POLICY for the PREVENTION and MANAGEMENT of STAFF and VISITORS SLIPS, TRIPS AND FALLS

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1 POLICY for the PREVENTION and MANAGEMENT of STAFF and VISITORS SLIPS, TRIPS AND FALLS DOCUMENT CONTROL: Version: 1 Ratified by: Risk Management Sub Group Date ratified: 19 th August 2015 Name of originator/author: Health and Safety Lead Name of responsible committee/individual: Risk Management Sub Group and Health, Safety and Security Forum Date issued: 21 August 2015 Review date: August 2018 Target Audience All Trust Staff

2 SECTION CONTENTS PAGE NO 1 INTRODUCTION 3 2 PURPOSE 3 3 SCOPE 3 4 RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 5 PROCEDURE/IMPLEMENTATION 5 6 TRAINING IMPLICATIONS 6 7 MONITORING ARRANGEMENTS 7 8 EQUALITY IMPACT ASSESMENT SCREENING 8.1 Privacy, Dignity and Respect 8.2 Mental Capacity Act 9 LINKS TO ANY ASSOCIATED DOCUMENTS 8 10 REFERENCES 9 11 APPENDICES 9 Appendix 1 Information and Guidance for Risk Control Factors, and hazard Checklist Page 2 of 19

3 1. INTRODUCTION 1.1 Slips and trips resulting in falls are the most common cause of major injuries in Great Britain with over a third of all accidents to employees reportable to the HSE under the Reporting of Injuries Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) were as a result of slips, trips and falls. Nationally over 2000 of these incidents are reported by the NHS every year. These accidents can be cut dramatically through planning and proactive management together with good housekeeping. Accidents are not an inevitable part of the healthcare working environment they can and should be prevented. 1.2 Rotherham Doncaster and South Humber NHS Foundation Trust (hereafter referred to as the Trust) will take all reasonably practicable measures to ensure that workplaces under their control are safe and without unnecessary risks of slips, trips and falls to all persons needing to access them PURPOSE The purpose of this policy is to enable the Trust to ensure that it provides a safe working environment free from slip, trip and fall hazards by: Ensuring all potential slip, trip and fall hazards in the workplace are identified; Any risk to a person s safety is adequately controlled, and in any case, reduced to the lowest level reasonably practicable; and Where necessary the appropriate risk assessments and hazard reduction methods are in place SCOPE This policy describes the procedures, which should be followed and the factors, which should be taken into account by all Trust managers and employees when dealing with aspects of slips, trips and falls in the workplace. The policy also addresses the Trust s legal obligations. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Trust Board The Trust Board of Directors has overall responsibility for the management of Health and Safety and to ensure this policy is implemented in a Trust Directorates 4.2 Chief Executive The Chief Executive has specific responsibility to ensure that responsibilities for Health and Safety are effectively assigned accepted and managed at all levels within the structure consistent with good practice throughout the Trust. Page 3 of 19

4 4.3 Business Assurance Director The Business Assurance Director is responsible for monitoring the effectiveness of this policy through the Risk Management Sub Group, the Health, Safety and Security Forum and the Organisational Learning Forum. 4.4 Head of Estates The Head of Estates has responsibility for ensuring that premises owned, managed or leased by the Trust are safe so far as is reasonable and do not present a hazard to Trust employees and others using premises for Trust delivered services. The Head of Estates will also ensure that where requested in accordance with this policy, any premises used by the Trust is provided and maintained in accordance with the requirements of the Workplace (Health, Safety and Welfare) Regulations. 4.5 Health and Safety Lead The Health, Safety Lead will assist the Trust in undertaking the measures needed to comply with relevant statutory provisions as required by the Health and Safety at Work and the Management of Health and Safety Regulations. 4.6 Managers/Supervisors Managers and supervisors have a responsibility to implement this policy and to ensure that all workplaces provided for the use of their department comply with this policy and the Workplace (Health Safety and Welfare) Regulations and that all reasonable steps are taken to maintain and where necessary, improve Health and Safety standards. Any defects to the workplace requiring repair or corrective action should be reported to Estates and a request made for the corrective action to be taken. If required, action should be taken to safeguard the area immediately. Managers will also bring this policy to the attention of all employees during local induction Managers have specific Responsibilities to: Ensure that this Policy for the Prevention and Management of Staff and Visitors Slips, Trips and Falls is implemented within their area of control Ensuring risk assessments are completed to encompass the hazards and risks of slips, trips and falls and, if necessary working at height, for environments where staff may be working and that staff for whom they are responsible are made aware of any control measures resulting from risk assessments Monitor the effectiveness of existing controls and implement any further measures agreed as a result of risk assessments Include inspection of the workplace with the Trust Safety Team inspection regime Thoroughly investigate accidents and incidents involving slips, trips and falls and use any reports of near misses to determine and address potential hazards and risks Ensure spillages and leaks and other defects which may result in a slip, Page 4 of 19

5 trip or fall are promptly addressed, reported and the area made safe Ensure all staff within their Department receive suitable training, information and training on slips, trips and falls prevention Enforce the Trust Dress and Personal Appearance at Work Policy 4.7 Employees All employees have a responsibility to make themselves aware of this policy and any decisions arising from the implementation of it. Any slip and trip hazards that they become aware of should be reported to their manager. Employees should also take steps to reduce the risks, such as keeping all areas tidy and removing any obvious trip hazards. All Trust employees are required by their contract of employment to co-operate with the Trust on Health and Safety matters and compliance with the statutory duty to take reasonable care for the Health and Safety of themselves and others who may be affected by their acts or omissions at work. This also includes compliance with this policy and all other Trust Health and Safety Policies. Any action to the contrary may result in disciplinary action or legal action under the Health and Safety at Work Act PROCEDURE/IMPLEMENTATION 5.1 MANAGING THE RISKS Understanding how risks can be controlled: Slips and trips are the most common cause of injury at work. Most slips occur when floors become wet or contaminated and many trips are due to poor housekeeping. To prevent slips and trips: Stop floors getting wet or contaminated in the first place Have effective arrangements for both routine cleaning and cleaning up spills Remove spillages promptly Leave smooth floors dry after cleaning or exclude pedestrians until is floor is dry Use the correct cleaning methods for the type of floor Look out for trip hazards Keep walkways and work areas clear of obstructions Encourage staff to keep the workplace tidy Consider the use of slip resistant flooring material Other causes include factors such as a poor level of lighting and external glare; human factors such as employees rushing, running or carrying heavy/cumbersome items or the use of inadequate cleaning regimes. Appendix 1 gives examples of how to control and assess the hazards and risks of slip, trips and falls. Page 5 of 19

6 5.2 LEGAL REQUIREMENTS The Health and Safety at Work Act 1974 requires employers to ensure the Health and Safety of their employees and others who may be affected by their work activity. In addition, employees must not endanger themselves or others and to co-operate with their employers Health and Safety Policies and procedures. The Management of Health and Safety at Work Regulations 1999 specify the legal requirement for risk assessments to be carried out and for effective risk control measures to be developed and enforced. The Workplace (Health, Safety and Welfare) Regulations require floors to be suitable for the purpose for which they are used and free from obstructions and slip hazards. 5.3 RISK ASSESSMENT PROCEDURE The Trust will ensure that any risk identified is adequately assessed in accordance with the Trust s Risk Assessment Policies and Procedures and the appropriate action taken to reduce the risk so far as is reasonable. It is a manager s responsibility to ensure that the necessary risk assessments are carried out for any workplace under his/her control and that appropriate action is taken to resolve the issues identified. The assessments should be reviewed annually, or after any significant changes, to ensure that standards are maintained and that new or additional hazards have not been introduced. What practical measures can be taken will vary in different situations. Each situation needs to be assessed to identify what factors cause slips, trips and falls and then to match practical control measures to these factors. 6. TRAINING IMPLICATIONS The awareness of slips, trips and falls, as well as teaching the principles of risk assessment will be covered during various training sessions including induction, statutory and mandatory training and health and safety training for staff and managers. Various methods of internal communication are utilised to raise staff and managers awareness including booklets / leaflets, face to face training and the use of ELearning including the HSE STEP tool which provides tutorials that help with the effective management of risk. As a Trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through: Page 6 of 19

7 Team Brief Trust wide mail drop Team meetings One to one meetings / Supervision Posters Weekly Newsletter Trust wide Special meetings Group supervision Practice Development Days CPD sessions Local Induction The Training Needs Analysis (TNA) for this policy can be found in the Training Needs Analysis document which is part of the Trust s Mandatory Risk Management Training Policy located under policy section of the Trust website 7. MONITORING ARRANGEMENTS Area for Monitoring Staff Slip, Trip and Falls Incident Reporting Assessment of Risk How Who by Reported to Frequency Safeguard IR1 Reports / Data Inspections / Audit / Risk Assessments Health, Safety & Security Forum, Risk Management Sub Group and the Organisational Learning Forum Safety Team, Managers, Quality Review Risk Management Sub Group Health, Safety & Security Forum, Risk Management Sub Group and the Organisational Learning Forum Quarterly Quarterly % of staff uptake of Training ESR Data Learning and Development Health, Safety & Security Forum, Risk Management Sub Group and the Organisational Learning Forum Quarterly 8. EQUALITY IMPACT ASSESSMENT SCREENING The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here Page 7 of 19

8 8.1 Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). Indicate how this will be met No issues have been identified in relation to this policy. 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. Indicate How This Will Be Achieved. All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act (Section 1) 9. LINKS TO ANY ASSOCIATED DOCUMENTS EXTERNAL Health and Safety at Work etc. Act 1974 Management of Health and Safety at Work Regulations 1999, as amended Workplace (Health, Safety and Welfare) Regulations 1992 Personal Protective Equipment Regulations 1992 Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 Health & Safety Executive - Slips and trips Causes STEP Tool. The Work at Height Regulations INTERNAL Risk Assessment Polices and Procedures Policy for the Management of Adverse Events and Near Misses Management of Serious Incidents Requiring Investigation Page 8 of 19

9 Policy for the Prevention and Management of Patient Falls First Aid at Work Policy Snow and Ice Clearing Policy Dress and Personal Appearance at Work Safe working at Height 10 REFERENCES Health and Safety Executive Information and Guidance 11 APPENDICES Appendix 1 provides information and guidance for risk control factors and a hazard checklist Page 9 of 19

10 APPENDIX 1 SLIP, TRIP AND FALLS RISK CONTROLS CAUSATIVE FACTORS PRACTICAL CONTROL MEASURES ENVIRONMENTAL FACTORS Contamination of the floor from: Spillages of solid, liquid materials Wet cleaning methods Footwear/clothing Natural contamination such as wet, and/or mud in outside areas Dry contamination, e.g. dusts, powders, polythene bags left on floors, product spillages or cardboard laid over spills Wind-driven rain, sleet and snow through doorways Condensation, e.g. from poor ventilation Eliminate contamination in the first place Maintain equipment to prevent leakage Install suitable entrance matting systems Place entrances to suit the prevailing weather (only an option during the initial design of the building) Put up effective entrance canopies If not reasonably practicable: Prevent contamination becoming deposited on walking surfaces Use dry methods for cleaning floors Cleaning and dry incoming footwear, by use of suitable entrance matting If not reasonably practicable: Limit the effects of contamination By immediate clearing up of spillages By prompt repair of leaks By limiting the area of contamination By restricting access to contaminated areas By using under floor heating, particularly at entrances If there is still a risk, follow the next steps: Page 10 of 19

11 CAUSATIVE FACTORS PRACTICAL CONTROL MEASURES ENVIRONMENTAL FACTORS Inherent slip resistance of the floor not maintained adequately, e.g. from incorrect or inadequate cleaning, maintenance or wear Maximise the surface roughness and therefore slip resistance of the existing floor surface Methods of cleaning and cleanliness of flooring is an important factor to consider, in conjunction with slip resistance. The frequency of cleaning will be determined by how many and the type of persons who will use the floor. Floor manufacturers are required to provide information on the cleaning regime needed to make their floor safe in the intended environment and this information should be passed to the appropriate employees. Just a tiny amount of contamination, wet or dry, is sufficient to make a smooth floor dangerously slippery. Take the following measures minimise the risks due to wet cleaning: Thoroughly dry the wet floor after cleaning Exclude people from wet cleaning areas until dry Clean by dry methods wherever possible Clean in sections so that there is always a dry path through the area Clean during quiet hours Thoroughly rinse wet cleaning areas Use warning signs to identify contaminated floors or floors after cleaning Spot cleaning and cleaning of spillage will be need between scheduled whole-floor cleaning (and it is equally important to thoroughly dry these areas). Frequent spot cleaning can supplement whole-floor cleaning Train, supervise and equip those who clean floors to ensure effective and safe cleaning Maintain floors and drainage to maximise slip resistance. A residual film of water is just as slippery as a puddle, and is more difficult to identify If this is not enough, take the following steps: Page 11 of 19

12 The Slip resistance of the floor is too low This is influenced by: The friction between the floor and footwear The presence of suitable surface micro-roughness The hardness of the floor Applications for sealing floors during installation Later modification of the floor surface such as inappropriate varnishing/sealing/polishing Increase the surface roughness of the existing floor Surface micro-roughness may be increased by acid etching, sand blasting, or coarse diamond grinding. However, any of these methods can destroy or permanently alter other desirable characteristics of the floor such as appearance, chemical resistance, durability and ease of cleaning. Flooring treated by some of these methods may develop unacceptable pattern staining affected, compromising the floor construction Note: Any benefits from an increase in the surface roughness (RZ) will be lost if contamination built-up occurs. Therefore any surface modification has implications for the cleaning regime. Changes in cleaning methods must be based on a risk assessment that considers any potential change of slip resistance The use of stick-on anti-strips may offer limited improvement, but strips should be placed very close to one another, and should be maintained carefully If it is possible to influence staff footwear, then antislip footwear may be an option. (See below) If this is not enough: Lay a more slip-resistant floor with higher surface roughness and higher coefficient of friction In a few cases a new floor may be needed: Draw up a performance specification for the supplier to meet. Specification should include specialist slip resistance data such as surface micro-roughness and coefficient of friction measurements Note: This data must always be specified for the as installed condition, and should be based on a pendulum-type test. Experience of how that floor performs in a similar situation may help and a small sample of the preferred materials will confirm manufacturer s claims and their suitability See the installation is correctly done Check to see the specification has been met Page 12 of 19

13 Steps and slopes: Do they cause sudden changes in step or not offer adequate foothold and/or handhold? Adverse environmental and other conditions hiding the condition of the floor and distracting attention Low light levels Shadows Glare Excess noise Extremes of temperature The use of repeating patterns on floor coverings that might be distracting to the eye, for example, by disguising a change in level Bulky/awkward personal protective equipment Check that steps give adequate foot and handhold, and that slopes have no sudden changes Is the lighting adequate? Are handrails in place? Are stairs clearly demarked visually? Remove all sudden changes in level Ensure stairs have clearly visible musings, good handrails, and suitable balustrades Ensure that the rise and going of each step in the stair is consistent in size throughout of the flight Ensure that any applied slip-resistant nosing does not create a tripping or heel-catch hazard Good visual cues for changes in floor level and surface are essential See that the prevailing conditions allow good visibility of and concentration on floor conditions For example provide adequate lighting, and see environmental demands do not distract attention from the floor condition Page 13 of 19

14 ORGANISATIONAL FACTORS The nature of the task being carried out such as: Analyse the tasks in any slip risk area to see that only careful walking is required The need to carry, lift, push, lower or pull loads The need to turn, to move quickly or to take long strides Distractions Having no hands free to hold on to handrails to stop a fall Encumbrance or restricted vision Tasks should not compromise ability to walk safely. Tasks should be: Mechanised to avoid the need for pushing, lifting, carrying, pulling etc. while walking on a slippery surface Move to safer areas and: ENVIRONMENTAL FACTOR Individual capability Poor knowledge of risks and measures Poor attitude to health and safety Poor eyesight Fatigue Physical frailty/disability Inadequate supervision Safety culture which is not supportive, for example where the risks are accepted as part of the job Allocate tasks in high slip risks areas only to those competent to follow slips precautions And: Supervise and monitor physical controls to see safe practices are followed And: Establish a positive attitude that slips risks can be controlled. This is achieved through clear line management responsibilities and consultation with workers Page 14 of 19

15 PERSONAL PROTECTIVE EQUIPMENT: FOOTWEAR FACTORS Footwear can offer insufficient slip resistance in combination with the floor surface, because of: Contamination of footwear Sole material Sole pattern Type of footwear Wear Fit Maintenance/renewal Select suitable footwear for the floor, environment and the individual Base this on experience and information/advice from suppliers. Ensure employees maintain issued footwear soles in good repair and keep them free from contamination. Replace them before they have worn smooth Where overshoes are required, use good quality reusable ones where possible, laundering them between uses. Disposable overshoes can be slippery, and are easily split INDIVIDUAL FACTORS Unsafe action by staff, due to: Awareness of risk Knowledge of how slips occur Lack of Information and training, or Distraction, carelessness Train, inform and supervise employees on the risk, the control arrangements and employees role(s) especially to: Clean as they go Report contamination Maintain footwear Walk appropriately to circumstances Set Procedures for visitors Page 15 of 19

16 TRIP RISK CONTROLS CAUSATIVE FACTORS PRACTICAL MEASURES FOR TRIPS RISK CONTROL ENVIRONMENTAL FACTORS Uneven Surfaces For example gulleys, holes, steps, car parks, walkways / paths to premises, flooring within premises Eliminate holes, slopes or uneven surfaces which could cause trips risks To do this: inspect the maintain floors so they have a consistent surface finish with no holes or damage to cause a tripping hazards. Highlight any changes in level, particularly at single steps and at the top and bottom of ramps. Make slopes gradual and steps clearly visible, avoid open gulleys and channels; and Good housekeeping Eliminate materials likely to obstruct walkways and therefore lead to trips Obstructions For example accumulation of articles such as trolleys, wheelchairs, medical equipment, waste, trailing cables, floor sockets etc. Adverse environment For example inadequate illumination to see floor properly, or glare For example analyse work flows and design process so waste and equipment does not accumulate on walkways Or if this is not reasonably practicable: Prevent material obstructing walkways For example provide sufficient suitable receptacles for the items, mark out walkways, working areas and receptacle locations and make sure they are kept free of obstruction; and Provide suitable lighting to permit obstructions to be seen Page 16 of 19

17 CAUSATIVE FACTORS PRACTICAL MEASURES FOR TRIPS RISK CONTROL ORGANISATIONAL FACTORS The nature of the task creates obstructions Safety culture which is not supportive For example where hazards and risks are accepted as part of the job. Analyse the tasks and process flows to see if work can be handled to eliminate or minimise obstructions And: Establish a positive attitude that trips can be prevented INDIVIDUAL FACTORS Safe practices not followed Train, inform and supervise employees Page 17 of 19

18 Checklist to Assist Managers Identify Hazards Associated with Slips and Trips; these might also lead to falls. Trust Site: Ward / Department: Area being assessed Name of Assessors: Job Titles: Contact Telephone: Date: HAZARD Please tick if hazard relevant to area being assessed Loose flooring Loose and worn mats / carpets Uneven indoor / outdoor surfaces Holes / cracks / pot holes Bumps / ridges / protruding nails Spills and splashes of liquids, solids or dusts Presence of mists, smoke, dust or vapour clouds Unsigned / unguarded wet floors (e.g. following cleaning) Cleaning at unsuitable times Unsuitable footwear Adverse weather (e.g. rain, sleet, snow or loose leaves) Change from a wet to dry surface (footwear still wet) Passageways with heavy pedestrian / trolley traffic use Unsuitable floor surface / covering Dusty / dirty floors Accumulation of waste Low wall and floor fixtures Filing systems or drawers that can open at ground level Poor location of electrical and telephone sockets Yes No Page 18 of 19

19 HAZARD Please tick if hazard relevant to area being assessed Items stored on floor - lack of storage Unmarked sloping surfaces Lack of hand rails on severe slopes / steps / stairs Grab rails are suitable and sufficient for purpose Equipment not stowed appropriately Unsecured cables, service pipes or conduits Use of extension leads Unguarded floor openings Unsuitable lighting levels Distracting noises / levels Vulnerable staff (e.g. poor eyesight, general health, fatigue, lack of supervision etc. If the YES box has been ticked please confirm what control measures are being implemented by completing the Health and Safety General Risk Assessment Document (http://nww.intranet.rdash.nhs.uk/wp-content/uploads/2014/09/health-and-safetyrisk- Assessment-Form5.doc) and attaching this completed checklist to the assessment. Page 19 of 19

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