Accident Prevention: Slips, Trips & Falls

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1 Accident Prevention: Slips, Trips & Falls Judith Davies BSc (Hons) SROT Falls Service Development and Project Manager Central Norfolk NHS East of England Ambulance Service NHS Trust

2 Slips, Trips & Falls Significance of the Problem High Risk Factors Environmental Fall Hazards on Premises Responsibilities of service providers and users The cost to service providers and users Taking Charge - service providers and users

3 Slips, trips and falls affect people from all walks of life

4 .and in many different circumstances

5 .and in many different environments

6 Significance of the Problem A major problem in the older population A third of people aged over 65 fall each year A third of those people will falls again in the next 6-12 months 62% of older people who die after an accident have had a fall Falls in older people cost the NHS over 1biliion per year It costs the NHS 5 million per day to treat osteoporosis

7 Hip Fractures A hip fracture costs ~ 12,000 per person (acute care only) Half of those who fracture their hip are never functional walkers again Up to 14,000 people die annually in the UK as a result of an osteoporotic hip fracture Over 95% of hip fractures are caused by falls 50% of older people suffering a hip fracture lose the ability to live independently 20% of older people suffering a hip fracture die within a year

8 Causes of Traumatic Spinal Injury Source: Spinal Injury Statistics

9 Head & Brain Injury 40-50% are due to road accidents 20-30% are due to accidents happen at home, work or elsewhere e.g. falls 10-15% 15% are due to assaults

10 A major issue for East of England Ambulance Service NHS Trust Falls account for 20% of ambulance calls We responded to 180,000 Emergency Calls last Year across Norfolk, Suffolk and Cambridgeshire Over 34,000 of these calls were to Falls 25,000 were people aged over 65 (~75%)

11 A major issue for East of England A major issue for East of England Ambulance Service NHS Trust Top Ten Emergency Responses 2005/ Falls Chest Pain Breathing Problems Unconscious Overdose Sick Person RTAs Convulsions / Fitting Haemorrhage Traumatic Injury

12 Risk Factors Falls are caused by factors inside the person = intrinsic, and/or outside the person = extrinsic Remember an individual may have one or many factors affecting their falls risk The more risk factors a person has, the greater their risk of falling

13 Intrinsic Risk Factors Long term medical conditions (e.g. stroke, Parkinson s, s, arthritis) Sudden onset medical conditions (e.g. urinary and other infections, flu) Medical conditions requiring close monitoring and management (e.g. diabetes, blood pressure, heart problems) Impaired mobility and balance (e.g. muscle weakness, foot problems) Poor or reduced vision (e.g. wrong glasses, cataracts, glaucoma) Alcohol consumption!

14 Intrinsic Risk Factors Mental health issues (e.g. depression, anxiety, fear of falling) Cognitive impairment (e.g. dementia, Alzheimer s) Incontinence (e.g. urinary urgency, difficulty managing) Medication Poor nutrition and dehydration Inadequate pain relief Inactivity/lack of exercise

15 Extrinsic Risk Factors Interpersonal communication/care issues: - Incorrect moving and handling techniques - Older person not seeking/unable to seek assistance - Carers not aware of older person s s functional level - Inadequate time given to older person to mobilise/self-care - Older person not regularly reassessed

16 Extrinsic Risk Factors Environmental Hazards - Trailing/loose bedding - Loose rugs/carpets/damaged flooring - Trailing cables/telephone wires, etc - General clutter, things kept on the floor - Spillages - Slippery surfaces (polished floors)

17 Extrinsic Risk Factors Environmental Hazards - Steps and Stairs - Inadequate lighting - Room layouts inadequate/blocked access - Inappropriate heights of chairs/beds/toilets - Inappropriate or worn footwear - Overlong/trailing clothing e.g. dressing gown cords

18 Extrinsic Risk Factors Environmental Hazards - Equipment: - Items out of reach - Handrails loose/not fitted - Non-slip mats/flooring not used in bathrooms, showers, toilets or kitchens - ADL equipment not supplied/used or poorly maintained - Inappropriate/lack of appropriate moving and handling equipment - Incorrectly prescribed, broken or worn wheelchairs and walking aids

19 External Surfaces Winter weather water, ice, snow Holes/Cracks Peebles/Uneven pavements Steep Ramps

20 Internal Surfaces Food and liquid spillages Clutter Trailing wires

21 Internal environment Shelves able to reach Stairs - rails, marked, etc Good lighting Space Trolleys e.g. Roma

22 Responsibilities of Service Providers Ensure health and safety is paramount at all times Providing safe environment Preventing hazards Reporting and taking action on hazards Follow up Evaluation and audit of safety procedures

23 Negligence Cost to Service Provider Premises liability can cost thousands of pounds Case Studies -The human cost of slip accidents

24 Case Studies -The human cost of slip accidents Alison Raised plinths cause trips at electrical retailer Matting still wet when shopping centre opened to the public

25 Cost to Service User Physical Emotional Social Financial

26 Responsibilities of Service Users Ensure your own and other service users safety Exercise caution at all times Report any hazards Providing information to assist service providers

27 Taking Charge Service Providers Training for staff around health and safety issues, risk factors, needs of those with impairments and disabilities, etc. Provide information for service users including complaints procedure (posters, bulletin boards, discussion groups, etc.) Regular safety checks (who, how often, etc.)

28 Taking Charge Service Users Think Accident Prevention and take all appropriate precautions. Report and action all hazards Provide information and advice for service providers Encourage staff to report problems do something about it Learning organisations

29 Falls are not always accidental in most cases they are predictable and preventable except falling in love!

30 Final Thought 80% of women surveyed would rather be dead than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home (Sakled et al 2000)

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