Policy: F8 Slips, Trips and Falls

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1 Policy: F8 Slips, Trips and Falls Version: F8/06 Ratified by: Trust Management Team Date ratified: 13 th May 2015 Title of author: Lead Nurse Older Persons Services Title of responsible Director Director of Nursing and Patient Experience Governance Committee: Patients Safety and Safeguarding Meeting Date issued: 13 th May 2015 Review date: March 2018 Target audience: All staff Trust wide Disclosure Status : B Can be disclosed to patients and the public EIA / Sustainability N/A Other Related Procedure or Documents: West London Mental Health NHS Trust Page 1 of 29

2 Equality & Diversity statement The Trust strives to ensure its policies are accessible, appropriate and inclusive for all. Therefore all relevant policies will be required to undergo an Equality Impact Assessment and will only be approved once this process has been completed Sustainable Development Statement The Trust aims to ensure its policies consider and minimise the sustainable development impacts of its activities. All relevant policies are therefore required to undergo a Sustainable Development Impact Assessment to ensure that the financial, environmental and social implications have been considered. Policies will only be approved once this process has been completed West London Mental Health NHS Trust Page 2 of 29

3 Version Control Sheet Version Date Title of Author F8/ Assistant Director, Primary Care Developments and the Head of Health and Safety. F8/02 April 10 Assistant Director of Primary Care Developments and Head of Health and Safety. F8/03 30/07/10 Assistant Director of Primary Care Developments F8/04 Mar 11 14/09/11 Assistant Director of Primary Care Developments Modernisation Lead for JCW and PHC Lead Status Draft policy issued as a working document. Draft policy issued as a working document Revised Policy cascaded Policy Revised Comment In May 09 Draft policy developed as an outcome of accreditation process of AIMS in Older Peoples Services and presented to the CSSG in September 09. Draft policy revised to incorporate comments from CSSG. October 09 Draft policy issued as working document on the 23 rd October Revised to reflect the NHSLA requirements and comments from consultation including medication aspects and a comprehensive Falls Risk Assessment Tool. Revised to reflect requirements for NHSLA Level 2. Policy presented to 20 th July Policy Review Group approved. Policy revised substantially to reflect NPSA Alert/2011/RRR001 Essential Care after an in-patient fall and to reflect NICE Clinical Guideline 56: Head Injury Policy revised with PHC Lead Dr Cohen. To be submitted to 29 th Sept Policy Review Group for approval. 01/03/12 Modernisation Lead for JCW and PHC Lead 16/03/11 2 Trust Management Team (TMT) Ratified by TMT on 14 th March 2012 West London Mental Health NHS Trust Page 3 of 29

4 F8/05 19/10/12 TMT Minor changes made to comply with NHSLA Assessment. F8/06 09/02/15 Approved for consultation at Feb 2015 PSS. Consultation ends 09/03/2015 West London Mental Health NHS Trust Page 4 of 29

5 Contents 1 Flowchart 5 2 Introduction (includes purpose) Scope 7 Definitions 7 Duties Chief Executive Accountable Director Managers Policy Author Local Policy Leads Ward/Department Managers All Staff Estates and Facilities Department Capital and Development Department 6 Systems and Recording Procedure/Processes Workplace Risk Assessment Clinical Falls Assessment Tool Falls Prevention Care Plan Incident Reporting Responsibilities for All Staff 8 Education Training Monitoring and Review Review Supporting Documents References Glossary of Terms/Acronyms 13/14 14 Appendices Appendix 1 Workplace Risk Assessment 15 Appendix 2 Falls Risk Assessment Screening Tool West London Mental Health NHS Trust Page 5 of 29

6 1. FLOWCHART Admission to services History of falls in past one year Assessment No history of falls Frequency, context and characteristics of falls history Multifactorial assessment to be completed: - Falls history - Gait, balance and mobility/muscle weakness - Osteoporosis risk assessment (using NICE pathway - Perceived functional ability/fear of falling - Visual impairment - Cognitive impairment, neurological examination - Urinary incontinence - Environmental hazards - Cardiovascular examination & medication review Consider age of patient Risk assessment of falls to be completed (NICE 2014) West London Mental Health NHS Trust Page 6 of 29

7 2. INTRODUCTION The aim of this policy is to ensure the risk of injury to Service users, staff and visitors arising from a slip, trip or fall, is adequately controlled and, consequently, minimised. 2.1 The NHS Institute for Innovation and Improving published, there will always be a risk of falls in hospital, however there is much that can be done to prevent significant harm and reduce risk of falling. 2.2 Falls affect approximately 60,000 people per year in the UK, resulting in up to 14,000 deaths people are reported to fall each day, with up to 33% being people over the age of 65 years, and up to 42% being people over the age 75 years. 2.4 Falls are reported to be a major cause of disability and mortality in the UK, and with an aging population, this is likely to increase. 2.5 A fall is the most common patient safety incident reported from in-patient services to the National Reporting and Learning Service (NRIS) of the NPSA. 2.6 A fall can precipitate the need for long-term care. Also, fear of falling can provide a significant limitation on daily activities and long-term psychological difficulties for the older person. 2.7 A ward where no patient ever falls is likely to be a ward where patients are unlikely to regain their independence and return home (PSO 2007a) 2.8 June 2010 NPSA arranged a falls prevention reminder to NHS organisations to follow guidelines aimed at the reducing of falls. This reminder was in response to publication of data of 283,438 reported slips, trips or falls between Oct 2008 and Sept NICE pathway: Falls in older people overview (2014) state: All healthcare professionals dealing with patients known to be at risk of falling should develop and maintain basic professional competence in falls assessment and prevention 2.10 NRLS recommends that each patient at risk of falling should receive multifaceted clinical and environmental interventions that could reduce the risk. To achieve this, NHS organisations must:- Ensure that circumstances of falls are properly described on local incident forms. Analyse and use reports of falls to learn about contributing factors. Base falls prevention policies on the evidence described in its report. Have appropriate guidance for staff. West London Mental Health NHS Trust Page 7 of 29

8 3. SCOPE This policy applies to all staff and all locations. 4 DEFINITIONS Fall Slip Trip a sudden unintentional change in position causing the individual to land on a lower level (or an object) other than as a consequence of a sudden onset of paralysis, epileptic seizure or overwhelming external force. Feder (2000) to slide involuntarily and lose one s balance or foothold. This is either corrected or causes the individual to fall. (Adapted from COED 2000) to stumble or fall accidentally (often over an obstacle) causing the individual to lose their balance. This is either corrected or causes the individual to fall. (adapted from COED 2000) 5. DUTIES The general risk management responsibilities of individuals and groups in the Trust are described in the health and safety policy (H3) and in the risk management policy (R1), both can be found under Policies and Procedures on the Trust s Intranet, and in the Trust s Health and Safety Policy and Manual (available on The Exchange see link in section 9). In addition, the following people and groups have specific responsibilities in the control of risks arising from slips, trips and falls 5.1 Chief Executive The Chief Executive is responsible for ensuring that the Trust has policies in place and complies with its legal and regulatory obligations. 5.2 Accountable Director The Director of Nursing and Patient Experience is responsible for the development of relevant policies and to ensure they comply with NHSLA standards and criteria where applicable. They must also contain all the relevant details and processes as per P3. They are also responsible for Trustwide implementation and compliance with the policy. West London Mental Health NHS Trust Page 8 of 29

9 5.3 Managers Managers are responsible for ensuring policies are communicated to their teams / staff. They are responsible for ensuring staff attend relevant training and adhere to the policy detail. They are also responsible for ensuring policies applicable to their services are implemented. 5.4 Policy Author Policy Author is responsible for the development or review of a policy as well as ensuring the implementation and monitoring is communicated effectively throughout the Trust via CSU / Directorate leads and that monitoring arrangements are robust. 5.5 Local Policy Leads Local policy leads are responsible for ensuring policies are communicated and implemented within their CSU / Directorate as well as co-ordinating and systematically filing monitoring reports. Areas of poor performance should be raised at the CSU / Directorate SMT meetings. 5.6 Ward/Department Managers These managers will ensure the ward/department areas in their areas of responsibility are safe and without risks to health. This will include: (i) (ii) (iii) (iv) (v) (vi) carrying out annual workplace inspections (see proforma on The Exchange); performing a slips, trips and falls risk assessment of the workplace when indicated following the workplace inspection (see appendix 1), acting on the assessment findings; reporting and investigating any slips, trips and falls incidents; reviewing periodically, the statistics concerning slips, trips and falls incidents to identify both trends and the appropriate action to take to reduce the current level of incidents; keeping pedestrian access and egress routes free from obstruction; and having an appropriate procedure for dealing with spills. Further, in regard to patients, managers will ensure their staff are aware of and use the: (vii) (viii) (ix) (x) Falls risk assessment tool, (Rio) Falls prevention processes, as appropriate Falls Clinics referral processes, as appropriate review the clinical assessment tool results, implementing any appropriate interventions. West London Mental Health NHS Trust Page 9 of 29

10 5.7 All Staff Staff will cooperate with their manager and will comply with their own responsibilities (see and 5.5.2). 5.8 Estates & Facilities department Both external to and within Trust buildings, this department will suitably maintain safe pedestrian access and egress routes. This will include making good flooring to an appropriate standard of health and safety and keeping routes free from obstruction. 5.9 Capital & Development department Similar to the Estates & Facilities Department, this department will, on Trust property, provide safe pedestrian access and egress routes as assigned. This will include providing suitable flooring. 6. SYSTEMS AND RECORDING 6.1 All information must be recorded using the RiO electronic recording system using the appropriate falls assessment tool available. 6.2 Risk assessments and incident reports (IR1) to be updated with information of any falls. 6.2 All information is to be recorded as soon as an assessment has been completed 6.3 Information pertaining to a slip, trip or fall occurs to be immediately recorded following such an incident. 6.3 Information to be recorded by the person undertaking the assessment or witnessing a slip, trip or fall. 7. PROCEDURES 7.1 Workplace Risk assessment Managers must: carry out a workplace risk assessment and, subsequently, reviewing it at least annually producing an implementation plan for any work required where a significant risk of injury exists, managers should ensure they carry out a slips, trips and falls risk assessment. West London Mental Health NHS Trust Page 10 of 29

11 7.1.2 This can be achieved by tailoring the generic risk assessment (see appendix 1) to create a local or service specific risk assessment. This should include a falls from height assessment Any risks which cannot be adequately controlled should be managed and escalated in accordance with the risk management policy, as appropriate The risk assessment should be reviewed, when circumstances have changed, making the risk assessment no longer valid, or annually, whichever is sooner See Risk Assessment and Risk Registers section of the Trust s Health & Safety Policy and Manual. 7.2 Clinical Falls Assessment Tool (for the assessment of the Service User) All patients who have a history of falls or an aetiology that would suggest likelihood of falls should be assessed, using the Falls Assessment Tool; this can be completed electronically on Rio, within 72 hours of their admission. This should include a falls from height assessment and a review of prescribed medication. This will form part of the physical examination and the outcome will be recorded on the patient s electronic record For those patients who have a history of falls, the assessment must be carried out immediately upon admission A Falls risk assessment should be conducted on every patient who has either recently fallen, has reduced mobility or who the clinical team consider is at significant risk of falling, using the NICE 2014 Multifactorial assessment guidelines. A score of twenty or more indicates a high to very high risk. For these patients, a Falls Prevention Care Plan/ Programme should be developed and evaluated regularly Patients should be re-assessed following any significant change in their condition. Their risk status must be documented and shared with all staff in the team For patients over the age of 65 years, Falls risk assessments should be repeated more frequently. 7.3 Falls Prevention Care Plan/ Programme Managers should ensure that, for those patients who are at significant risk of falling, an appropriate plan of care has been formulated and implemented. This will include a referral to the Trust s Physiotherapy department An assessment of need for inflatable cot sides must be performed initially and, subsequently, updated regularly. If cot sides are required a care plan describing how risks are managed must be written. West London Mental Health NHS Trust Page 11 of 29

12 7.3.3 When developing a treatment plan for those service users who are at significant risk of falling, the Multi-Disciplinary Team should consider any clinical interventions Where clinically indicated a referral must be made to the relevant Falls Clinic. 7.4 Incident Reporting All incidents involving slips, trips and falls will be reported and an incident form must be completed All incidents are reported at the Incident Reporting area of The Exchange. This includes user guides and demonstrations. An Incident Management area can also be found here. 7.5 Responsibilities for All Staff Staff will cooperate with their manager and, in particular: (i) (ii) (iii) (iv) report to them any slip, trip and fall hazards, such as spillages keep work areas clean and tidy remove any obvious trip hazards reporting any slip, trips and falls incidents, in accordance with the incident reporting policy (I8) And, in regard to patients: (vii) (viii) (viii) (ix) use the Falls risk assessment tool, on Rio. use the Falls Clinics referral processes as appropriate support the manager in the review of the clinical assessment tool results, implementing any appropriate interventions use the falls prevention processes as appropriate. 8. EDUCATION AND TRAINING 8.1 CSU PHC Leads will ensure that staff are provided with suitable information, instruction and training in relation to managing the risk of injury arising from slips, trips and falls, details of which can be found on The Exchange or Training Matters. 8.2 Local PHC Leads will facilitate a presentation to ward managers on the clinical aspects of slips trips and falls, the managers will be responsible for the dissemination of this information to their teams which should be repeated annually. 8.3 The Trust Physical Healthcare Forum will provide direction and support for the co-ordination of appropriate training. 8.4 Managers will ensure all staff attends training as required including updates. West London Mental Health NHS Trust Page 12 of 29

13 8.5 The Health & Safety Executive (HSE) Slips and Trips e-learning Package (STEP) provides a useful e-learning tool which anyone can access (see 8.6 Monitoring of Training All new staff to the Trust will receive information on Slips, Trips and Falls in the Health and safety presentation at induction. Attendance will be recorded electronically on the exchange. Refer to M12, Mandatory Training Policy Ward Managers will keep records locally of attendance at the Slips, Trips and Fall presentation. Senior Nurse Managers will keep a central register of attendance. 9. MONITORING AND REVIEW Several performance measures will be used to monitor compliance with this policy; these include: 9.1 Work Place Risk Assessment Work Place Risk Assessments are to be reviewed quarterly See Inspection, Audit and Review section of the Trust s Health & Safety Policy and Manual. 9.2 Incident Reporting Quarterly, managers will review the ward/service slips, trips and falls incidents, identifying and analysing any trends and producing appropriate action plans to minimise the risk of recurrence All action plans associated with patient falls risk assessments will be monitored within the CSU Ward Governance structure See Inspection, Audit and Review section of the Trust s Health & Safety Policy and Manual. 9.3 General The Physical Healthcare Group will work with the Clinical Audit and Effectiveness department to identify and agree audit and research topics that will demonstrate compliance with this policy The Trust Physical Healthcare Group will monitor any issues relating to the effective implementation of this policy. West London Mental Health NHS Trust Page 13 of 29

14 10. REVIEW 10.1 The Policy will be reviewed three yearly. All relevant national clinical guidance and Health and Safety requirements are to be considered for inclusion in this policy Policy reviews will be the responsibility of the Chair of the Trustwide Physical Healthcare Group and the Trust s Health and Safety Manager. 11. SUPPORTING DOCUMENTS This protocol should be read in conjunction with the following Trust Policies: - M5 Safer Moving and Handling - H3 - Health and Safety Policy - I8 - Incident Reporting and Management Policy - R1- Risk Management Strategy and Policy - Slips, Trips and Falls Procedure (September 2008) - West London Mental Health NHS Trust Health & Safety Policy and Manual (http://theexchange/sorce/app_centre/launch_app.asp?apphandle=risk_ Mgt&fhandle=RISK_MANUAL_SEARCH ) - Incident Report via the Exchange - Risk Assessment Proforma (http://theexchange/sorce/docs/dt24134v/25640_0/workplace%20inspec tion%20proforma%2c% %20%2d%20final.doc ) 12. REFERENCES - Feder, G. 2000, Guidelines for the prevention of falls in people over 65 - The National; Service Framework For Older People (2001) Standard 6 - The National Institute For Clinical Excellence Guideline 21 (2004) - Our Health, Our Choice, Our Say DOH (2006) - The Health and Safety at Work Act The Health and Safety (Workplace) Regulations Management of Health and Safety at Work Regulations GLOSSARY RiO Trust patient Information System The Exchange Trust Intranet West London Mental Health NHS Trust Page 14 of 29

15 ACRONYMS NRIS NPSA HSE NICE NRLS PHC STEP National Reporting and Learning Service National Patient Safety Agency Health and Safety Executive National Institute of Health and Clinical Excellence National Reporting and Learning Services Physical Health Care Slips and Trips e-learning Package West London Mental Health NHS Trust Page 15 of 29

16 Appendix 1 Developing a LOCAL SLIPS, TRIPS AND FALLS risk assessment Service and ward managers and team leaders are expected to carry out explicit (i.e. written) slips, trips and falls risk assessments for those Trust services that pose a significant risk of injury to patients and staff etc. This paper provides guidance on how to carry out a ward/service-specific risk assessment starting with the corporate, generic, risk assessment as a template. For the purposes of carrying out a service-specific risk assessment, the corporate risk assessment is only a guide. Its full content is unlikely to be relevant in its entirety to any one service, therefore appropriate amendments and additional entries will need to be made to all columns of the risk assessment Indicators that an explicit risk assessment may be necessary might include a high level of accidents, significant level of employee and/or service user complaints, etc. If you are unsure whether the service needs to carry out an explicit risk assessment, you should seek further advice from, in the first instance, your line manager and then, if necessary, either the Occupational Health or Health and Safety Services. RISK ASSESSMENT CONTENT Column 1 - Identify Hazard This column contains a fairly comprehensive (but not exhaustive) list of the hazards/factors which are commonly thought to create a significant risk of slips, etc. The presence and effect of each individual hazard should be considered on its own, in isolation. Additional hazards that are relevant to particular service environments or professions can be added, as required. Column 2 - Groups at risks In this column, you should list the groups who are likely to be affected by the hazard. Column 3 - Suggested control measures This column provide a fairly comprehensive list of the typical control measures which are used typically to control the hazard in question You should delete those controls which are not currently in place NB The controls which are not used currently may need to be implemented and, therefore, listed in column 5 West London Mental Health NHS Trust Page 16 of 29

17 Column 4 - Risk Rating In this column you should give your opinion to what extent the particular hazard, with its present levels of control, is contributing to the risk of slips etc i.e. high, medium or low Those hazards rated as High risk will be those requiring high priority actions to ensure the risk is adequately controlled (and reduced to as low a level as is reasonably practicable). Those hazards rated as Low risk will be those risks meriting lowest priority attention. Column 5 - Actions/measures required Where the residual risk has been assessed as either high or medium, action should be taken to reduce the level of risk still further. If they are not already in place, if appropriate, you can use some of the controls listed against the hazard in the generic risk assessment Column 6 - When by? Where necessary actions have been identified, their proposed completion date should be recorded, together with the individual responsible for implementation. The risk assessment should be reviewed either when circumstances in the workplace change or annually, which ever occurs soonest. West London Mental Health NHS Trust Page 17 of 29

18 Appendix 1 (cont) Generic workplace Slips, trips and falls risk assessment Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date Surface Uneven floor surface arising from damage or overuse e.g. cracks or debris All staff Service users Contractors Members of the public Select and use appropriate floor construction material and surface for anticipated type and degree of use Repair floor surface Regularly monitor (e.g. in periodic workplace inspection) and maintain surface Unintentional changes in floor level e.g. arising from construction, the use of door bars, or changes in floor surfaces All staff Service users Contractors Members of the public Use warning signs Signpost changes in floor level Design out level changes and implement Use warning signs (intentional) changes in floor level e.g. ramps, stairs, slopes, All staff Service users Minimise ramp gradients, ensuring the gradient is consistent and gradual Provide handholds, handrails etc West London Mental Health NHS Trust Page 18 of 29

19 Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date etc Contractors Members of the public Make unobvious changes highly visible e.g. use hazard markings. Design out level changes Ensure consistency in size of stair treads and risers Ensure stair nosing s are highly visible Remove floor covering Keep carpets etc flat; Use floor covering with non-slip backing Trim any frayed fibres that might cause trips Ensure the floor covering remains stuck down or fixed firmly in all places Floor coverings e.g. poor quality carpets, raised, loose carpet tiles, slippery mats or rugs All staff Service users Contractors Members of the public Changes in floor surface (such as moving from tiles to carpet, or moving from a polished floor to a carpeted office), etc Minimise such changes in floor surface (to help achieve consistency in user expectation) Adjacent floor surfaces have similar slip resistance levels Slip resistance of surface is inherently too low Maximise or increase surface roughness e.g. through etching, sandblasting, etc Increase floor surface resistance Increase floor hardness Use appropriate (e.g. anti-slip) West London Mental Health NHS Trust Page 19 of 29

20 Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date Obstructions footwear Temporary obstruction (either on the floor or otherwise) Change work flows to minimise likelihood of obstruction build-up Good housekeeping Dispose of (unwanted) items Place (wanted) items elsewhere in permanent, purposely-built, store Ensure items are not stored in pedestrian routes Exclude people from the area Any items stored in pedestrian routes are stored temporarily along the walls or on suitable wall shelves Ensure objects are removed on which clothing may catch Maintain a clear path to a width of at least 1.6m (?) along the pedestrian route Maintain a clear path to a height of at least 2.6 metres(?) along the pedestrian routes Use highly visible warning signs Highlight the obstruction West London Mental Health NHS Trust Page 20 of 29

21 Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date Permanent obstruction (either on the floor or otherwise) e.g. electrical and telephone sockets Design out obstruction Maintain a clear path to a width of at least 1.6m (?) along the pedestrian route Maintain a clear path to a height of at least 2.6 metres(?) along the pedestrian routes Slippery surfaces Dry material or dust contamination Clean spills immediately Maximise surface roughness (and, therefore, slip resistance) Maintain area (and equipment in the area) to prevent contamination Design entrances to the area to minimise ingress of contamination Install dust capture systems to minimise spread of dust Have contamination cleaned promptly (report to cleaner) Erect warning signs Exclude people from the contaminated area Use appropriate cleaning regime West London Mental Health NHS Trust Page 21 of 29

22 Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date Fluid contamination Clean spills immediately NB when cleaning spills, maintain dry path through the area, use a dry cleaning method, if possible, and clean during quiet areas Use appropriate cleaning regime Design entrances to the area to minimise ingress of contamination Design floor to drain away spillages Maximise surface roughness (and, therefore, slip resistance) Maintain area (and equipment in the area) to prevent contamination e.g. Install equipment and items to capture or contain leakage e.g. drip trays/buckets, mats to dry wet footwear, towels, Have contamination cleaned promptly (report to cleaner) Erect warning signs Exclude people from the contaminated area Distracting conditions West London Mental Health NHS Trust Page 22 of 29

23 Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date Lighting If the lighting is too bright, reduce light levels and/or glare If the lighting is too low, increase lighting levels Excess noise Reduce noise levels Extremes of temperature Ensure temperature remains within comfortable limits Excessive repeating eye patterns e.g. on walls or floor coverings etc Visual distractions are minimised Task Load carrying Carry out manual handling assessment Select load carrying route which minimises likely obstructions Mechanise manual handling operation Ensure load is not too heavy, too bulky, not awkward, etc People Behaviour and attitude Establish a positive attitude that slips, trips and falls can be prevented e.g. through publicity, consultation, West London Mental Health NHS Trust Page 23 of 29

24 Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date involvement, etc Train, inform and supervise employees and service users Allocate tasks in high-risk slip areas only to those competent to follow slips precautions No rushing around Capability Staff not permitted to drink alcohol Staff not fatigued Hazard Groups / individuals at risk Existing controls Category of risk : high, medium, low Actions / measures required Action by? Action date Heights All staff Service Users Contractors Members of the Public Warning/Hazard Signs Limited/No access to heights West London Mental Health NHS Trust Page 24 of 29

25 Appendix 2 West London Mental Health NHS Trust Page 25 of 29

26 West London Mental Health NHS Trust Page 26 of 29

27 West London Mental Health NHS Trust Page 27 of 29

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