Management of Slips, Trips and Falls including those from Height Policy

Transcription

1 Management of Slips, Trips and Falls including those from Height Policy Version Number: Name of originator/author: Name of responsible committee: Name of executive lead: V4 Head of Occupational Therapy/Head of Health and Safety Risk Committee Chief Nurse and Director of Quality Assurance Date V1 Issued: October 2007 Last Reviewed: March 2014 Next Review date: February 2016 Scope: Trust Wide MMHSCT Document Code: CL19 1

2 Document Control Sheet Executive Lead Lead Executive Chief Nurse and Director of Quality Assurance Author and Contact Head of Occupational Therapy/Head of Health and Safety Number Type of Document Policy Document Purpose The policy is designed to describe what constitutes a fall and the risk associated with slips, trips and falls including those from a height, for service users, staff and others. It describes the Trust approaches to addressing these risks. Scope of Document Trust wide Version 3 Consultation Professional Heads, Falls Steering group (operational and professional representatives) 2 weeks Approving Risk Committee Approval March 2014 Committee Date Ratification and Date Lead Executive Approval for updates 19 June 2014 V1 Valid from Date October 2007 Current version is valid from approval date Date of Last Review March 2014 Date of Next Review Procedural Documents to be read in conjunction with this document: February 2016 The Trust standard is 3 years. Shorter or longer reviews can be agreed by the approving Committee Bedrail policy Moving and handling (People) Policy Essential Care after a falls protocol Guidelines for nursing the unconscious or conscious impaired patient Training Requirements There are Training requirements for this procedural document Briefing on policy and pathway Financial Resource Impact There are Financial resource impacts Staff training time Equipment and adaptations Patient safety campaigns Document Change History Changes to this document in different versions must be detailed below. Rationale for the change should also be given Version Number / Name of procedural document this supersedes Type of Change i.e. Review / Legislation / Claim / Complaint Date Details of Change 2 Review 14/2/13 Review by the Falls Steering group: 1. The duties have been refined to clearly articulate what is required to promote the policy. 2. The falls pathway flowchart has been 2

3 amended from requiring that just Later Life patients are screened for falls within 24 hours to all service users admitted to inpatient services.(policy, Appendix 2). This remains subject to 1) a service user presenting with a fall, has a history of falls or is being admitted to later life ward or 2) an assessment identifying risk of falls. This has been changed to make the process clearer for staff across all care groups. 2 Claim 14/2/13 Although moving and handling people training includes the Trust stance on non-catching when a patient is falling, his was not referred to in the Slips, Trips and Falls Policy. A reference to noncatching and the Moving and Manual Handling (Minimal Lifting) policy has been added within the policy to offer extra clarity for staff. Completed by Falls Steering group. 3 Review 16/2/14 Review completed to ensure the policy meets NICE guidance CG161. Pathway updated to reflect reduced age of falls screening. External references used in the creation of this document: NHSLA Risk Management Standards NHSLA Document Template for Procedural Documents Privacy Impact N/a Any issues? Choose an item. Assessment submitted Fraud Proofing N/a Any issues? Choose an item. submitted If not relevant to this procedural document give rationale: Policy authors are asked to consider each of the nine protected characteristics under the Equality Act We expect you to demonstrate that throughout the policy process you have had regard to the aims of the Equality Duty: 1. Eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Act; 2. Advance equality of opportunity between people who share a protected characteristic and people who do not share it; and 3. Foster good relations between people who share a protected characteristic and people who do not share it. Please provide a brief account of how you have done this, further work to be completed and any support you have had in considering the aims and working in compliance with the Equality Duty. If you are unclear on how to do this or would like further advice and support then you may contact quality.admin@mhsc.nhs.uk. It is the responsibility of the approving group to ensure this statement reflects the Trusts 3

4 objectives and position with compliance as set out within the NHS Equality Delivery System In line with the Trust values we may publish this document on our External Website. Is there any reason you would prefer this is not done? No It is the Authors responsibility to ensure all procedural documents comply with the Trust values If you are unclear on any of the requirements in the document control sheet then please before proceeding 4

5 Monitoring and Compliance Requirements For audit, CQC Registration and NHSLA purposes all procedural documents must have monitoring requirements or key performance indicators set by the authors, Committees or Lead Directors. This allows the Trust to routinely monitor the effectiveness and impact of their procedural documents on a regular basis. Does this procedural document offer support or evidence for the Trusts registered activities and outcomes? Yes Primarily Choose an item. Additional Not Applicable Additional Choose an item. Is this an NHSLA Document? Yes Which Standard does this relate to? Minimum Requirement / Standard / Indicator to be monitored & Section of document it appears Process for monitoring 4 - Safe Environment Which Criterion Responsible Individual / Group Frequency of Monitoring Responsible Group for review of results / action plan approval / implementation Level 1/a Duties p2-4 Review Falls Steering Group Yearly Risk Committee Level 1/b Risk Assessment Review Falls Steering Group Yearly Risk Section 7.1.1b page 5 Committee Level 1/c Learning and Development Review Falls Steering Group Yearly Risk Section 6.1.1c page 6 Committee Level 1/d Raising Awareness Review Falls Steering Group Yearly Risk Section 6.1.1d pages 5 Committee Level 1/e - Monitoring Section 9.1.1e pages 6 Audit Falls Steering Group Yearly Risk Committee 4/3 Slips Trips & Falls (Staff & Others) 4/4 4/3 Slips Trips & Falls (Patients) Choose an item. Comments Section 5.1.1a, Page xxxxxx Risk assessment will be reviewed as and when circumstances change Learning and Development issue training reports on a monthly basis Leaflets are available on guidance for the prevention/reduction of slips, trips and falls. The Falls Steering Group will analyse falls data n an annual basis and develop and action plan. NB: If you have selected audit you should complete the required audit registration form and standards document and submit these with your expected timescales for completing the audit to quality.admin@mhsc.nhs.uk as soon as possible and no later than 4 weeks prior to the audit commencing. The Group / Committee should also ensure the monitoring work is added to their yearly schedule of monitoring and action logs as appropriate 5

6 Management of Slips, Trips and Falls including those from Height Policy Contents Section Title Page 1 Executive Summary 8 2 Introduction 8 3 Definition of a Fall 8 4 Purpose 8 5 Legal Requirements 9 6 Duties and Responsibilities Chief Executive Executive Directors General and Line Managers Employees Estates and Facilities Corporate Assurance Framework Clinical Governance Committee Health and Safety Committee Risk Manager Audit Manual Handling Co-ordinator 11 7 Learning and Development Raising Awareness 11 8 Risk Assessment 12 9 Management of Slips, Trips and Falls Falls involving Service Users Falls involving Staff and Others 12

7 10 Monitoring References 13 Appx 1 Falls Screening and Intervention Tool 15 Appx 2 Falls Pathway 19 Appx 3 Multi-Factorial Assessment 20 Appx 4 Guidance for Staff outlining likely causes and suggested actions 23 If you need to have this information translated into another language please contact the Mental Health Linkwork Scheme on or linkworkers.mentalhealth@nhs.net. If you require it in larger print, Braille, audio or other formats please contact the Communications Team on or communications.admin@mhsc.nhs.uk 2

8 Management of Slips, Trips and Falls including those from Height Policy 1. Executive Summary This policy details actions require to reduce the risk of slips, trips and falls including those from a height, for service users, staff and others.falls and fall-related injuries are a common and serious problem particularly for older people. The policy described responsibilities of all staff in the context of health and safety and falls risk. The patient focused Falls pathways described in this policy is based on the NICE guidance 161 which provides recommendations for the assessment and prevention of falls in older people. 2. Introduction Manchester Mental Health & Social Care Trust is aware of its responsibilities for managing the risk associated with slips, trips and falls including those from a height, for service users, staff and others. Slips and trips resulting in falls are the most common cause of major injuries in the workplace in Great Britain (HSE IND G 225, Preventing Slips and Trips at Work). Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than 2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs. The patient focused Falls pathways described in this policy is based on the NICE guidance 161 which provides recommendations for the assessment and prevention of falls in older people. 3 Definition of a Fall Any unintentional event whereby an individual comes to rest on the ground or another lower level, with or without loss of consciousness National Institute of Clinical Excellence (NICE CG 21, 2004) This includes falls (also slips and trips) from any height onto any surface lower than the patient was originally on. 4 Purpose The purpose of this policy is to describe the process for managing risks associated with slips, trips and falls involving patients, staff and any other persons who might come on to Trust premises. 8

9 It will examine the contributory factors that lead to slips, trips and falls and will outline the duties and responsibilities of all staff. 5 Legal Requirement The Health and Safety at Work etc Act 1974 lays down a general duty on an employer to ensure the safety and welfare of the employees and others who may be affected by the work activity, so far is reasonably practicable. (Please refer to Trust Health and Safety Policy) The Management of Health and Safety at Work Regulations 1999 lays down the legal requirement for risk assessments to be carried out and the necessary controls are put into place. The Workplace (Health, Safety and Welfare) Regulations 1992 requires that the condition of floors and traffic routes be suitable for purpose. They should have no hole or slope or be uneven or slippery and should be kept free from hazards or obstruction which may cause a person to trip or fall. The National Patient Safety Agency 3 rd Report 2007 recommends that each patient at risk of falling should receive multifaceted clinical and environmental interventions that could reduce the risk 6 Duties and Responsibilities 6.1 Chief Executive The Chief Executive has overall responsibility to ensure that the risk associated with slips, trips and falls including those from a height, for service users, staff and others are managed appropriately. 6.2 Executive Directors The Chief Executive has delegated responsibilities within an Executive Director s portfolio framework. The Director of Nursing and Therapies has responsibility for clinical standards (and thus management of slips, trips and falls of service users) The Director of Finance and Estates/deputy Chief Executive has responsibility for Health Safety and Welfare (and thus management of slips, trips and falls of staff and others) The Director of Finance and Estates/deputy Chief Executive has responsibility for learning and development and thus must ensure that training needs of staff are considered and delivered Executive Directors have a responsibility to ensure that any action plans associated with the management of slips, trips and falls are registered on the Trust s action plan register Executive Directors have a responsibility to ensure that the organisation wide/care group risk registers/assurance frameworks are populated with risks identified from any risk assessments, action plans or gap analysis. 9

10 6.3 General and Line Managers 6.4 Employees Ensure that environmental and where applicable, patient risk assessments for slips, trips and falls are carried out in their areas of responsibility and that appropriate actions are taken to reduce these risks so far as is reasonably practicable. Ensure that adequate housekeeping is maintained in their areas of responsibility Ensure that staff are aware of this policy and their responsibilities within it. Monitor all slips, trips and falls incidents and take action as necessary Report any flooring defects to the Estates Department Help Desk. Ensure that any slips or trip hazards are reported to their line manager Ensure they clear up any spillages and use the appropriate warning signs Ensure the environment is kept clear of clutter and that adequate housekeeping is maintained. Position equipment to avoid trailing cables across pedestrian routes Ensure they wear suitable footwear Ensure that the clinical pathways for falls are adhered to within the Trust, including completion of the approved risk assessment tools. 6.5 Estates and Facilities Ensure that guidelines HTM 61 Flooring are considered when introducing new or refurbished floor surfaces. Monitor contractors and sub-contractors to ensure that they do not create slip and trips hazards. Ensure roads, pathways and car park areas on trust premises are suitably treated during adverse weather conditions (e.g.snow and ice) in order to reduce the risk of slips, trips and falls. Maintain appropriate lighting in general areas to reduce the risk of slips, trips and falls. 6.6 Corporate Assurance Framework The Risk Committee, Clinical Governance Committee and the Quality Board have a responsibility to ensure that the management of slips, trips and falls (including falls from a height) for service users, staff and others is reviewed via the work plans of the Health and Safety Committee. The chairs of relevant Sub Groups have a responsibility to ensure that any reports and actions resulting from the management of slips, trips and falls are: included on meeting agenda for agreement, included on their associated work programme and rated as per Trust corporate assurance framework. 6.7 Clinical Governance Committee Clinical Governance Committee must ensure that any clinical risk assessment tools for service users are approved for use within the Trust. Any Care Pathways must also be regularly reviewed and that incident reports on service user falls must be received (via quarterly incident report). 10

11 6.8 Health and Safety Committee Health and Safety Committee must ensure that any risk assessment tools for staff and others are approved. Incident reports on staff and others must be received and monitored by the Health and Safety Committee. 6.9 Risk Manager The Risk Manager is responsible for ensuring any CAS Alerts relating to slips, trips and falls are forwarded to the chair of the Falls group for action Audit The Falls steering group will ensure that any relevant audits regarding slips, trips and falls of service users, staff and others are included in the annual audit plan Manual Handling Co-ordinator The Manual Handling Co-Coordinator will raise awareness of the management of slips, trips and falls to all trust staff as part of manual handling training and policy procedures. Please refer to the Trust s Minimal Handling (Manual Handling) policy under Learning and Development on the Trust intranet and Procedures for the safe and effective use of bedrails within in-patient areas. df 7 Learning and Development All staff are required to undertake appropriate training in line with the Trust training needs analysis and the Trust Mandatory Training Policy. Each member of staff has an individual responsibility to ensure they have accessed or attended appropriate training that has been arranged for their benefit. 7.1 Raising awareness The Health and Safety Executive can be accessed for advice and awareness regards slips, trips and falls including information concerning falls from height on the following links: for falls for advice and guidance concerning slips. The Trust has a leaflet to support service users and carers to reduce the risk of falls: 8 Risk Assessment In the first instance all wards and departments will need to carry out a risk assessment of the environment, activities and staff awareness to identify any factors that constitute a slip, trip or fall hazard, including falls from a height. Falls screening and intervention tool must be completed if 50: 11

12 Inpatient- within 24 hours of admission Community on initial contact or at least annually Using the risk assessment tool an assessment must be completed for patients of all ages: After a fall With assessed falls risk With history of falls Non patient risk assessments should be carried out following the environmental assessment when factors constituting a slip, trips or fall (including falls from a height) are identified taking into account all health and social care Trust settings. 9 Management of Slips, Trips and Falls 9.1 Falls Involving service users. When a fall occurs all inpatient staff must follow the protocol for post fall care, please also see appendix 2 All health and social care staff must comply with the community pathways outlined in the Appendix 2 Falls pathway including appropriate risk assessment and documentation regarding the management of falls. Appendices 1, 3 and 4 outline the relevant screening, assessment and documents that must be completed if pathway in appendix 2 indicates they are required. Leaflets for the prevention and management of slips, trips and falls in inpatient and community settings and information on use of bed rails can be found via the following link on the Trust Intranet. The Trust does not support the practice of catching or support the full body weight of a falling person. Guidance is detailed in the Trust s Moving and handling (People) Policy and associated mandatory training. 9.2 Falls Involving staff and others All members of staff have a general duty to take reasonable care for the Health & Safety of themselves and other persons who may be affected by their acts or omissions. All safety rules, regulations and codes of practice relating to the work area should be observed. Appendix 6 outlines the relevant information for staff. There is also an information leaflet for staff on the use of bed rails and a leaflet designed for temporary clinical staff on the Trust Intranet on the following link. df The Trust has a programme for raising awareness and investigations of slips, trips and falls involving service users, staff and others. This includes: Leaflets for staff and service users Awareness to staff via Trust communications 12

13 Clinical audit programme via the annual audit forward plan Monitoring of trends, incident reporting and review Aggregated analysis of incidents, complaints and claims. 10 Monitoring o o o o o o Matrons will monitor the number of incidents within their area and review actions taken, interventions and care plans as appropriate. Staff training will be monitored by learning and development who will produce a report from information on ESR (electronic staff records) on numbers of attendance and follow up where required which will be reported bi-monthly to the Trust Board via the Health and Safety Committee, Risk Committee and Quality Board. The manual handling co-ordinator will provide a report for slips, trips and falls involving service users to the health and safety committee bi-monthly. The health and safety advisor will present a report for all RIDDOR incidents to the risk committee annually and they will include a report for slips, trips and falls including falls from a height. The Falls group will analyse falls data for service users annually and develop an annual action plan. Falls will be monitored in line with NPSA never events 11 References DOH (2001). National Service Framework for Older People. Department of Health, Crown Copyright. DOAS (2006) national guidance on falls Health & Safety Commission (2000). Revitalising Health & Safety. London, Health & Safety Commission Health & Safety Executive (1999). Management of Health & Safety at Work Regulations- Approved Code of Practice & Guidance. London, HSE. Health & Safety Executive (2004). Review of RIDDOR trip accident statistics London, HSE. Health & Safety Executive (2004). A Strategy for Workplace Health & Safety in Great Britain to 2010 and Beyond. London, Health & Safety Executive. Health &Safety Executive (2003). Preventing Slips and Trips at Work. London, HSE. Health &Safety Executive (2006). Reducing Slips and Trip Accidents in the Health Service. London, HSE. Healthcare Commission (2006). The Annual Health Check in 2006/07. London, Healthcare Commission. 13

14 National Institute of Clinical Excellence (2004). CG21 Falls. The Assessment and Prevention of Falls in Older People, Clinical Guidance. London, NICE. National Patient Safety Agency (2007). Slips, Trips & Falls in Hospitals. London, NPSA. National Patient Safety Agency (accessed October 2011) NHSLA (2007). NHSLA Pilot Risk Management Standards for Mental Health & Learning Disability Trusts, NHS Litigation Authority. OPSI (1974). Health & Safety at Work Act.O. o. P. S. Information, Crown Copyright 14

15 Appendix 1: Falls screening and interventions tool Screening /X Recommended Actions Action/AMIGOS date History of falls* Admitted or referred with falls/falls since admission -Check where, when, how and why fallen?- if cause identified please detail in comments box and make appropriate referral - Mobility/gait and balance assessment Anxious about falls -Ensure appropriate environment and orientate Unknown cause -Consider medical review Taking 4 or more medications* -Medication Review At risk of osteoporosis -Osteoporosis screen and treatment Previous or current fragility fracture -Medication review Unable to rise from a chair unaided* -Assess for mobility aid Uses walking aid -Supervise and assist to mobilise 15

16 Poor mobility and/or balance* -Increase observation levels Diagnosis of Stroke or Parkinson s disease* -Balance and mobility assessment -Medication review Sedated Confused/Agitated/Disorientated Cognitive impairment -Check for delirium causes Dipstick urine Check for infection Dehydration Constipation Pain Medication Wanders -Orientate to environment and make safe -Medical +/or medication review if required -Give supervision/ assistance to mobilise -Assess and modify environment Perception problems -Orientate to environment -Patient is safe and independent -Medication review 16

17 -Allocate bed near toilet -Bottle or commode in room Continence issues -Routine to assist to toilet -Night lighting -Medication review -Medication review -Improve hydration Symptomatic postural BP drop -Monitor BP -Teach patient self management strategy Alcohol/drug usage -Consider detox support Unsafe Environment -Complete environment risk assessment Living Environment Hazards -Order equipment -Modify environment -Ensure suitable clothes/footwear Wearing unsuitable clothing/footwear -Organise eye test Poor foot/nail condition/foot pain 17

18 -Refer to Podiatry -Ensure visual and/or hearing aid present Visual difficulty Hearing difficulty -Refer to Audiology and/or Optometrist Other (please specify): ie, Bedrail, Blackouts. Pain, Seizures, poor diet and fluid. Action taken: Summary of risks and comments Care plan documented? Location of plan: Sign/date 18

19 Appendix 2: FALLS PATHWAY Presents with a fall OR has a history of falls OR is being admitted to later life ward OR is over 50 years old and judged to have an underlying condition that may put them at risk of a fall Assessment identifies risk of falls Complete Screening and intervention tool (within 24 hours if inpatient admission) YES NO Give general Health and Well being advice and falls leaflet I a a T i Are 3 or more of the * items are ticked NO YES Recurrent Falls Single injury falls Single fall with abnormal gait and balance Impaired mobility/use of adaptations to aid mobility Single explained fall with normal gait and balance T i Complete interventions in the Falls screening tool Multi-factorial Assessment Complete indicated interventions Give general Health and Well being advice and falls leaflet Give general Health and Well being advice and falls leaflet Record outcomes Repeat Falls screening annually if service user is 50 or over IMPORTANT: Consider at all stages if there are other services or agencies involved in addressing falls risk with the service user and whether the Trust contributes to their falls management plan. 19

20 Appendix 3: Multi-factorial Assessment Medical Component of a Multi-factorial Assessment (minimum requirement, other parts will be directed by clinical findings) Past Medical History including history of Stroke, Parkinson s disease, epilepsy, fracture, arthritis Falls History - Description including by a witness, activity at the time of falls, frequency, when and where - Any loss of consciousness - Prodromal symptoms- lightheaded, dizziness, Medication History Smoking and alcohol Urinary incontinence or urgency Visual impairment or change in vision Hearing impairment Pulse rate and rhythm Lying and standing blood pressure Auscultate for aortic stenosis Visual acuity and fundoscopy Sensory and motor neurological assessment especially power in hip and foot flexors, proprioception loss Assess gait Tests for cognitive function, anxiety and depression U&E, FBC, B12, Calcium, LFT, RBG, TSH, 12 lead ECG, urine dipstick and CXR as clinically indicated NOTE If the cause of fall remains unexplained or blackouts suspected, refer to Medical problem/ unexplained falls pathway Falls History Activity at the time of Fall When and where Frequency of falls Ability to get up from the floor unassisted (unassisted, not requiring help from another person) How many falls in the past twelve months Changes to lifestyle as a result of falling, e.g. not going out alone, now uses walking aid, not getting to the bath etc What footwear was worn at time of fall Urinary and Faecal Continence Assessment Is there urgency of micturition? Is person taking diuretics? Does s/he have problems at night? Does s/he have access to commode at night? Is s/he wearing appropriate aids? R d ti Ask Assess Are you frightened of falling? What frightens you? (eg lying there all night, fractures) Ability to summon help Ability to prepare for a long lie Use appropriate assessment tool Tinetti Fear of falling falls efficacy scale (FES) FES-I (Yardley) ConfBal ABC UK Recommendation Teach strategies to get up from floor Provide info re summoning help Teach coping strategies to prepare for long lie Consider: Referral for stress and anxiety management Referral to mental health services 20

21 Assessment of Hearing Check for ear wax Check hearing aid working /batteries fitted and working Ensure correct use of hearing aid Advise about having hearing tested and corrected Recommendation Assessment of Visual Impairment Has there been any change in vision? Has the individual visited Optician during the last 12 months? Is the individual wearing their glasses and are they clean? Assessment of gait, balance, joint range of movement and muscle strength Assess gait, balance, joint range of movement and muscle strength. Assessment tools may include: Functional ability Subjective questioning of ability to manage personal and domestic activities of daily living. Choose appropriate treatment Recommendation Refer to Audiologist if appropriate Assessment of Home Hazards Poor lighting, particularly on stairs Stairs Loose carpets or rugs Trailing bed clothes Slippery floors Need for safety equipment such as grab rails Poor heating Trailing wires Cluttered rooms Pets Recommendation Visit the Optometrist annually if there is history of Diabetes Glaucoma or immediate family member with Glaucoma Early cataracts that need monitoring - Over 70 years of Age Visit Optometrist every 2 years if no problems Timed get up and go test Timed Unsupported Steady Stand (TUSS) Timed sit to stand from standard 18 chair Berg Balance test POAM (Tinetti) Check use of and / or provide appropriate mobility aid (Guidelines for Collaborative management of elderly people who have fallen: CSP and College of Occupational Therapists, 2000) Refer for Rehabilitation Programme Provide appropriate mobility aids Refer for Environmental or Home Hazard assessment Refer to Social Services or home care. Review Alcohol Intake Determine units of alcohol consumed per week Recommendation Recommendation Identify need and refer for Equipment, Aids and adaptations and minor repairs Advise about risks of taking alcohol with medications Give sensible drinking advice Advise about immediate and long term risks of falling due to dulling of neurological capacity from alcohol 21