) The outcome of cognitive and capacity assessments must be taken into account when undertaking the multifactorial falls assessment The multifactorial assessment identifies the specific risk issues for the individual patient and the care plan should address specific risk issues and show how you intend to manage these risks. If the course of action is unclear discussion must be made with senior colleagues and other members of the MDT and documented in the patient record The prevention of falls has many aspects and is related to many other possible care problems and the falls prevention care plan should be integrated as part of the overall individual patient care plan., e.g., incontinence, malnutrition Where patients are identified as being at risk of falls, written, as well as oral information must be provided about falls prevention, to the patient and carers All patients identified as at risk will be given the Trust Falls Prevention in Hospital leaflet (Appendix 2) and have an opportunity to discuss its content with a member of the multi-disciplinary team. This action will be confirmed and documented as part of the Multifactorial Falls Care Plan For patients who have positive responses to red flag questions as indicated in the patient assessment document then this is an immediate indication that the patient is at risk of falls. 6.2 Multifactorial Falls Care Plan Where a risk of falls has been identified a Multifactorial Falls care plan must be completed Appendix Interventions for reducing the risk of a patient falling must be documented on the - Multifactorial Falls care plan and will usually include: Environmental issues Equipment issues Referral onto other professionals Individualised interventions to reduce the risk falls e.g. those associated with vision, postural changes in blood pressure, cognitive behaviour, presence of delirium, mobility, continence The Multifactorial Falls care plan must be reviewed:- 1. Weekly (maximum) 2. Immediately following a fall and/or a change in the patient s condition 3. Ward transfer/move and the review must be fully documented in the patient records Where someone has impaired communication or comprehension due to an underlying condition such as dementia or learning difficulty then an appropriate alternative will be explored if deemed appropriate. For example, discussion with carers/next of kin community settings Author: Lisa Minshall Version 3: March

13 6.2.5 All adult patients where bed rails are considered will have a bed rails risk assessment completed in line with Trust SOP All patients assessed as at risk of falls will be commenced on a minimum of 2 hourly intentional rounding and the frequency expected must be documented on the daily care chart Pressure Pads and Sensor Alarms should be considered for a patient as part of their plan of care. Staff must balance the use of this equipment as a safety tool against Other important factors such as the dignity, privacy and the rights of the patient. It must be used as a falls preventative and must not be used to restrict patient movement. This will be documented in the care plan Patients assessed as being at risk of falls following their discharge from hospital must be reviewed for their need to have a home assessment prior to their discharge. In some cases it may not be appropriate to provide a home or environmental assessment. This is a clinical decision which is made by the Occupational Therapy Team depending on individual patient need The discharge summary sent to the patient s General Practitioner (GP) on their discharge must clearly identify when a high risk of falls is identified during a hospital stay, so that the patient can receive additional support in the community as required (e.g. referral to Locality Frailty Team/Intermediate care per local referral criteria). 6.3 The environment and equipment As part of care planning, nurses must make a professional assessment to ensure the environment minimises the risk of falls and identify any additional equipment that may be needed Beds should be kept at the lowest possible height unless providing direct care or patient is considered to be independent when transferring in and out of bed and not at risk of falling out of bed. The bed should then be at the optimum height for the patient to transfer as a bed that is too high/low may increase their risk of falls Bed orientation should also be considered to ensure patients are exiting the bed from a familiar side Special beds that can be lowered to just above the floor should be considered for those patients who are extremely restless and agitated and are at high risk of falling out of bed, whilst taking into account the patient s dignity and comfort. Nursing a patient on a mattress on the floor is not usually acceptable If it is felt that increased supervision is required then cohort nursing - the practice of grouping together patients with intensive nursing needs should be considered. This ensures that staffing resources are used most efficiently and enables better observation and vigilance of these patients wellbeing and safety Cohorting may not be appropriate for all patients e.g. patients with challenging behaviour, infection control precautions. In these circumstances the RN and community settings Author: Lisa Minshall Version 3: March

14 Matron, should agree on the most appropriate course of action. This should be clearly documented in the patient s Falls Risk Care Plan If one-to-one nursing is necessary then an enhance care assessment should be undertaken (appendix 4) and discussed with the matron and or departmental manager Bed rails must only be used in conjunction with the Trust s Policy Using Bed Rails Safely. Please ECT Bedrail Usage SOP 6.4 Assessment and care of patients who have fallen in an inpatient setting Patient falls are often unpredictable and staff should avoid attempting to catch a falling patient as this is likely to increase the potential for additional harm to both the falling person and staff. Where safe to do so, staff should assist the patient downwards and safely to the floor. Manual Handling Policy ECT227 If staff are faced with this situation they should apply the principles of safer handling suitable to these events and safer systems of work as taught and provided by the Trust If a patient falls the relevant ECT Post Falls Protocol Appendix 5 should be followed and a Post Falls Protocol Care Plan should be commenced. Appendix 5a If a patient should fall a suitably qualified clinician should make an immediate visual and first aid assessment of the patient at the scene of the fall prior to moving the patient as per the Patient Post Fall Protocol in Appendix The patient s Airway, breathing, circulation and Glasgow Coma Scale (GCS) must be assessed The patient must then be assessed for signs of fracture or serious injury, for example: obvious fractures; including neck of femur and cervical spine, head injury, significant soft tissue injuries, pain on movement and any change in neurological status before the patient is moved. NB: Any patient falling from a significant height must be treated as an emergency In addition, the medical team routinely caring for the patient should be made aware that the patient has had a fall the medical team should ensure that the patient review is recorded in the medical notes The patients NOK or carer should be informed by telephone immediately if the patient has suffered an injurious fall and by the end of the shift for noninjurious falls A post falls protocol care plan should be completed for patients as part of the patients care record. A copy of the post fall protocol will be displayed in the nurses/team office to make easy to find (Patient Safety First, 2009) community settings Author: Lisa Minshall Version 3: March

15 6.5 Management of a Patient with Visible, Reported or Suspected Severe Injury following a fall: If any serious injuries are visible, reported or suspected then urgent medical assessment and examination should be made and a doctor should be called immediately to assess. Where patients are present with suspected injuries, e.g. to the spine or lower limbs, or who are unable to move themselves from the floor without physical assistance, they should be recovered to a place of safety using an appropriate safer system of handling practice suitable to their condition in accordance with the requirements of the NICE standards. These methods may include the use of inflatable lifting devices or hoisting using a suitable stretcher sling and spreader bar. Staff must seek assistance from personnel who are familiar with these devices if they have not been trained in their use Physical lifting from the floor must be avoided as this increases the risks of exacerbating any existing injury and raises the potential for further harm to both patient and handlers. Where suspected cervical/ or serious injuries then a call for immediate medical assessment. If advice is required on patient moving and handling of patients with suspected cervical injuries then please contact any of the following: A&E Moving and Handling trainers (Mon - Fri ) Community hospitals should contact emergency 999 ambulances Management of a Patient with NO Visible, Reported or Suspected Severe Injury following a Fall: A set of baseline observations including initial neuro obs - must be completed and documented to detect any new acute illness, or to detect any harm from the fall. If there are no serious injury reported, suspected or visible then the patient can then be assisted in getting up or assisted into bed using appropriate supervision/manual handling aids. Please refer to ECT Manual Handling Policy Manual Handling Policy ECT227 Results need to be acted upon and observations repeated as the clinician s assessment and patient s condition indicates Any minor injuries sustained, such as cuts or abrasions as a result of the fall must be treated appropriately and on-going observations and management will be dictated by the nature of the injury and the initial assessment It is important that safe retrieval of the patient who has fallen is managed correctly. Staff must know how to access and operate lifting equipment, and have the expertise to manage suspected cervical injury and hip fractures where immobilisation or flatlifting is required - Manual Handling Policy ECT Management of a hospital patient who has fallen and who are prescribed Anticoagulants All patients who have had a witness /unwitnessed fall with a visible or suspected head injury and who are on anticoagulant therapy must be reviewed by a doctor as a priority so consideration and assessment in line with NICE standards can be made in community settings Author: Lisa Minshall Version 3: March

16 relation to the increased risk of bleeding associated with suspected or actual head injury. 6.7 Unwitnessed falls - Hospital in - patients If a fall is unwitnessed then please refer to the Patient Post Fall Protocol Appendix 5 and follow the protocol contained in the green boxes. Move the patient if safe to do so by using the appropriate safe system of work 6.8 Additional interventions required post fall A Multifactorial Falls Care Plan must be implemented- If it is already in use the Falls Care Plan must be reviewed and updated. A review of the patient s bed position in the ward should be carried out and, if necessary, moved into easy observation points if necessary. The patients NOK or carer should be informed by telephone immediately if the patient has suffered an injurious fall and by the end of the shift for noninjurious falls. Any lessons learnt following the investigation of a fall should be shared with all ward staff at team meetings. 7.0 PREVENTION AND MANAGEMENT OF FALLS IN THE COMMUNITY SETTING 7.1 Assessment of risk All community patients who are admitted onto caseload must have a patient fall multifactorial risk assessment commenced at initial assessment - and must be completed within 1 week of assessment being commenced Where identified the assessing clinician should consider referral onto a relevant Allied Health Professional for completion of the multifactorial assessment and intervention All patients who are at risk of falling should be given a falls prevention advice/leaflet Falls and Injury Reducing the Risks Booklet - Appendix 6 and have an opportunity to discuss its content with a member of the multidisciplinary team. This will be documented in the EMIS record The outcome of cognitive and capacity assessments must be taken into account when undertaking the multifactorial falls assessment For patients identified as at risk of falls the multifactorial assessment will be reviewed at least every 12 months or immediately following a fall, or a change in the patient s condition. community settings Author: Lisa Minshall Version 3: March

17 7.1.6 All adult patients where bed rails are considered will have a bed rails risk assessment completed 7.2 Multifactorial Falls Care Plan Depending on the outcome of the assessment, relevant plans of care should be identified on the nursing record and must be implemented Interventions for reducing the risk of a patient falling must be documented on the patient record system (EMIS) should include: A review of medication Consideration of assessment by a relevant healthcare professional such as; Physiotherapist, Occupational Therapist or Podiatrist Individualised interventions to reduce the risk falls associated with vision, postural changes in blood pressure, cognitive behaviour, presence of delirium, mobility, continence and the environment Where patients are identified as being at risk of falls, written, as well as oral information must be provided about falls prevention, to the patient and carers Where someone has impaired communication or comprehension due to an underlying condition such as dementia or learning difficulty then an appropriate alternative will be explored if deemed appropriate. For example, discussion with carers/next of kin Pressure Pads, Sensor Alarms and pendant alarms for community patients should be considered for a patient as part of their plan of care. Staff must balance the use of this equipment as a safety tool against other important factors such as the dignity, privacy and the rights of the patient. It must be used as a falls preventative and must not be used to restrict patient movement. This will be documented in the nursing associated records. 7.3 Assessment and Management Of Patients Who Fall In The Community Setting If a patient is witnessed falling or a fall related near miss occurs: Always check the area first in order to ensure your own safety Check the patient for signs of significant injury An immediate assessment of any injury or harm should be done, taking action as necessary to make the individual safe Do not attempt to move the person unless it is safe to do so, particularly if head injury, cervical spine injury or fracture to any part of the body is suspected if in doubt always call for assistance via 999 If a severe injury is evident or suspected on initial assessment - dial 999 for transfer to Accident and Emergency If the patient is assessed as having a fall without a severe injury return them to bed/chair using appropriate moving and handling technique and refer to GP. Perform baseline observation and document in patient notes and inform next of kin/ main carer All incidents must be reported via the Trust incident reporting system and should include patient details, time, location and circumstances of the falls. The patient should be asked to account for how they slipped, tripped or fell. A clear account of the fall, if known, should be clearly documented for future reference in their nursing notes community settings Author: Lisa Minshall Version 3: March

18 Reassess risk and document any actions required. If indicated initiate referral for medication review, community therapy services or specialist nurse assessment and document all interventions in the patient s record The nurse should gain consent to inform the patients NOK or carer of the fall if not already present Please see Community Post Fall Protocol Appendix USE OF BEDRAILS - HOSPITAL AND COMMUNITY Bedrails are designed to reduce the risk of patients accidentally slipping, sliding, falling or rolling out of bed. They DO NOT prevent a patient getting out of bed and falling elsewhere as they are not designed for, and should not be used to limit the freedom of patients, nor should they be used to restrain patients with conditions likely to cause erratic or violent movements. Registered Clinical Staff are responsible for ensuring patients are appropriately assessed for the use of bed rails in line with the Bedrails SOP. A bed rails assessment MUST be carried out prior to the use of any bed rails and re evaluated following any change in the patient s condition (see bed rails SOP for further details). 9.0 EDUCATION AND TRAINING Corporate Induction Programme includes Falls Awareness. Clinical Induction Programmes and Manual Handling Training include raising awareness of the Falls Policy and how to deal with the fallen patient. The details of mandatory training for falls, including eligibility and frequency, are described in the Trust s Mandatory Training Needs Analysis (TNA). Staff attend classroom or ESR delivered Essential Update training every three years and undertake refresher training in the intervening years as identified by their manager. Monitoring of staff competence in falls assessment and management Appendix1 will form part of the individual s annual performance review (appraisal) and where necessary, additional training provided The Trust L&D Team will carry out annual updating of staff responsible for people handling at the Mandatory Manual Handling Refresher Training sessions. Use of Slings and Hoists: training regarding use of slings and hoists is included in the Manual Handling training provided across the Trust Falls Information Leaflet Appendix 2 will be available in all areas for staff, patients and carers. community settings Author: Lisa Minshall Version 3: March

19 10.0 MONITORING AND EFFECTIVENESS Audit and compliance Data is collected around the number of falls and harm from falls on the internal incidence (Datix) system Regular monitoring of falls incidence will be via the analysis of slip, trip and fall incidents, RIDDOR reported incidents, complaints and corporate claims by the Clinical Governance department and will support the means for evaluating the effectiveness of this policy. This data forms monthly ward reports for each ward, so that departmental managers/senior sisters ward managers can analyse and compare their own. Quarterly reports of this data are presented at the Quality Governance Committee (sub group to Trust Board), Quality Forum and Harm free Care Groups). The Policy will be reviewed annually or when national guidance changes EQUALITY STATEMENT This policy has undergone an equality impact assessment screening process using the toolkit designed by the NHS Centre Equality & Human Rights. community settings Author: Lisa Minshall Version 3: March

20 References: National Patient Safety Agency (2007) Slips, trips and Falls in hospital Patient Safety Observatory, 3rd Report NPSA, London. National Patient Safety Agency (2011) essential care after a Fall in Hospital in Hospital.NPSA, London. NICE (2013) Clinical Guideline 161 Falls: Assessment and Prevention of falls in Older People, Royal College of Physicians (2012) implementing Fall safe: Care Bundles to reduce Inpatient Falls. Associated reading /information Risk Management Policy Incident Reporting and Investigation Policy. Manual Handling Policy. Policy for the development, management and authorisation of policies. Being Open Policy. Policy for Use of Bed Rails. community settings Author: Lisa Minshall Version 3: March

21 Appendix 1 Prevention and Management of Falls Prevention and Management of Falls Competency: This competence requires the clinician to demonstrate knowledge and ability to undertake primary or secondary prevention of falls risks and identifying older people at risk of falls. The process should involve a holistic assessment of each individual and his or her specific needs. Evidence against the Trust KSF dimensions : HWB1; HWB2; HWB3; HWB6 Relevant Knowledge/Training/Qualifications: Stat and mandatory e- learning module Trust Falls Policy: Trust Bed Rails Policy. Benner's Stages: Stage 1 Novice Stage 2 Advanced Beginning Stage 3 Competent Stage 4 Proficient Stage 5 Expert Performance Indicator: Stage 3 Band 2,3,4 and 5 : Stage 4 BAND 5 and over STAGE 3 Demonstrates understanding of the context of the falls agenda. Has undertaken the trust e- learning package on Falls Awareness/prevention. Demonstrates underpinning knowledge of falls risks and ability to undertake multifactorial falls risk assessment including: Self- Assessment Document competency stage (1-5) and sign 1 st Assessment Stage 2 nd Assessment Stage Final sign off by Mentor Variance Actions Date/initial Date/initial Date/initial Date/initial Date/initial Able to discuss/identify: 1. What are the key factors that contribute to a patient risk of falling relating to the care environment including being an identified environmental hazards and take action to eliminate them and report actions to senior staff. 2. What can be done to prevent falls - including the identification of common hazards which could lead to slips, trips and falls and how to manage them and keep the risk to a minimum 3. The medical causes of falls and how to recognise signs of these 4. Professional responsibility in the assessment of falls. 5. The possible physical and psychological effects of falls on older people and those who care for them. Demonstrates understanding of your responsibilities and role in relation to patients who are at risk of falling or who have fallen Shows understanding of Trust Policy. community settings Author: Lisa Minshall Version 3: March

22 Explain the actions required to ensure safe management if you are the first responder to an individual who has fallen. Demonstrate knowledge of reporting procedures following a patient fall Demonstrates understanding of assessment of mobility including: normal posture, gait and balance How to recognise and respond to deviations from these. Demonstrate the effective and safe use of falls prevention equipment a) High low beds b) Falls Alarms c) Falling Leaf signs d) Slippers and slipper socks Demonstrates understanding of the need for effective communication regarding falls management when transferring or referring care to another healthcare professional or clinical area. Demonstrates ability to undertake Case/risk identification through undertaking the recognised Trust Multi-factorial Risk assessment in line with local policy. Record the risk of falls and identify the Multi-factorial interventions undertaken to minimise the risk STAGE 4 Demonstrates ability to undertake and facilitate a multifactorial patient falls assessment and Care plan development using: a) Falls risk assessment in admission document b) Bedside rails assessment tool c) Mobility and manual handling assessments Discuss and demonstrate appropriate management of any patient who has fallen using the falls policy guidelines. Demonstrate use of appropriate referral pathways for clients with continuing or very high risk of falling. community settings Author: Lisa Minshall Version 3: March

23 Demonstrates ability to use appropriate health promotional material in clinical area. Support staff initiatives in developing effective falls management in your sphere of influence. Facilitate/ undertake audit of falls management practice in ward / department. Demonstrates clinical leadership offering structured /ad hoc teaching and support to ensure best practice is delivered maintained and demonstrate the ability to teach other professionals the standard competencies relating to Falls risk assessment & first line management. Annual Review Year Year Year Year Year Year Year Year Year Stage Date Variance: (list competencies & complete variance form) Staff signature Assessor signature Evidence of competency maybe demonstrated using the methods below a minimum of x2 is required, Written evidence Observation Testimonial Discussion/Questioning Reflection Simulation/questioning WE O T QD R S community settings Author: Lisa Minshall Version 3: March

24 Appendix 2 Falls Prevention in Hospital Leaflet Falls Prevention in Hospital Information for patients, relatives & carers For further details please speak to nursing staff Falls Co-Ordinator available via bleep 9137 Macclesfield District General Hospital Ref: Review: 03/2020 community settings Author: Lisa Minshall Version 3: March

25 Falls in Hospital Welcome to our hospital. A small, yet significant number of accidents in hospitals are due to falls. The measures detailed in this leaflet are designed to minimise the risk of patients falling whilst in hospital, however, some patients may still fall even if we have done all these things. By working in partnership with patients, their relatives and carers East Cheshire Trust aims to reduce the number of falls that occur while patients are in our care. We are committed to ensuring your safety is a top priority whilst you are in our care For our patients Why do people fall in hospital? There are many reasons why someone may fall. This could be due to; Problems with mobility and/or memory People feeling weaker than usual, especially following a period of bed rest The effect of new/change in medication Loss of confidence in the elderly, especially those who have previously fallen Unfamiliar surroundings Poor footwear To reduce the risk of you having a fall whilst you are in hospital, please follow these guidelines: Ask staff to familiarise you with the ward and toilets Keep the call bell in easy reach at all times Use your call bell to get help and call for assistance If you have been advised not to, please do not attempt to get out of bed or walk around by yourself Call for assistance if you feel weak or dizzy Avoid stretching or bending to reach things and when turning, take your time Be careful when getting out of your bed or chair or when you are moving around Be aware of obstacles, wet floors and other people around you Wear supportive, well-fitting shoes or slippers that have non-slip grip on the soles Stay hydrated - Drink plenty of fluids 8 cups per day Wear appropriate, clean glasses if normally worn If you normally use walking aids, please arrange for them to be brought in and checked by staff community settings Author: Lisa Minshall Version 3: March

26 Please do not be afraid to ask us for help, we are here to help What happens if I fall? If you fall in the Trust the following will happen: m the nursing staff to try to prevent further falls severity of the fall). To relatives, visitors and carers We would also ask that you: Share any information on previous falls, how your relative/friend normally copes and if they are falling at home Leave the patient s room/area tidy by replacing chairs/furniture Ask the nursing staff to put bed rails back if they were in place Make sure the patient s call bell is within easy reach Replace bed tables/chairs moved during your visit If your relative or friend is experiencing any confusion or is disorientated let the nursing staff know that you are leaving. They can then resume frequent visits to the patient, to check they are alright and offer help. Bring in well-fitting shoes from home (shoes are better for mobility) For patient s safety please advise staff on any spillages, trailing cables, obstacles or any other concerns If a patient is at high risk of falling we may: Put the bed in a different position Put the mattress on the floor Move the patient s position within the ward Use the safety sides on the bed Use a different bed Some patients will still fall even if we have tried to do all of the things mentioned in this leaflet, being in hospital does not mean we can prevent falls. Thank you for your cooperation - We wish you well during your stay with us. Please help us to keep you as safe as possible Other formats this information is available in alternative formats such as large print or electronically on request. Interpreters can also be booked. Please contact the Patient Advice and Liaison Service (PALS) offices, found in the main reception community settings Author: Lisa Minshall Version 3: March

27 Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: Phone: Textphone: Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation contact Communications and Engagement on Admission information The trust accepts no responsibility for the loss of, or damage to, personal property of any kind, in whatever way the loss or damage may occur, unless deposited for safe custody. Please leave valuables at home. If you need to bring personal items that are expensive, for example micro hearing aids, please be aware that you do so at your own risk East Cheshire NHS Trust is committed to ensuring that patients and staff will always be treated with dignity and respect. There will be no age, disability, gender, race, sexual orientation or religious discrimination NHS Direct (part of NHS Choices) is a 24 hr phone advice service providing confidential health advice and information. Phone: (Textphone ) community settings Author: Lisa Minshall Version 3: March

28 Appendix 3 - Care Admissions Assessment FINAL Inpatient Care Admission Booklet.pdf community settings Author: Lisa Minshall Version 3: March

29 Appendix 4 - Enhanced Care Risk Assessment & Care Plan community settings Author: Lisa Minshall Version 3: March

30 community settings Author: Lisa Minshall Version 3: March

31 Appendix 5 - ECT Post Falls Protocol community settings Author: Lisa Minshall Version 3: March

32 Appendix 5a: Falls Care Plan (including Post Falls Care Plan) FALLS CARE PLAN (including Post Fall Care Plan) Care Plan Number Date Time commenced commenced Health care professional commencing care plan Name: Signature: Care Element Peronalised Care plan for patients assessed as at risk of FALLS Desired Outcome To reduce the risk of falling in hospital through maximising a safe environment Care Individualised Care Plan actions (1-12): commenced: Ward Care Discontinued: Health Care Professional Discontinuing care action: Date Time Date Time Signature Print Name 1. Advise patient that they are at risk of falls and provide advice about asking for help before they move about. 2. Place patient in high visible bed space- escalate to nurse in charge if not immediately available 3. If patient is at risk of falls then display falling leaf symbol is displayed above patients bed, IDT board and update electronic handover 4. Implement Commode tagging (where risk identified around toileting needs) 5. Inform family that their relative has been assessed as at risk of falls and encourage family members to participate in their care- complete relatives care plan. 6. Ensure that the patient has access to the correct walking aid (complete mobility care plan) 7. Refer to physiotherapist for further mobility assessment/balance assessment as appropriate. 8. Ensure that the hospital chair and bed is at the correct height to promote safe transfers. 9. Implement the use of high-low bed for patients at risk of climbing out of bed 10. Implement the use of falls/pressure sensor (circle appropriate) to enable early alert for patients moving 11. Ensure that medication review has been undertaken by pharmacist since this admission 12. Consider the need for enhanced care assessment. Patient ID Label community settings Author: Lisa Minshall Version 3: March