Patient Slips, Trips and Falls Policy

Transcription

1 Patient Slips, Trips and Falls Policy Patient Slips, Trips and Falls EQUALITY IMPACT The Trust strives to ensure equality of opportunity for all both as a major employer and as a provider of health care. This policy has therefore been equality impact assessed by the LIG to ensure fairness and consistency for all those covered by it regardless of their individual differences, and the results are shown in Appendix 6. Version: 5.0 Authorised by: Risk Management Committee Date authorised: 6 th June 2013 Next review date: June 2016 Document author: Lucy Hoyle/ Beverley Tabernacle

2 VERSION CONTROL SCHEDULE Version Number Issue Date Revisions from previous issue 1 Original Issue 1.1 April 2007 Amendment 1.2 April 2007 Addition of Appendix F Cot Side & Bed Rail Assessment Paediatrics 2.2 Sept 2007 Addition of Policy Development/ Consultation/ Implementation information 2.3 Feb 2008 Review of policy and training matrix 0.3 July 2009 Draft: Review of policy Review of ICP 3.1 April 2010 Correction to Appendix error 4.0 April - October 2010 Separation of Policy & ICP. final version Slips, Trips & Falls Policy Version 3 revised in line with new strategic direction for falls & osteoporosis and the launch of a new governance framework Need to move this document on to reflect a more generic model 5.0 June 2013 Changes to wording throughout policy Addition of section 7.1 Management of falls in hospital Addition of section 7.4 Management of Patients who have fallen References added Addition of post injury flowchart Addition of NICE head injury guidelines Review and update of all appendices Page 2 of 27

3 TABLE OF CONTENTS Page 1. INTRODUCTION PURPOSE AND POLICY STATEMENT SCOPE DEFINITIONS DUTIES FALLS AND RISK IN-PATIENT FALLS ASSESSMENT Management of falls in hospital Children Osteoperosis screening The management of patients who have fallen INPATIENT INCIDENT REPORTING ENVIRONMENT AND EQUIPMENT Bedrails Environment PATIENT INFORMATION/EDUCATION TRAINING FOR STAFF POLICY DEVELOPMENT & CONSULTATION IMPLEMENTATION AND PROCESS FOR RAISING AWARENESS OF FALLS AND SLIPS TRIPS AND FALLS RELATING TO PATIENTS MONITORING (table appendix 5) REFERENCES/BIBLIOGRAPHY REVIEW Appendix 1 Post injury flow chart...error! Bookmark not defined. Appendix 2 NICE head injury guidelines..18 Appendix 3 Protocol for the use of safety rails Appendix 4 Childrens safety rail assesment.. 23 Appendix 5 Falls prevention whilst in hospital Patient leaflet Appendix 6 Monitoring Appendix 7 Equality Impact Assessment..27 Page 3 of 27

4 1. INTRODUCTION There is much evidence to show the devastating impact on patients both physically and emotionally when they sustain a fall. Everyday approximately 2,300 people experience a fall and this is more dominant in those aged 75 years+. The National Patient Safety Agency (NPSA) found that in an average 800 bedded Acute Trust there will be about 24 falls every week and over 1,260 falls every year representing the highest volume patient safety incident reported in hospital trusts. (NPSA; 2007). The national surveys of slips, trips and falls, have identified concerns associated with the risks patients face when admitted to hospital settings. Nationally, approximately 152,000 incidents are formally reported each year but this is seen as simply the tip of the iceberg due to the lack of systems and processes within the NHS. The Operational Framework states that improved outcomes and efficiencies in the NHS can be generated via the use of prevention packages created for older people via a joined up falls service. (2010) It is known that a significant number of incidents result in death or severe/moderate injury which in turn costs an approximate 15million to the immediate health care system. Besides the care to patients, the NHS has a statutory responsibility to ensure employees are protected from hazards such as slips, trips and falls within the workplace. 2. PURPOSE AND POLICY STATEMENT The purpose of this policy is to identify adult patients who are at risk of falling and to identify the interventions required to reduce the risk to each individual patient. This Policy also will include the appropriate use of bed safety equipment to reduce risks further. This policy when disseminated to staff should ensure that staff recognise it is their responsibility to identify those patients with a history of falling and/or are deemed at risk of a fall receive a falls risk assessment within 8 hours of admission to hospital. Where risks have been identified, necessary clinical actions will be taken and recorded to minimise the risks. These actions will be clearly documented in the patient s clinical records /care plan and any actions that have not been taken with the rationale for action being explicitly clear. Once the issues have been addressed a review of the risk assessment will be undertaken and those patients who remain in hospital in excess of 7 days will be reviewed on a weekly basis. In all instances the circumstances surrounding a fall must be documented in the patient s care plan/notes and via the Trust s Incident, Complaints and Claims Reporting and Investigation Policy. The patient and where appropriate their relative/carer should be informed of the assessment and what remedial steps are being taken. This should also be documented in the patient s records. The hospital works collaboratively with NHS Tameside & Glossop in the provision and management of a falls and osteoporosis service in order to ensure safety is maintained in relation to slips, trips and falls. This Policy will work in conjunction with the existing falls integrated care pathway, the falls care plan and the assessment of bed rails. It takes into account the requirements of Page 4 of 27

5 the NPSA, NHSLA, the Care Quality Commission and the associated national, regional and local audits. Policy aims to: reduce the total number of falls occurring in the Trust by providing an evidence-based, patient-centred approach to reducing the risks associated with slips, trips and falls to all adults - provide guidance for the actions to be taken when a patients (or staff) have fallen. - Ensure staff are aware of the risks associated with falls management and prevention and that they receive training and guidance in falls management and prevention strategies Policy objective to: - support the safety of patients and engender a culture of falls management and prevention being everybody s business no matter which department/division/ environment to employee is based. The document aims to compliment existing policies and the new strategic direction for falls within the organisation e.g. In order to meet this objective, the Trust will implement the following Strategy. All adult patients at high risk of falls will be screened/assessed in accordance with the integrated falls pathway and a falls care plan will be developed and implemented in a timely manner Bed Safety rails are in use within the Trust to aid in the prevention of patients falling. To support the use of safety rails, a Safety Rail Protocol is in place (Appendix 3) Bedrail assessments will be undertaken in a timely manner and these will be accurately recorded in the patient s records. A risk management incident form will be completed and submitted to the Risk Management Team in accordance with the Incident, Complaints and Claims Reporting and Investigation Policy A risk management incident form will be completed and submitted for all patients nursed on the floor Ward staff will take all steps necessary to complete an environmental assessment and submit relevant risks for inclusion on the local risk register. Where further actions are required the Ward Manager and or Matron are responsible for implementing changes and where issues can not be resolved locally or require further resources will be responsible for development of an action plan and submission to the relevant local group for monitoring The policy will be reviewed every 3 years unless changes to clinical guidance or National Statute dictate otherwise. 3. SCOPE This Policy is applicable to all employees and includes those who work for the organisation as bank staff, agency personnel, locum capacity, volunteers and stakeholders involved in the pre-admission, admission, investigation, direct care and discharge of patients at the Trust. 4. DEFINITIONS For the purpose of this Policy document the following definitions are made Page 5 of 27

6 Fall - An unexpected event in which the participant comes to rest on the ground, floor or lower level [Prevention of Falls Network Europe (ProFaNe)] Slip generally associated with situations related to a loss of friction between the foot and the underfoot surface, [Lortie and Rizzo]. Trip the sudden arrest of movement of the foot with continued motion of the body [Manning]. Fall from a height A place is at height if a person could be injured falling from it, even if it is at or below ground level. 5. DUTIES Chief Executive The Chief Executive has overall accountability for ensuring that the Trust meets its statutory and non-statutory obligations in respect of maintaining patient safety and appropriate standards of privacy and dignity and confidentiality in relation to patient slips, trips and falls. Director of Clinical Services The daily operational responsibility for compliance and monitoring is delegated to the Director of Clinical Services as the Chair of the Falls Programme Board. Therefore, their responsibility is to ensure employees uphold the principles of falls management when dealing with patients and their carers. They are also responsible for ensuring this Slips, Trips and Falls Policy is effectively implemented and monitored. Director of Nursing Responsible for ensuring that all nursing staff up hold the principles of falls management when caring for patients. They will ensure that this policy is effectively communicated and maintained throughout the organisation, and that steps are taken to ensure robust arrangements are in place to reduce, and where possible eliminate potential risks. They will present falls data for the year to the Trust Board as part of the Risk Management Annual Report. Deputy Director of Nursing The Deputy Director of Nursing supports the Director of Nursing in the delivery of the falls policy, its components and has a responsibility to compliance. Falls Nurse Specialist This is the strategic lead for the Trust and to programme manage the implementation of the falls and osteoporosis structures and governance framework for the organisation. In the spirit of the NHS Constitution, the role will facilitate the fostering of openness and involvement by representation from the public, patients and carers throughout the falls reporting structures. It will also monitor trends on inpatient episodes provided by the risk management team and work towards steps being taken to minimise risks whilst promoting falls and osteoporosis prevention and management. Director of Estates and Facilities The Associate Director of Facilities has the duty to ensure that the built estate and its supporting infrastructure is in a satisfactory and safe condition, and that it complies with relevant statutory and mandatory requirements. This includes the duty to ensure that any risks presented by the built environment in relation to the management of slips, trips and falls are properly assessed and managed. Page 6 of 27

7 Ward Managers, Matrons, Divisional/Departmental Managers Are responsible for undertaking a risk assessment of all falls, slips and trip hazards within their area of responsibility and thereafter reviewing risk assessments in the light of changing activities or priorities,. There should be spot checks to ensure those patients who are deemed as needing a falls assessment and/or review have the clinical actions recorded in the patients records. To reduce risks to a lowest level they are charged with implementing and monitoring appropriate control measures, within the scope of their responsibility. It is their responsibility to ensure the facilitation of falls and osteoporosis staff training. Falls Team This comprises a consultant physician, a specialist nurse, physiotherapists and occupational therapists. The Falls Team is responsible for the development of the falls service and the implementing of falls prevention and management strategies within the Trust. They will develop policies and procedures as required. They will offer expert advice and guidance on the care of patients identified as being at risk of falling and accept referrals from clinical staff when required. They will develop and deliver falls prevention and management training. Falls Link Nurses Are responsible for provision of advice and support at ward level and liaising with the Falls Nurse Specialist. They will assist in incident investigation and attend any falls group meeting. Each ward must have a falls link nurse. Risk Management Department Recording falls incidents in a database enables the Trust to identify trends and target local improvements. The Trust has an aim to increase reporting and establish goals to reduce harm to all their inpatients. The Risk Litigation and complaints Manager is responsible for ensuring that the Risk Management Team record reported incidents on the Trust incidents databse and produce monthly statistical reports to the Falls Nurse Specialist and the PCT s Falls Coordinator on the nature and severity of such incidents indicating the trends. In addition data on falls incidents will be produced for the following committees Clinical Governance and Accountability Committee (quarterly risk management report) Risk Management Committee (Monthly Incident report). Reports from these sources may be discussed and used to evaluate the effectiveness of the policy and systems by the following falls subgroups Clinical service/training and development Patient safety/risk management Evaluation/Clinical audit Fracture femur/best practice tariff Pharmacists Are responsible for carrying out medication reviews and highlighting to clinical staff any medicines prescribed which may increase a patients risk of falling and for providing advice on alternative medicines. Page 7 of 27

8 All staff Falls and osteoporosis prevention and management is everybodys business so all staff are held accountable for ensuring compliance with the Trust s Policies and Procedures in relation to patient Slips, Trips and Falls. Staff have a responsibility to ensure steps are taken to ensure patients experience a safe environment during their hospital stay and, within their scope of responsibility, Trust premises comply with the Health & Safety at Work Act (1974), reporting to the relevant manager where there are health and safety concerns. All reporting of accidents/incidents are in accordance with the Trust s Incident, Complaints and Claims Reporting and Investigation Policy and staff attend the relevant training identified regarding risk management. 6. FALLS AND RISK Falls management requires an approach that increases patient safety in the hospital by identifying patients at risk and implementing interventions that reduces patients falls, including consideration and assessment of environmental risk factors. It is, however, recognised that patient safety should be balanced with the promotion of patient recovery and independence, with the aim of discharging patients home safely. The management of patients at risk of falls should be tailored to individual risks and needs. It is essential to identify patients considered to be at risk of falling as part of the admission procedure. This is in addition to the general steps required to reduce all falls on Trust premises as described in the general Trust slips trips and falls Policy. Requirement to undertake risk assessments for the management of patient falls (including falls from height) It is essential that staff identify patients considered to be at risk of falling as part of the admission procedure 7. IN-PATIENT FALLS ASSESSMENT The Management of Falls in Hospital (NHSLA 3.3b) Management of Hospital Inpatients (NHSLA 3.3b) All patients admitted to the Trust as an unplanned inpatient should have a falls risk assessment done on their admission to the ward using the appropriate Falls screening tool documentation which is part of the Falls ICP. This assessment should be undertaken by a registered nurse, a student nurse or a non registered member of staff on the condition that this will be checked and countersigned by a registered nurse. If this assessment identifies or in the clinical judgment of the assessor the patient is at high risk of falling, and to assist the Falls Co-ordinator, staff will ensure that there is a falls Page 8 of 27

9 Medway alert in situ. A detailed falls assessment using this tool must be completed for all patients within eight hours of their admission. For planned patient admissions where it is expected a patient will remain in hospital for more than 24 hours a FRAT assessment must be completed as part of their admission. If a patient is admitted as a day case they should have a FRAT score on admission, If patient scores above 3 and they fit the clinic criteria a referral should be made to falls clinic (referral form available on the trust intranet site) FRAT assessments must be reviewed every seven days and under the following circumstances. if the patient s condition changes or they suffer a fall, if they are transferred to another clinical area. If a patient is identified as being at risk of falling (including falling from heights i.e. chair or bed), a falls care plan must immediately be commenced (located within the Falls Nursing Documentation Pack). In addition if the patient is considered as being at extremely high risk of falling consideration should be given to referring them to Physiotherapy, Occupational Therapy, the Falls Nurse Specialist and any other appropriate health care professionals in order to ensure a multifaceted assessment and care. Patients who are safe to be medically discharged home but are still considered at risk of having further falls will be referred to the outpatient Falls Clinic or the Community Falls Service on discharge if follow up and further assessment are appropriate. Staff should also consider if the use of bed rails is appropriate or whether a specialist low bed or crash mats are required. Please refer to the policy for protocol for the use of safety rails (Appendix 3) for further guidance. When a patient has been identified as being at risk of falling they must be given a Falls Prevention Whilst in Hospital Patient and Care Information Leaflet (appendix 5), this must be discussed with the patient and their carer. For any patient identified as being at risk of falling, the Falls ICP must be commenced. The following steps should also be considered depending on the falls assessment: The intentional rounding tool (available on the trust intranet) must be commenced for all patients who have been identified as being at risk of falling. It must be completed every time a member of staff visits a patient which must be a minimum of every two hours. The patient must be informed of the results of the falls risk assessment and the care plan discussed with them. This will ensure they have understanding of their care. This discussion should be documented in their bedside documentation. Ensure the patient wears appropriate and safe footwear and does not walk barefoot or with socks around the ward area. Liaise with family to provide safe fitting slippers or other footwear for use while the patient is in hospital. Ensure the patient s nurse call buzzer, bedside table, drinks and other personal items such as slippers are within easy reach. Ensure a safe environment by removing all obstacles in the ward environment which may increase the risk of falling Ensure that appropriate walking aids are available on the ward for the patients at risk of falling. Liaise with Physiotherapist to provide initial assessment in order to identify the appropriate walking aid required. Page 9 of 27

10 Consider if the patient requires a raised chair seat or toilet seat to make getting in and out of chairs easier, to minimize the risk of falling from a height. Ward chairs which are too low to get in and out of easily should not be used with patients identified as being at risk of falling. Identify any environmental hazards (i.e. grab rails in bathroom and toilets) and report them to the ward managers or to the maintenance department Consider manual handling issues and if necessary liaise with the Trust Manual Handling Advisor for expert advice. When a patient is considered to have temporary or permanent cognitive impairment the following action should be considered in order to prevent and reduce the risk of falling: When possible, consider moving the patient closer to the nurses station or observation bay to maximize staff surveillance of those patients at risk. If necessary consider one to one nursing. Consider using the most appropriate falls prevention equipment: sensor alarm system, ultra low bed to minimize the risk of falling from a height, crash mats. If ultra low bed is not available and until bed can be rented/lent from another department, a mattress can be used to nurse patient taking into consideration patient safety versus patient privacy and dignity. (guidance for this is located within the trust s falls ICP) Long curtains should be used when a mattresses is going to be used on the floor until ultra low bed can be provided. Moving and handling assessments must be undertaken/updated for any patient being nursed on a low level. If a patient is confused or agitated please report this to your line manager/shift coordinator and if appropriate request one to one observation if required. Continue closely monitoring the patient until an improvement is achieved and the risk reduced. Liaise with the Falls Nurse Specialist if unsure what preventive measures should be used and if equipment not available at the ward level If appropriate ensure patients at risk of falling, having mobility/balance problems and with history of falls are referred to physiotherapist and occupational therapist for further assessments. Record lying and standing blood pressure if patient has a history of falls and liaise with medical team for assessment and review if appropriate. Inform the medical team responsible for the patient s care, if a patient at risk of falling is on any anticoagulant therapies. For all patients who suffer a fall while in hospital a falls log should be initiated, (located within the trust s falls ICP), this will enable each fall to be documented. Following each fall, the patient s relative or carer should be informed of the incident and this should also be documented within the patient falls log. Professional judgment should be used in relation to the appropriate time when patient relatives/next of kin should be informed. It is recommended however, that if patients suffer serious injury which can modify patient care/prognosis relatives should be informed immediately 7.1 Children Children can be at risk of falls in particular falls from height due to their inquisitive and exploratory nature these issues are addressed by implementation of generic controls within the service and the use of the safety rail assessment included in the appendices of this policy. There may also be children who are particularyl vulnerable to falling due Page 10 of 27

11 to medication and or condition. These patients should be individually assessed as to their needs and these needs met within the plan of care for the child. 7.2 Osteoporosis Screening Patients who are aged 50+ will receive osteoporosis screening unless this assessment is declined by the patient. Such negative outcome should be recorded in the appropriate documentation 7.3 The Management of Patients who have fallen Following a patient fall, the priority is to ensure their immediate safety, prevent any further injury and to promote healing. Initial checks should be undertaken using the ABCDE approach as described in the Advance Life Support Guidelines 6th Addition to establish if a moderate or serious life threatening injury has been sustained, first aid should be administered and emergency assistance called if required, Neuro observations must also be immediately commenced. For any patient who has sustained a head injury the NICE guidelines for the neurological observation of the patient with head injury (Clinical Guideline 56, NICE, September 2007 ) must be followed Appendix 2. The following actions must then be taken. Remove hazards and check safety, The patient should then be initially assessed using the ABCDE approach (Ref 17) The patient should be reassured and checked before any attempt is made to move them. Check for evidence of bone injury by palpation and visual checking. Ask the patient if they have any pain or discomfort. Check whether patient is able to move all limbs as before - compare against their usual mobility level. Check for evidence of bruising, abrasion, laceration, swelling, shortening or rotating of limbs and joints etc., including in the head and spine. Monitor patient s level of consciousness and whether there is or was any loss of consciousness. In the event that the patient has sustained a blow to the head, a medical review should immediately be sought whether there is any external evidence of injury or loss of consciousness or not. Neurological observation should be initiated, according to the NICE guidance (ref 9). If moderate or serious injury is suspected immediate medical assistance should be called. The patient must only be moved/ transferred once the medical team are happy that this can be done safely. If required specialist equipment such as a spinal board or scoop stretcher must be used to moved/transferred the patient If the patient does not appears to have sustained an injury or a minor injury, assist them to stand if possible and then recheck for: Complaints of pain or discomfort Evidence of limb shortening, dislocation, external rotation, inability to bear weight or pain on applying pressure Check whether the patient is experiencing dizziness or feeling faint Evidence of injury not previously noted when patient was on the floor Offer the patient first aid if required. The patient should continue to be closely monitored for appearance of injury or evidence of shock. Check patients PARS every 30 minutes along with their neuro obs until advised by medical staff that this can be Page 11 of 27

12 discontinued. Staff should be aware that many elderly patients will have a higher potential for fractures than younger adults and that fractures can be induced with minimal impact force this includes patients at risk from spontaneous fracture. Staff should also be aware that falls might cause a fracture that is not immediately apparent, in that the fracture has not displaced. In this instance, the patient may not complain of pain at the time of injury, but may do so some days later. The Post Injury Flow Chart Appendix 1 should be followed. 8. INPATIENT INCIDENT REPORTING All incidents of falls must be reported in accordance with the Incident, Complaints and Claims Reporting and Investigation Policy. Serious untoward Incidents, i.e. falls that result in serious injury, must be reported and investigated in line with the Incidents, Complaints and Claims Reporting and guidance related to incidents graded high.. Staff should discuss the actions and learning points that have arisen from any incidents at team meetings and clinical governance meetings. This should also be shared across other wards and hospitals through governance forums and mechanisms, in order that the safety of patients and the quality of the care they receive is constantly monitored and improved. Discussion of falls prevention and reduction strategies will be held by the Patient Safety, Risk Management and Audit Subgroup when appropriate. This subgroup should regularly liaise with the Clinical Re-design & Training Subgroup when any untoward incidents arise. A Falls Care Plan should be completed following an inpatient incident and this should be re-evaluated as the patient s condition changes in relation to the risks... All patients who experience a fall should be assessed by a doctor and the assessment and care appropriately documented in the medical records. 9. ENVIRONMENT AND EQUIPMENT 9.1 Bedrails Patients receiving care often have impaired mobility and, they may be less aware of their surrounding environment. e.g. dementia, visual impairment, delirium or, those affected by anaesthetics, sedatives, painkillers or other medication. Their ability to stay safely in the middle of the bed can be affected by strokes, paralysis, epilepsy, muscle spasms or other conditions and as such, this puts them at greater risk of falling from the bed. Bedrails are designed to reduce the risk of patients accidentally slipping, sliding, falling or rolling out of bed. Bedrails when used in this way are not classed as restraint. Bedrails will not prevent a patient leaving their bed and falling elsewhere and must not be used for this purpose. In some circumstances the use of safety rails may be due to a temporary state and although the patient may not necessarily be on the falls ICP pathway safety rails may be part of the generic controls used to reduce risk to these patients. This is particularly relevant for patients who may be recovering from heavy sedation, those who have had pre operative medication or recovering from an anaesthetic. Where this is the case the generic assessment that it is appropriate and reasonable to employ the use of safety rails prevails and this does not require individual assessment. Page 12 of 27

13 Where there are other more individual reasons for the use/continued use of bedrails or the patient is on the Falls ICP pathway the Bedrails assessment document in the Falls ICP document should be used to document the decision to use the safety rails. The bedrails assessment in relation to children is included in the Appendices of this policy and should be used to assess the use of bedrails in all children. The patient and their relatives/carers or court appointed deputies or IMCAS should be involved wherever possible in the discussion regarding the use of bedrails. The decision and rationale to use bedrails and conversations with patient and their relatives/carers, court appointed deputies or IMCAS must be fully documented in the patient s care plan and the use of the same must be reviewed at least daily. It is the responsibility of all ward staff to ensure that bedrails are well maintained and have no broken or damaged parts and must fit the bed appropriately. 9.2 Environment Staff need to remember that patients at higher risk of falls must be cared for in an environment that minimises future falls episodes. Where appropriate staff can seek advice on the care and use of the bed/safety rails form the manufacturer in relation to in the management of care of safety rails. All staff must make professional assessments from the care plan as to what equipment may be needed to prevent inpatient falls. Specialist equipment, such as low beds should be considered after a risk assessment has been completed and discussed with the senior nurse to the ward manager or matron. The decision to nurse patients on the mattress on the floor to minimise and control risks that can not be controlled otherwise should always involve a senior member of the nursing or medical staff and include an individual assessment of need and be reported using the Trusts incident reporting system. 10. PATIENT INFORMATION/EDUCATION All patients and/or relatives and carers will be kept fully informed as to progress and effectiveness of any falls interventions and strategies implemented. Staff will have access to education and information will be provided that is relevant to the maintenance of the patient s safety in relation to falls prevention, both as an inpatient, and on discharge. 11. TRAINING FOR STAFF The organisation sees staff training is the most important aspect of falls prevention as without a good understanding of key issues related to in-patient falls, staff (in all departments) cannot make adequate and timely decisions regarding patient care. Training enables staff to respond with confidence and enables them to understand falls prevention and management as well as evidence based best practice. To ensure falls and osteoporosis becomes everybody s business mandatory multi-disciplinary training and falls awareness are key to the effective implementation of this Policy. All staff who undertake patient falls risk assessments within the hospital will receive awareness training on the completion and use of the in-patient falls risk assessment, development of a falls care plan and other relevant documentation identified within this Page 13 of 27

14 Policy. The training needs analysis requirements, delivery mode and monitoring of attendance of this Policy are described in Trust s Mandatory Training and Induction Policy. Requirements include: Identification of relevant staff groups Frequency of training Attendance and follow up of non attendance Monitoring of compliance and the process the organisation will follow should gaps in compliance be identified Although not implemented at present there are proposals to supplement minimum requirements of training with ward based learning and e-learning. Working in conjunction with the Falls & Osteoporosis Programme Board the Clinical Re-design and Training Subgroup will further develop guidance for ward managers and matrons on the necessary Falls Management, Bed Rail Assessment and Falls Integrated Care Pathway training requirements Discussion of falls prevention and reduction strategies and incidents will be held by the Patient Safety, Risk Management and Audit Subgroup when appropriate. This subgroup should liaise with the Clinical Re-design & Training Subgroup when any untoward incidents which indicate training issues to be a factor in the incident, or where audit has been carried out which has monitored the effectiveness of training POLICY DEVELOPMENT & CONSULTATION This policy was developed by the Deputy Director of Nursing in liaison with the Falls Co-ordinator and Risk Manager. The Policy was circulated to the Falls Group and Consultant Lead and comments incorporated before ratification by the Clinical Governance Committee. 13. IMPLEMENTATION AND PROCESS FOR RAISING AWARENESS OF FALLS AND SLIPS TRIPS AND FALLS RELATING TO PATIENTS Support in the implementation of the policy throughout the Trust will be provided by the role of the PCT-managed Falls Coordinator and the Medical Lead for falls management. Policy implementation is maintained through a variety of sources as listed below and at different frequencies: Number of falls reported through Risk Management will include: a) Slips, Trips & Falls b) Patients nursed on floor Use of falls screening tool as per ICP, supported by additional assessment tools dependant on ICP requirements/ guidance Referral of complex cases to Falls Coordinator for advice and support Page 14 of 27

15 Multiple Fallers Medway Alert system in place Reassessment of repeat fallers/ High Risk Patients Regular training and awareness events, via Education and Training department. Raising awareness about preventing and reducing the number of slips, trips and falls involving patients The processes for promotion of staff training and raising awareness of falls management and strategies for the prevention and reduction of falls will be facilitated by the Education and Training Department.. Falls incidents will be reported, by use of incident forms, through agreed Risk Management structures and reports which include information on falls produced for discussion produced including the monthly incident report which is discussed at Risk Management Committee and distributed to Divisional Leads and quarterly risk management report which includes information on any relevant initiatives or changes in practice and is distributed to Risk Management Committee and Clinical Governance and Accountability Committee. There may also be ad hoc promotion through various media such as promotion of the National Falls Safety Week and occasional screensavers and occasional articles in the Closing the circle and staff matters publications. 14. MONITORING (table appendix 6) The mimimum requirements for policy monitoring are decribed in the table Appendix REFERENCES/BIBLIOGRAPHY 1.Collin, C., Wade, D., Davies, S., Horne, V. (1988) The Barthel ADL index: a reliability study. International Disability Studies 10: Department of Health (1997) New NHS, Modern, Dependable. London:HMSO 3.Department of Health (2000) The NHS Plan. London: HMSO. 4.Department of Health (2001) National Service Framework for Older People. London: HMSO. 5.Healey F., Oliver D. (2006) Preventing falls and injury in hospitals: where are efforts best directed? Health Care Risk Reports, NPSA 6.Health Education Authority (1999) Older People Older People and accidents. Fact Sheet 2. London:HEA 7.MHRA Device Bulletin DB2006 (06) The safe use of bedrails. 8.MHRA Device Alert (207/009) Bed Rails and Grab Handles. 9.National Institute of Clinical Excellence (NICE) guidelines for the neurological observation of the patient with head injury Clinical Guideline 56, NICE, September National Patient Safety Agency (2005) Building a Memory: Preventing Harm, Reducing Risks and Improving Patient Safety National Patient Safety Agency (2007), Slips, trips and falls in hospital. Patient Safety Observatory Page 15 of 27

16 12.Oliver, D. (in press June 2006) Assessing the risk of falls in hospital. Time for a rethink? Canadian Journal of Nursing Research 13.Oliver, D., Britton, M., Seed, P., Martin, F., Hopper, A. (1997) Development and evaluation of evidenced based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. British Medical Journal 315: Oliver D., Daly F., Martin F., McMurdo M. (2004) Risk factors and risk assessment tools for hospital in-patients. A systematic review. Age and Ageing 33: Oliver, D., Hooper, A.H., Seed, P. (2000) Do Hospital Fall Prevention Programs Work? A Systematic Review. Journal of the American Geriatrics Society 48: Oliver,D., Healey, F. (2006) Preventing falls and injury in hospitals: the evidence for intervention. Health Care Risk Reports, NPSA 17.Resus Council, Advanced Life Support Guidelines 6th Addition, Tameside Hospital NHS FT. Falls Integrated Care Plan. Version 3.0. Dec St Helens and Knowsley Teaching Hospitals NHS Trust. Policy for the Reduction and management of patient falls (including from height) Version 3. July Salford Royal NHS Foundation Trust. Prevention and Management of Falls Policy. Issue 5. January REVIEW This policy will be formally reviewed 2 years after first approval, or earlier depending on the results of monitoring, audit results, new national guidance or recommended changes in practice. Page 16 of 27

17 Appendix 1 Post Injury Flow Chart Page 17 of 27

18 Appendix 2NICE Head Injury Guidance Page 18 of 27

19 Page 19 of 27

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21 Appendix 3 Protocol for the use of Safety Rails The following guidelines have been developed in line with the NPSA Safer Practice Notice 17 (26/02/07)1, MHRA Device Bulletin 2006 (06) Safe Use of Bed Rails 2 and MHRA Device Alert 2007/ 009 Bed Rails and Grab Handles 3. Tameside Hospital NHS Foundation Trust has established the following guidelines for staff in relation to the use of patient safety rails within the Trust: The guidelines should be used in conjunction with Tameside Hospital NHS Foundation Trust Patient Slips, Trips and Falls policy document, in order to ensure that all possible interventions are taken into account in the maintenance of patient safety with regards to Patient Slips, Trips and Falls The decision to use safety rails to maintain patient safety is the responsibility of the Nurse completing the Safety Rails Risk Assessment Form. (See Falls Nursing Documentation Pack) The decision should be made following an assessment of the patients capacity to consent to/refuse the use of bed rails with reference to the Trust s consent policy and the Mental Capacity Act (2005). If the patient is found to lack capacity to make decisions the family can be involved in the decision making process, and if the patient has no nominated advocate the decision should be made at an MDT meeting. This process should be supported by clear rationalised documentation in the patient s nursing notes, and should include the rationale for the decision to employ safety rails as a means of maintaining patient safety. Review of the use of such rails should be made daily as a minimum and should be based on patients individual requirements. Documentation must include the frequency of which such reviews should be made. The only appropriate use of safety rails is to reduce the risk of patients accidentally slipping, sliding, falling or rolling out of bed. When used in this manner, the use of safety rails is not classed as restraint. e.g. Safety rails should be used to assist a patient to avoid something they do not want to do (fall out of bed) as opposed to stopping a patient from doing something they want to do (get out of bed). All patients should be individually assessed, in relation to cognitive impairment and nature of illness using the Safety rail assessment (page 7 of the Falls Nursing Documentation Pack, previously known as Falls ICP) Further advice and guidance on the use of safety rails should be sought from the Falls Coordinator or relevant Matron Page 21 of 27

22 ADULT SAFETY RAILS ASSESMENT Safety rails are not suitable and should not be used if: - the patient objects - if they are at risk of climbing over/ around them Consider risk of entrapment and if safety can be maintained If it is not suitable to use safety rails, alternative methods must be explored, discussed and documented. All patients with safety rails in situ must be reviewed at least every 24 hours. Document results in nursing notes 1. Could the patient s condition increase the risk of entrapment? 2. Fall prevention: Trust Falls Risk Assessment Tool (FRAT) score Yes No Comments 3. Patient requesting use of bed rails 4. Have safety rails been used previously? 5. Other: (please state) Clinical factors: Yes No Additional Actions (e.g. risk assessments) 6. Is the patient restless? 7. Is the patient drowsy? 8. Is the patient confused? 9. Has the patient a history of falls? 10. Does the patient require continual observation? If the answer to ANY of the above questions is YES follow the plan below Is the patient able to get in and out of bed without assistance? Yes DO NOT USE safety rails (unless at patient request) No Consider use of safety rails Does the patient understand the use of safety rails? Yes No Consent obtained Date/ Time:. Consent from Relative/ Carer Date/ Time:. Outcome Yes No Actioned by Safety Rails to be used at all times Safety Rails to be used only at night Safety Rails to be used State Why: Date Actioned Reviewed by Review Date Call Bell given Start: Sign/Date: Designation: Discontinued: Sign/ Date: Designation Page 22 of 27

23 Appendix 4 Childrens Safety Rail Assessment Cot Side & Safety Rail Assessment Children ONLY Name Age Hospital No. Ward Cot sides or Safety rails should be used for ALL infants and children at risk of falling from the cot/ bed. The cot/ bed should be set at the LOWEST level possible if there is a risk of the infant/ child climbing over the side. The purpose of this assessment is to determine the patient s needs for the use of bed safety rails. The following factors need to be considered and recorded: Where does the child usually sleep at home?... Why are bed safety rails being considered? Fall prevention Patient Safety Y N Other please state... Clinical Factors Is the patient unsettled? Is the patient drowsy? Is the patient unaware of their surroundings? Y N Does the patient have special needs? Please document.. If the answer to any of the above is yes follow the plan below: Does the parent/ carer understand the use of bed safety rails? YES NO Consent obtained YES NO Bed rails to be used To be used at all times Night time use only Bumpers to be used Yes No Date review decision due... Date of review decision...(frequency, refer to care plan) Decision of review/comments. Assessment by..date:.. Page 23 of 27

24 APPENDIX 5 Falls Prevention whilst in Hospital Patient & Carer Information Leaflet Reasons for falls There are a number of reasons for someone falling. These may include: environment Everyone has a role to play in preventing falls What you can do: 1. Bring into hospital any equipment you normally use, such as walking aids. 2. If you have a walking aid, make sure it is in good condition and that you use it rather than using the furniture or walls for balance. Also ensure it is clearly labelled with your name and address. 3. If you have spectacles, please ensure that you bring them with you and only wear your distance ones when walking. Take special care when using bi-focal/vary-focal glasses. 4. Wear comfortable clothing that is not too long or loose. Whenever you are up and about wear comfortable, low heeled shoes, non slip shoes and slippers that fit properly. Ensure that all your items are clearly labelled with your name. 5. Use your call bell when you require assistance and keep it within easy reach. 6. Take your time when getting up from sitting or lying down. 7. Let staff know if you feel unwell or unsteady on your feet. 8. It staff recommend that you need assistance or supervision when moving, please ask for assistance and wait until they come to help you. 9. Familiarise yourself with your bed area, its furniture and where the bathrooms are located. Look out for any hazards such as spills and clutter that may cause a fall and tell staff about these hazards. 10. Keep your fluid levels up by drinking plenty of fluids, as hospitals are very ward and you can easily dehydrate. Advise for carers, relatives and friends For the safety of patients, it would help us greatly if you would report any possible problems in the ward to staff, such as: We would also ask that you: Page 24 of 27

25 them to trip If you have a fall you must inform the staff immediately and they will take action to identify what contributed to the fall. The aim is to reduce the risk of you experiencing another fall. If nursing staff feel it is appropriate you may be assessed by a doctor. The staff may also repeat some or all the falls risk assessments. This may result in changes being made to your care plan. However any changes to your care plan will be discussed with you or your relatives. Remember preventing falls is just as important when you go home. Before you leave hospital you may be referred to our follow up services. They will help make your home safer and help reduce your risk of falling. Page 25 of 27

26 Appendix 6 Monitoring What How Frequency (per year) How the organisation assesses the risk of slips, trips and falls involving patients, staff and visitors (including falls from height How the organisation trains staff, in line with the training needs analysis Compliance with policy requirements for completion of patient falls risk assessments in yearly performance report On admission/ Transfer or following return from hospital leave Repeat risk assessment within one week of the initial Falls risk assessment Risk Assessments relating to Staff and visitor falls will be monitored by, Confirmation of identification of high risk areas Completion of Department checklist Completion of risk assessments identified from the checklist Attendance at Corporate induction and compliance with Mandatory training(health & Safety sessions) Confirmation that falls prevention information is included in Trust induction and mandatory training 1 1 Reporting to Executive Governance or Assurance committee Executive Governance or Assurance committee How awareness is raised about preventing and reducing the number of slips, trips and falls involving patients, staff and visitors Patient falls information is displayed on the ward information notice boards. Falls Safety Calendars 1 Executive Governance or Assurance committee Page 26 of 27

27 APPENDIX 7 EQUALITY IMPACT ASSESSMENT Yes/No Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? no no no no no no no YES yes Yes Yes no no no no Justifiable age 65 plus in line with National recommendations Clinical need requires differing consideration for these groups As above Page 27 of 27