TRUST POLICY AND PROCEDURES FOR THE PREVENTION OF IN-PATIENT FALLS AND THE USE OF BED SAFETY EQUIPMENT IN ADULTS

Transcription

1 TRUST POLICY AND PROCEDURES FOR THE PREVENTION OF IN-PATIENT FALLS AND THE USE OF BED SAFETY EQUIPMENT IN ADULTS Reference Number CL-RM Version: 2.13 Status Final Author: Pam Twine Job Title Senior Nurse Clinical Governance Version / Amendment History Version Date Author Reason 1-2 Jan July 2008 Pam Twine Reformatted for NHSLA July-August 2008 Pam Twine Draft versions 2.6 August 2008 Pam Twine Final version 2.7 December 2008 Pam Twine Risk assessment tools removed as now updated and printed 2.8 Sept 2010 Gill Ogden Monitoring section updated 2.9 March 2011 Elaine Goodwin Updated policy and risk assessment tool 2.10 May 2012 Pam Twine Minor amendments 2.11 Nov 2012 Debra Auskerin Minor amendments 2.12 Jan 2014 Lynn Fryatt Addition of SOP for walking frames 2.13 Dec 2014 Linda Wood Addendum re sensor pads Intended Recipients: All staff involved in the care and management of patients who are identified as at risk of falls Training and Dissemination: Training will be part of Manual Handling Training and dissemination will be via Policy contacts and the Intranet. There will be a communication launch via synapse as part of a communication plan. Page 1

2 To be read in conjunction with: Trust Policy and Procedures for Managing the Risks Associated With Slips, Trips and Falls Including Work at Height for Staff and Others, Guidelines for the Management and prevention of Delirium, Maintaining a Safe Environment. Continence Pathway In consultation with and Date: Matrons Advisory Group and Director of Nursing Meeting Feb 2011, MAC June 2011, JPAC June 2011, Trust Falls Group, Risk Committee, Incident Review Group, EIRA stage One Completed Stage Two Completed Yes N/A Procedural Documentation Review Group Assurance and Date Approving Body and Date Approved November 2012 Minor amendments approved by PDRG on behalf of ME Date of Issue January 2014 Review Date and Frequency Contact for Review Executive Lead Signature Approving Executive Signature November 2014 (then every 3 years) Chair of the Trust Falls Group. Director of Patient Experience & Chief Nurse Director of Patient Experience & Chief Nurse Extension agreed by Management Executive until 31st March as Awaiting Relevant Documentation Page 2

3 Contents Section Page 1 Introduction 4 2 Purpose and Outcomes 4 3 Definitions Used 4 4 Key Responsibilities/Duties Trust Board Divisional Directors/Managers Registered Practitioners Trust Falls Group 6 5 Managing the Risks Associated with Slips, Trips and Falls Use of Bed Rails Training Awareness Raising and Promotion Post Fall Management 8 6 Monitoring Compliance and Effectiveness 9 7 References 9 Appendices Appendix 1 Falls Risk Assessment Flowchart 10 Appendix 2 Appendix A Appendix B Appendix 3 Physiotherapy Management Guidelines for Inpatients at Risk of Falls 1. Berg Balance Score Falls Risk Assessment tool Standard Operating Procedure for the Provision of Walking Frames to Inpatients Page 3

4 TRUST POLICY AND PROCEDURES FOR THE PREVENTION OF IN-PATIENT FALLS AND THE USE OF BED SAFETY EQUIPMENT 1 Introduction A patient fall is the most common patient safety incident reported to the National Patient Safety Agency (NPSA). There are a number of patients who suffer trauma following a fall whilst in our care. It is the intention of this Trust to reduce the incidence of this happening by assessing each patient individually and identifying his or her risk. Once the risks are identified there will be referral protocols and interventions to address the risks in an endeavour to reduce or to remove them. Reassessment will take place on a weekly basis or if any of the following apply:- if the condition of the patient changes, on transfer to another clinical area whilst an in patient in hospital, following a fall Although this policy does not incorporate patients attending an outpatient setting then the principles are the same, and a common sense approach is needed, to prevent falling from couches and trolleys. Any patient identified as having a previous history of falls or has fallen on this hospital admission should not be moved/outlied unless clinically appropriate. This excludes the normal pathway movement e.g. Medical Assessment Unit to a Ward 2 Purpose and Outcomes To identify those patients who are at risk of falling within the Trust and to identify the interventions required to reduce the risk to each individual, this includes the use of bed safety equipment where appropriate i.e. bed safety rails, sensor pads and low/low beds. The outcome expected will be a reduction in the incidence of patient falls through: The use of appropriate risk assessment for all adult patients. The utilisation of relevant referral protocols and care outlined within this policy. Appropriate staff training. A process for raising awareness about prevention and reducing the number of slips trips and falls involving patients. Page 4

5 A process for monitoring compliance with the requirement to undertake risk assessment. The development of action plans and implementation of changes where the monitoring has identified deficiencies. 3 Definitions Used Falls Risk Risk Assessment Bed safety equipment (bed rails) Mattress Floor Low/ Low Bed Sensor pads The probability of a fall occurring. The tool used to assess the patient s risk status. Raiseable safety rails to minimize the risk of someone falling out of bed of a size that does not cause entrapment A temporary alternative for someone who is considered to be at risk of falling from the bed by climbing over bed rails. A bed designed to provide floor level nursing with a height adjustable function. The bed is suitable for patients where there is a risk of falling and bed rails are not appropriate ( there is a risk associated with the use of this bed in patients that require resuscitation) A sensor pad that can be placed either in a chair or on a bed that alerts nursing staff that the patient has got up 4 Key Responsibilities/Duties 4.1 Trust Board The Trust Board has responsibility for supporting the Falls prevention aims of this policy as part of mandatory training. 4.2 Patient Safety Group The Trust Falls Group reports to the Patient Safety Group and will provide support and receive 6-monthly reports and will also report to the Trust Risk Committee. 4.3 Divisional Directors and Managers In consultation with staff all Divisional Directors and Managers will ensure: Provision of training for staff. That staff are aware of the policy and process of Risk Assessment for falls and are supported to meet the standard. Page 5

6 That falls incidents are reported via IR1s in line with the Incident reporting Policy. That where possible preventive action regarding the environment of care is carried out. Monitoring of the incidence of falls and feedback of relevant information to staff 4.4 Registered Practitioners Registered practitioners will complete the falls risk assessment and use of bed safety equipment. Following completion of the falls risk assessment and bed safety equipment assessment ensure that appropriate measures are put in place to prevent or minimise the risk of patients falling. Ensure that all assessments and interventions are documented. 4.5 Trust Falls Group The purpose of the Falls Safety Group is to develop an effective Falls Strategy for inpatients within the Trust and to work with the wider community to ensure that patients receive the right care and management in the health community. By reviewing the causes and incidence of falls and identifying areas where policies, procedures or better skills could have potentially led to a better outcome, changes can be prompted to drive forward the agenda for improvement. The group will proactively aim to reduce the number of in-patient falls and critical incidents, in line with the recommended outcomes from the High Impact Actions, Towards Excellence work stream, Safety Express and LIPS programme. The group provides assurance and evidence to assist in meeting NHSLA standard 3.5 falls prevention. This includes: In liaison with the Community Integrated Care Pathway Group develop and implement a falls prevention and treatment strategy which includes: Integrated Care Pathway for all patients presenting to the Trust with a history of falls. An effective falls risk assessment policy for the Trust, (this will be based on best practice / research evidence, and will link into other local work streams such as dementia care) Review falls related data to include: o Falls rates overall (by bed days), areas and degree of harm o Contributory factors identified through investigation of significant falls Page 6

7 o Compliance with falls prevention process measures o Compliance with post fall actions taken o National benchmark in relation to falls prevention initiatives and process measures To develop and implement a training and education plan that supports the strategy so we have well trained staff offering advice, education and information for patients and cares regarding falls prevention and management. To audit the effectiveness of implementation of the strategy. To communicate with other relevant groups on falls prevention and treatment. To provide regular reports to the Patient Safety Group. Group members to ensure implementation of actions agreed within own area of responsibility (Directorate/role specific). The Group meets monthly and provides a six monthly Report to the Patient Safety Group and to the Risk Committee. 5 Managing the Risks Associated with Slips, Trips and Fall Adult patients (aged 18 years and over, excluding maternity patients) will be assessed when admitted to the Trust. Wherever practical, a multidisciplinary approach to the risk assessment will be made. Additionally, the process may involve discussions with the patient/carers or significant others. All risk assessments must be documented using the agreed pro-forma and the decision regarding whether to use bed rails must be documented in the nursing/midwifery records. Where bed safety equipment has been identified as required, the need for this will be reassessed by a registered practitioner a minimum of once daily to determine the continued need.- this will be documented in the Patient Nursing record. Reassessment of the risk of falls must be:- undertaken weekly when the patient s condition changes, on transfer between clinical areas following a patient fall in hospital. Ensure that the appropriate Risk card is placed above the patient s bed, this will act as a visible prompt for staff. 5.1 Use of Bed Rails and Sensor pads Addendum to Section 5.1: Following a review of recent research and a presentation to the DHFT Risk Committee it has been agreed that the use of Sensor Pads for in-patients will not be a routine intervention in the Page 7

8 management of patients at risk of falling. This does not preclude their use where clinical assessment & judgement by the multi-disciplinary team provides robust reasoning for the use of a sensor pad. Addendum A risk assessment to determine the appropriate use of bed rails must be carried out for all patients that are deemed at High risk of falling. Those patients who are internally transported on a bed or trolleys to other areas e.g. theatre or diagnostic departments, must have the rails in the raised position during patient transportation. If the risk assessment and subsequent care planning identifies the need for bed rails, sensor pads Low/ low bed and these are unavailable for any reason, this must be clearly documented in the nursing records, and an IR1 form completed in line with the incident reporting policy. Following a review of recent research and a presentation to the DHFT Risk Committee it has been agreed that the use of Sensor Pads for in-patients will not be a routine intervention in the management of patients at risk of falling. This does not preclude their use where clinical assessment & judgement by the multi-disciplinary team provides robust reasoning for the use of a sensor pad. If the patient is to be discharged with bed rails please refer to DERBY S ADULT HEALTH & HOUSING & NHS TRUSTS POLICY FOR THE SAFE USE OF BED RAILS IN COMMUNITY 5.2 Training Falls risk assessment has been incorporated in all manual handling training to raise awareness of the management of slips, trips and falls involving patients. The Community of Practice are producing scenario based teaching and also an E- Learning package to support the falls agenda 5.3 Awareness Raising and Promotion The Falls Group will capitalise on all opportunities to promote the prevention of patient falls. This includes: Falls Awareness events Articles in Trust publications Patient Information Leaflets 5.4 Post Falls care and management Page 8

9 The management of patients post fall is important to ensure they receive care that does not cause further harm to them. The risk assessment tool incorporates the care post fall the key points are: Before the patient is moved check for injuries using a top to toe approach looking for signs of fracture or spinal injury Use a safe patient handling technique to place the patient back into bed/chair- Stating the method used e.g. hoist/ board If the patient has had an un-witnessed fall - start neurological observations as per Trust Head Injury Guidelines. Record the patients vital signs following all falls Contact the NNP/On call Medical staff to review the patient (using the SBAR communication tool) and the EWS escalation algorithm for time scales Complete an IRI If the patient has sustained a fracture please escalate this following the IR1 escalation process Inform patient s relatives as per their individual instructions (i.e. first contact relative) Repeat the Falls Risk Assessment tool including measures and interactions Ensure this id documented in the nursing records 6. Monitoring Compliance and Effectiveness An audit tool has been developed to audit compliance against the Policy Monitoring Requirement : To undertake appropriate risk assessments for the management of slips, trips and falls involving patients (including falls from height) Incidents Trends relating to patient falls Monitoring Method: Review of Health Records Audit review data relating to completion of falls risk assessment for patients Review of Incident data relating to patient falls by area, type and degree of harm Report Prepared by: Trust Falls Group Chair Page 9

10 Monitoring Report presented to: Patient Safety Group Frequency of Report Six Monthly 7. References MDA 2001 Advice on the safe use of bed Rails DB 2001(04) July 2001 Bell. J (1997) The use of restraint in the care of elderly patients British Journal of Nursing th May 6 (9) p Everitt. V Brindel-Nixon J. (1997) The use of bed rails: principles of patient Assessment Nursing Standard October 1997 Vol 12 NHSLA (April 2008) Risk Management Standards for Acute Trusts NPSA Rapid Response Report NPSA/2011/RRROO1 Essential Care after an Inpatient Fall Page 10

11 Appendix 1 FALLS RISK ASSESSMENT Registered Practitioner Using the Falls Risk Tool and the bed rails/ sensor pads assessment tool carry out Risk Assessment on all patients Low Risk of Falls No Yes Responses Display PINK Low Falls Risk card. High Risk of Falls Any Yes triggers Display RED High risk of falls card. Follow Management Actions and interventions Reassess Weekly or if Condition Changes AND on internal Transfer AND post fall Page 11

12 Appendix 2 Physiotherapy Management Guidelines for Inpatients at Risk of Falls 1. Aim To ensure patients assessed as high risk of falling receive a physiotherapy assessment and an appropriate intervention to ensure as safe as possible discharge. 2. Referral Process 2. Referral Process All patients seen in MAU will have a Falls Risk Assessment Tool completed. This assessment tool will be carried out by nursing staff and will identify a patient as being a low or high risk of falling. The Risk Assessment will be repeated whenever a patient is transferred to another ward or department, a change of condition, after 7 days or after a fall. Patients will be referred to physiotherapy by the medical or nursing staff involved that has carried out the Risk Assessment. A physiotherapy referral will be triggered when a patient is identified as being at a high risk of falling. (See stage 2 of falls risk assessment ) The physiotherapist should discuss with Nursing or Medical staff, those patients who have only fallen in hospital to determine the mechanism of the fall (if known) and make a decision regarding the required level of input. 3. Physiotherapy Assessment and Intervention The Physiotherapy assessment and subsequent intervention may vary according to where and when a patient is assessed. However, there are certain standards within the procedure that must be met and completed by time of discharge. The time span between initial assessment and discharge could vary between less than four hours for a patient in A&E to several weeks for a patient who goes on to receive rehabilitation at a peripheral hospital 4. Minimum Standards for Physiotherapy Assessment All physiotherapy assessment tools must include the following components: 1. After explaining the procedure to the patient, verbal consent must be obtained. 2. Social History. (including potential hazards within a patient s environment. ie. steep stairs, loose carpets or rugs, badly fitting footwear or clothing.) 3. The present and past history of any falls/near misses 4. Confidence levels and fear of further falls Page 12

13 5. Mobility current level and preadmission level, including aids used. 6. Balance basic level can be assessed at bedside and should include such components as sitting balance, sit to stand and standing unsupported. 7. Following assessment, SMART goals must be identified with the patient and documented. N.B. In the presence of fractures, consider contraindications to mobility and balance and adhere to usual pre and post op guidelines Whenever possible, the physiotherapy assessment should be more comprehensive. In addition to the above items objective measures could be included, such as: 2. Timed Up and Go 3. Berg Balance Scale (see Appendix A) 4. Range of movement / power in lower limbs. 5. Minimum Standards for Physiotherapy Intervention Following assessment of a patient the following must be achieved by time of discharge: 1. The ability to walk and/or transfer at a level sufficient for a patient to function at home, with or without carer support. 2. Provision of appropriate mobility aids, as required. 3. Completion of a satisfactory stair assessment, if needed. 4. The provision of information regarding the prevention of falls Age UK, Staying Steady booklet. 5. Consideration by the physiotherapist, and the patient whenever possible, whether there is a need for further rehabilitation at home or as an out patient, and subsequent referral as appropriate, e.g, Intermediate care scheme, reenablement scheme, SPARC, Falls clinic community physiotherapy. 6. Throughout interventions patients must be motivated to actively participate in their therapy rehabilitation programme. 6. Further Standards for Physiotherapy Intervention Further physiotherapy intervention will benefit a falls patient and should aim to: 1. Increase a patient s stability during standing, transferring, walking and other functional movement by; Balance training Strengthening the muscles around the hip, knee and ankle Increasing the flexibility of the trunk and lower limbs Improving coordination 2. Help a patient to regain their independence and confidence, to relearn and practise their previous skills in every day living, and to cope successfully with increasing threats to their balance and increasingly demanding functional tasks. Page 13

14 3. Teach patient strategies to cope with any further falls and prevent a long lie. If possible a patient should be trained how to get up from the floor. These interventions can be delivered in the form of falls exercise classes and/or in one to one physiotherapy sessions. Monitoring Physiotherapy assessment and intervention for a fall s patient in Derby Hospitals NHS Foundation Trust will be audited against the minimum standards set out in these Guidelines. The Guidelines will also be audited and adapted as necessary in line with current best practice and Governmental directives. References National Service Framework for Older People, standard six: Falls. The National Collaborative Audit for the Rehabilitative Management of Elderly People who have fallen. Page 14

15 Patient sticker (Appendix A) Berg Balance Scale Date: Date: Date: Date: Score Score Score Score 1 Transfers 2 Sitting with back unsupported 3 Sitting to standing 4 Standing to sitting 5 Standing unsupported 6 Standing unsupported with eyes closed 7 Standing unsupported with feet together 8 Reaching forward with outstretched arms 9 Pick up object from floor 10 Turning to look behind 11 Turn 360 degrees 12 Standing unsupported with foot in front 13 Standing on one leg 14 Alternate foot on step Total Date Signature Print name Designation Page 15

16 Berg Balance scores continued Date: Date: Date: Date: Score Score Score Score 1 Transfers 2 Sitting with back unsupported 3 Sitting to standing 4 Standing to sitting 5 Standing unsupported 6 Standing unsupported with eyes closed 7 Standing unsupported with feet together 8 Reaching forward with outstretched arms 9 Pick up object from floor 10 Turning to look behind 11 Turn 360 degrees 12 Standing unsupported with foot in front 13 Standing on one leg 14 Alternate foot on step Total Date Signature Print name Designation Page 16

17 DERBY HOSPITALS NHS FOUNDATION TRUST APPENDIX B INPATIENT FALLS RISK ASSESSMENT AND MANAGEMENT PLAN STAGE 1 TRIGGER QUESTIONS Complete the assessment below to identify the level of risk on all patients. This form must be completed by a registered professional. Please affix patient s sticker here (to include name, address, GP, DOB and Hospital No) Date Time Ward/ Area 1. Does the person have a history of falls in the previous year? If known approx date of last fall? Insert date. 2. Is the person prescribed or affected by any of the following? Anti-psychotics Sedatives Cardiovascular medication Taking 4 or more medications Alcohol/drug abuse or withdrawal 3. Does the person s medical history include: Arthritis Confusion/Dementia Incontinence/ Urgency Postural hypotension Neurological disease/temporary or permanent neurological deficit (e.g. Parkinson s, Stroke, Head injury) 5. Does the person have sensory impairment i.e. partially sighted /registered blind/impaired hearing? 6. Does the person currently demonstrate any of the following: Needs support to walk or transfer Wanders Signature Yes No All NO No ANY Positive YES response Yes Display Low Risk Card Above Bed Display High Falls Risk Card Above Bed and Complete Stage 2 THIS ASSESSMENT MUST BE REVIEWED: AFTER 7 DAYS AND AFTER A FALL- ASSESSMENT ON TRANSFER, CHANGE OF CONDITION, PLEASE USE A NEW FORM FOR EACH COMPLETE THE BED SAFETY EQUIPMENT ASSESSMENT ON PAGE 3 Page 17

18 MULTI-FACTORIAL FALLS ACTIONS (REMEDIES) STAGE 2 Risk Factor Interventions/Control Measures Date Time Signature 1. History of Falls Check the length of clothing (trip hazard) Ensure the Bed at lowest height if appropriate Display Falls Risk Card Check lying BP, standing BP, or sitting BP Give the patient /relative the falls information leaflet 2. Balance, Transfers and Walking Complete a DIAG form Referred to occupational therapist Referred to physiotherapist Assess footwear/foot care Identify minimum supervision that the patient requires with activities of daily living state Medication Caution: If on warfarin increased risk of serious head injury following a fall Caution: Do not transfer after night sedation given, unless clinical status prevails. Review compliance with medications and ask about symptoms of dizziness 4. Continence Complete routine urinalysis and temperature check to exclude infection Implement an individual toileting programme/ Continence Pathway 5. Progressive Discuss normal care routine with carer/patient Confusion 6. Acute Confusion Determine cause of acute confusion and refer to delirium guidelines Put the bed at the lowest height Risk Assess for the use of a Low/low bed 7. Nutrition and Hydration Nutritional assessment e.g. MUST tool Encourage regular fluid intake 8. Vision If glasses worn, check they are being worn appropriately (e.g. distance etc) and are clean Discuss ward layout e.g. location of toilet 9. Hearing If hearing aid is worn, check it is correctly worn and that it is working Use a pen and pad for a secondary communication aid- or picture board if appropriate 10. Osteoporosis Clients with one or more risk factors may warrant further assessment and/or treatment the more risk factors, the higher risk of osteoporosis. Discuss with ward doctor 11. Environmental Consider best bed location on the ward eg bay sideroom Scan the immediate environment for trip hazards Ensure the patient has their call bell to hand Page 18

19 Risk Assessment For The Use of Bed Safety Equipment Is the person at risk of falling out of bed? Yes No Date Does the person s physical size present a risk e.g. entrapment of any part of the body? Does the person s behaviour present a risk e.g. confused? Does the patient have the Potential to climb over or out of the bottom of the bed ( Significant risk of falls if Answering yes) Does the person s movement pose a risk, e.g. spasm, balance, convulsion and restless, etc, challenging behaviour,? If provided, is the person likely to use the bed rails for supporting, turning in bed or sitting up in bed? Does the person independently transfer out of bed? Following this assessment, what is the appropriate method for reducing the risk to the person Use of bed rails for safety Bed rails considered but not appropriate On discharge will there be an ongoing need for bed safety equipment? Yes No Date Destination on Discharge Hospital Residential Home Nursing Home Own Home Hospice Risk Assessment For The Use of Pad Sensors In Patients That Lack The Ability To Retain Information Is the person at risk of falls from sitting or standing? Is the person at risk of falls from the bed? Demonstrate evaluation on a daily basis in the nursing documentation Yes No Type Ordered Chair Bed Both Date Ordered Date Installed Page 19

20 Essential Care following an inpatient fall These measures are essential post fall Date Time Signature Before the patient is moved check for injuries using a top to toe approach looking for signs of fracture or spinal injury Use a safe patient handling technique to place the patient back into bed/chair- State method used e.g. hoist/ board. If the patient has had an un-witnessed fall - start neurological observations (see flow chart below) Record Vital signs following all falls Contact the NNP/On call Medical staff to review the patient (Using the SBAR communication tool). Use the EWS escalation algorithm for time scales Consider the need for an x ray of the appropriate limb Complete an IRI Number W.. If the patient has sustained a fracture please escalate this following the IR1 escalation process Inform patient s relatives as per their individual instructions (i.e. First Contact relative) Repeat the Falls Risk Assessment tool Trust Adult Head Injury Guidelines Record baseline observations including BM, neurological observations and EWS Observe for other injuries Continue to record EWS Continue neurological observations ½ hourly for 2 hours for all patients then 1 hourly for 4 hours then 2 hourly for 4 hours until reviewed and GCS Consistent and remains 15 or as per any other instructions Give simple analgesia as prescribed by the doctor If the patient s condition deteriorates at any stage report to NNP/ medical staff to obtain urgent review and restart ½ hourly observations. Page 20

21 Document History Version 1 October 2013 Document Location: Derby Hospitals NHS Foundation Trust Standard Operating Procedure for the Provision of Walking Frames to Inpatients Document to be distributed to all clinical areas where walking frames are issued to inpatients An electronic copy will be placed on the Trust Intranet This document will also be added to the Trust Falls Policy as an appendix Document Sponsor/Author: Karen Price Therapy Service Manager Ruth Stewart (Physiotherapy Clinical team leader) Amanda Carter (DME Band 7 Physiotherapist) Revision History: Date of original document: October 2013 Date of Revision: October 2014 Revision Number: N/A Revision Date: Summary of Changes: N/A Author: Ruth Stewart Amanda Carter Approval: Approval granted at Division of Medicine Quality Group 2 October 2013 Name Alastair McCance Sharon Martin Libby Keep Lynne Murray Hogsflesh Title Divisional Medical Director Divisional Director Head of Nursing Quality Improvement Lead Distribution: To be adhered to across the Trust where patients are provided with wheeled or static zimmer frames, wheeled gutter frames and delta frames (mobility aids) by Physiotherapists, to facilitate their mobilisation and promote independence. Mobility aids provided to the patient on loan, for short term use whilst in hospital, or issued for discharge, should remain with the patient at all times from the point of provision. This includes being transferred from one inpatient area to another or if going for an investigation. Page 21

22 Objective Scope Title Page 22 Role To ensure patients have continuous access to mobility aids, following provision by a Physiotherapist, for inpatient use at Derby Hospitals NHS Foundation Trust. Applies to all inpatients who require a mobility aid for safe mobility and manual handling. Compliance from all staff working at Derby Hospitals NHS Foundation Trust is required. Stages of the Process Role and Responsibilities Time scales Label mobility aids for individual patient use. Ensure labels are completed following assessment and provision of equipment for short term loan whilst an inpatient in hospital. Removal of the labels should only be undertaken by Physiotherapists and Physiotherapy assistants. Ensure short term loan labels and mobility aids undergo infection control procedures when they are no longer required by a Physiotherapy assistants will produce the labels and laminate them for multiple use. The mobility aids will have the labels attached to them by physiotherapists issuing the equipment. The labels will be wiped clean between patient use as part of the deep cleaning procedure of the equipment and the string attaching the label to the frame will be changed between patients. The maintenance of the mobility aids will also be reviewed at this time, including ferrules and general condition. Ferrules should be changed if deemed necessary and if the equipment is in poor maintenance then it should be condemned. Short term loan labels can also be attached to the aids by the designated store person as new stock arrives on site; alongside physiotherapists and assistant staff working in local areas. Physiotherapists are to complete the labels following assessment, and the provision of a mobility aid for short term loan whilst a hospital inpatient. The label must show the name of the patient, whether they are transferring or mobilising, and also how much assistance they require to use the mobility aid (see appendix 1) This equipment must then remain with that patient at all times. If the patient is discharged to another hospital, the mobility aid should remain on the ward the patient was discharged from and receive a short term loan aid from the accepting hospital. In this case, the transfer and/or mobility status of the patient will be clearly documented in the transfer summary by the nursing staff. All removed labels must undergo infection control procedures. The strings must be changed and the label must be wiped clean with actichlor. The aid must also be cleaned with actichlor. Ferrules must be checked and

23 patient, before prescribing to another patient, or returning to local equipment stores. Physiotherapists and assistants must ensure correct labelling of equipment where it is provided for long term loan on discharge from hospital. Physiotherapists and Physiotherapy assistants to ensure that any equipment provided for long term loan has been issued on TCES. Physiotherapists to ensure mobility posters indicate the functional ability of individual patients and the aids required for transfers and mobility. changed if necessary and the general condition of the equipment should be reviewed. If deemed unsafe, the equipment must be condemned. OR All removed labels must undergo infection control procedures. Used labels must be placed in a box for processing, i.e. strings changed and label wiped clean with actichlor and a pre strung label collected to replace it. All Physiotherapists, Physiotherapy assistant staff and the therapy Storeperson hold responsibility for ensuring this occurs. Ferrules must be checked and changed if necessary and the general conditions of the equipment should be reviewed. If deemed unsafe, the equipment must be condemned. Local areas can decide which infection control procedure they wish to follow. Physiotherapists and assistants to ensure that any mobility aid provided for long term loan on discharge from hospital is labelled with the name of the patient and that it is To take home. Appropriate safety checks must also be completed for each issue and documented in the therapy notes, including general condition of the equipment and the wear on the ferrules. The ferrules can be changed if necessary. If the equipment is deemed unsafe it must be condemned. This equipment must then remain with that patient at all times. The patient must be discharged with their mobility aid to ensure safety on arrival at their discharge address (see appendix 2) The short term loan label must be removed and undergo infection control procedures as documented above. Physiotherapists and Physiotherapy assistants must follow local policy to ensure any equipment provided for long term loan on discharge from hospital has been issued on TCES. Physiotherapists completing assessments on individual patients will document on a poster above the patient s bed which aid and how many members of staff are required for transfers and/or mobility (see appendix 3) If the patient is transferred to another ward, the nursing staff are responsible for ensuring the poster remains with Page 23

24 Nursing staff to ensure that prescribed mobility aids remain with the patient at all times including when patients leave the ward to go for investigations or other interventions where they will be required to transfer or mobilise. Porters to ensure individual patients have their mobility aids with them if being transferred to other wards or being taken for investigations. Supporting Information: NICE guidelines for falls NSF for older people Safety Thermometer Ward Assurance Appendices: the patient s documentation so that it can be placed above the bed on arrival to the accepting ward. The physiotherapy documentation within the medical notes will also clearly state how the patient is transferring/mobilising on the ward. Nursing staff to ensure that ward domestics, housekeepers and other staff do not remove mobility aids from ward bays when rooms are being cleaned or tidied. Porters to check whether a mobility aid has been prescribed to the patient on the ward and if so, transport the aid along with the patient. 1) Mobility labels for short term loan on the ward The labels attached to the mobility aids loaned to inpatients will show the following wording: Property of Therapy Services. FOR USE BY TRANSFERS ASSISTANCE OF 2 ASSISTANCE OF 1 MOBILISING INDEPENDENT Please ensure that this walking aid remains with this patient at all times. Please do not remove from the hospital. Page 24

25 2) Mobility label for long term loan for discharge home FOR USE BY Property of Therapy Services. THIS MOBILITY AID IS FOR DISCHARGE Please ensure that this walking aid remains with this patient at all times and the patient takes this aid home. 3) Mobility posters Mobility posters will be A4 in size and located above the patient s bed on all inpatient wards. The patient s name will be on the poster alongside a picture of the mobility aid to be used. The number of people required to assist with patient transfers and mobilisation will be clearly documented. The poster will also clearly state whether the patient should only be transferring or can be fully mobilising. An example can be seen below: MR X Page 25

26 Please mobilise with zimmer frame and assistance of 2. Thank you Date: Profession: Page 26

27 Appendix 4 Please find below the variety of posters that can/will be seen on the wards and the variety of written instructions that may accompany them: ZIMMER FRAME Can be used for transfers and/or mobilising in the ways described below: Independently by the patient. With supervision of one person. With supervision of two people. With assistance of one person. With assistance of two people. The poster will have one of these recommendations and whether the patient is transferring only or whether they can mobilise. Page 27

28 WHEELED ZIMMER FRAME Can be used for transfers and/or mobilising in the ways described below: Independently by the patient. With supervision of one person. With supervision of two people. With assistance of one person. With assistance of two people. The poster will have one of these recommendations and whether the patient is transferring only or whether they can mobilise. Page 28

29 WHEELED GUTTER FRAME Can be used for transfers and/or mobilising in the ways described below: Independently by the patient. With supervision of one person. With supervision of two people. With assistance of one person. With assistance of two people. The poster will have one of these recommendations and whether the patient is transferring only or whether they can mobilise. Page 29

30 DELTA FRAME / 3 WHEELED WALKER Can be used for transfers and/or mobilising in the ways described below: Independently by the patient. With supervision of one person. With supervision of two people. With assistance of one person. With assistance of two people. The poster will have one of these recommendations and whether the patient is transferring only or whether they can mobilise. Page 30