Slips, Trips & Falls Policy

Slips, Trips & Falls Policy Executive or Associate Director lead Policy author/ lead Feedback on implementation to Chief Operating Officer Joel Gordon (Health and Safety Risk Adviser) Joel Gordon (Health and Safety Risk Adviser) Date of draft January February 2013 Dates of consultation period January February 2013 Date of ratification March 2013 Ratified by Executive Directors Group Date of issue April 2013 Date for review April 2016 Target audience All SHSC staff and the Board of Directors Policy Version and advice on document history, availability and storage Policy version 05 This policy is stored and available through the SHSC intranet. This policy is an updated version of the 2010 Slips, Trips, Falls Policy. That policy should now be removed from use. Slip, Trip, Falls Policy (Version 5 2013) Page 1 of 25

Contents: Section Page 1 Introduction 3 2 Scope of this policy 3 3 Definitions 4 4 Purpose of this policy 4 5 Duties 5 6 Specific details 6 6.1 - Organisational arrangements for the assessment of slips, 6 trips, falls involving staff, service users (PATIENTS) and others (including falls from height) 6.2 Actions to be taken by staff to prevent slips & trips 8 6.3 - Organisational arrangements to train staff inline with the 8 Trusts Training Needs Analysis (TNA) 6.4 - Organisational arrangements for raising awareness about 9 preventing and reducing the number of slips, trips and falls involving staff, service users and others 6.5 Reporting incidents of slip, trip and falls 9 6.6 Actions to be taken by the Facilities Directorate 9 7 Dissemination, storage and archiving 10 8 Training and other resource implications for this policy 10 9 Audit, monitoring and review 10 10 Implementation plan 12 11 Links to other policies, standards and legislation 13 12 Contact details 13 13 References 14 Appendix A - Treatment of suspected fracture 15 Appendix B - Multifactorial Falls Risk Assessment 16 Appendix C - Slip and trip risks assessments (not patient 18 specific) Appendix D - Simple steps to reduce slip and trip risks 19 Supplementary Sections: Section A Equality impact assessment form 20 Section B Human rights act assessment checklist 23 Section C and consultation process 25 Slip, Trip, Falls Policy (Version 5 2013) Page 2 of 25

1. Introduction Slips and trips resulting in falls are the most common cause of major injuries in all workplaces in Great Britain and the second biggest cause of over-3-day injuries. Patient falling is the most common patient safety incident reported to the National Patient Safety Agency (NPSA) from inpatient services. According to NHS Employers website, over the last four years, the total estimated cost of reported civil injuries claims for slips, trips and falls involving employees and the public, in or on NHS premises in England, exceeded 25 million. Typical claims averaged around 5,000. Some have been as high as 600,000. Slip, trip and fall incidents can be cut dramatically through good planning, positive management and good housekeeping. The consequences of not doing this are increased risks of: serious injuries to patients and staff higher medical costs and longer waiting lists staff absences due to sickness other associated costs, such as staff replacements increased cost of litigation claims Legislative requirements The Health and Safety at Work etc Act 1974 (HSWA) requires employers to ensure the health and safety of all employees and anyone who may be affected by their work. This includes taking steps to control slip, trip and fall risks. The Management of Health and Safety at Work Regulations 1999 builds on HSWA and includes duties on employers to assess risks (including slip, trip and falls risks) and where necessary take action to safeguard health and safety. The Workplace (Health, Safety and Welfare) Regulations 1992 requires floors to be suitable, in good condition and free from obstructions. People must be able to move around safely. Care Quality Commission (CQC) requirements The CQC has specified in their Core Standards, that: Healthcare services are provided in environments which promote effective care and optimise health outcomes by being a safe and secure environment which protects patients, staff, visitors and their property, and the physical assets of the organisation. NHSLA Risk Management Standards The NHSLA Standards Risk Management Standards require organisations to have an approved documented process for managing the risk associated with slips, trips and falls involving service users, staff and others that is implemented and monitored. Slip, Trip, Falls Policy (Version 5 2013) Page 3 of 25

2. Scope of this policy The policy encompasses the processes required for the prevention of slips, trips and falls. This is a Trust-wide policy which applies to all staff in all Directorates and services without any exceptions. This policy also applies to staff that work in Sheffield Health and Social Care NHS Foundation Trust (SHSC) services but are not employed by SHSC. Where staff employed by SHSC work in services provided by other organisations they have a duty to follow the policies of the organisation they are working in, and comply with their processes. 3. Definitions FALL - A Fall is an event which results in an individual or a body part of the individual coming to rest inadvertently on the ground or any other surface lower than the individual, whether or not an injury is sustained (Cohen & Guin; 1991). SLIP - A Slip is a slide accidentally causing the individual to loose their balance, this is either corrected or causes the individual to fall. TRIP - A Trip is to stumble accidentally often over an obstacle, causing the individual to loose their balance. This is either corrected or causes the individual to fall. Hazard - A hazard can be defined as anything with the potential to cause harm, loss or suffering and can relate to all kinds of situations including clinical treatments or Trust finances as well as traditional health and safety issues. Risks - May affect the whole Trust, Directorate, unit, department or individual. Risks may relate to health and safety, the provision and/or quality of service or care, the finances of the Trust or its reputation etc. 4. Purpose of this policy The Purpose of the policy is to: To enable SHSC to gain assurances that it provides a safe working environment that so far as reasonably practicable, is free from the risk of slips, trips, and falls; To ensure that appropriate systems are in place so that potential slip/trip/fall hazards are identified; To ensure that risk assessments are completed and that appropriate control measures and/or remedial actions are in place; To ensure that staff are aware of the risks and take appropriate actions to prevent falls that result in serious injuries including fractures, to vulnerable service user groups; To ensure staff know what immediate actions to take in the event of an actual or suspected fall. Slip, Trip, Falls Policy (Version 5 2013) Page 4 of 25

5. Duties Trust Board The Trust Board has ultimate responsibility and ownership for health and safety, its implementation within the Trust and ensuring its effectiveness in the management of good health and safety practice and safe environment for staff, service users, volunteers, visitors and contactors. Chief Operating Officer Overall accountability for patient safety is with the Chief Operating Officer. Clinical and Service Directors Clinical and Service Directors will ensure that systems are in place to reduce and control manual handling risk and are monitored for effectiveness. They will support their departmental and line managers to discharge their duties as described in this policy. More specifically: Ensure that all departmental and line managers are aware of the policy and are supported in implementing the policy throughout the Trust; Ensure that departmental & line managers fulfil their obligations to manage the risk from slips, trips and falls. Ensure that processes are in place to raise awareness regarding falls; Ensure that for all staff and service user groups there are prevention/reduction strategies in place for slips, trips, and falls (including working at height). That information relating to the number of Slips/Trips/Falls that occur are collected and the information is analysed to detect trends and to monitor improvements. Building and departmental managers Building and departmental managers must ensure that appropriate risk assessments are completed to identify and manage environmental slips, trips and falls hazards for areas under their control. Falls NICE Guidelines Steering Group The Trust 'Falls NICE Guideline Steering Group' is working within the Trust on the following issues: NICE Falls guidelines 2004 DOH; The use of the Multi Factorial Falls Screening tool for all community and Inpatient areas. Screening tools are to be available for download from Insight (MFFRA tool guidelines); Training package for staff in these areas; Links to city-wide Falls Stakeholder Group; Provision of training packs. Managers All Managers (those managing staff and/or environments) are responsible for: An effective dissemination of the policy information; Liaison with lead clinicians and staff; Ensuring that suitable and sufficient risk assessments are undertaken in accordance with this policy, including control mechanisms; Ensuring corrective actions are implemented and staff are advised of corrective actions taken; Slip, Trip, Falls Policy (Version 5 2013) Page 5 of 25

That the lessons learned and collated information is shared through the Governance framework; Ensuring that this policy and guidance are applied within their sphere of responsibility; Ensuring that staff are aware of and comply with their responsibilities under this policy; Demonstrating that staff have received appropriate training in these arrangements. All Staff All Staff are responsible for: Ensuring that any work they undertake does not create or leave any slip, trip or fall hazards; Ensuring all spillages are cleaned up using appropriate methods for the contaminant (see the Infection Control Policy for further advice); Ensuring other hazards, e.g. defective floor coverings, are appropriately acted upon and reported before going off duty; Ensuring that the workplace /care environment is maintained and kept free from all hazards including slip, trip and fall hazards; Following the guidance in this policy; Following relevant patient / service user care plans and risk assessments; Not putting themselves or the patient / service user at undue risk; Escalating any concerns with slip, trip and fall risks (patient and environment) Supporting improvements to work processes to reduce the risk of Slips Trips and Falls within the workplace/care environment. 6. Specific details 6.1 Organisational arrangements for the assessment of slips, trips, falls involving staff, service users (PATIENTS) and others (including falls from height) In order to ensure that, wherever possible, slips, trips and falls are prevented; managers must ensure that potential slips, trips and falls hazards in the premises have been identified and the risk assessed see the Risk Management Policy for more details. The assessment must consider the typical persons that may be present in the premises e.g. staff, service users, visitors. Wherever necessary, reasonable adjustments to premises and or work activities will be made to accommodate those who may be more at risk from harm. For further information on reasonable adjustments for members of staff, see the Equal Opportunities and Dignity at Work Policy. Service users who are particularly at risk of slips, trips and falls must have a specific assessment in place for them see below. 6.1.1 Risk assessments relevant to service users who are at risk of slips, trips, or falls It is important that all service users are assessed for falls and the multi factorial interventions are realistic and agreed with the service user /carer and are implemented and documented. Slip, Trip, Falls Policy (Version 5 2013) Page 6 of 25

NICE Falls Guidelines (2004) DOH - Screening and multi factorial assessment to be carried out: All service users over 65 years of age or who have a mobility difficulty (irrespective of age), under the care of SHSC, should be screened for falls in line with NICE Guidelines (2004); Osteoporosis screening is included in the Multi-Factorial Falls Risk Assessment tool; Service users with an identified difficulty should be offered multi factorial assessment and interventions; The service user s environment where ever that is should be assessed and adjusted accordingly with the agreement of service users and carers; Identify if the service user has a fear of falling and offer appropriate advice or referral for psychological interventions; A medication review is recommended for service users who are prescribed 4 or more medications; Hydration - refer to hydration tool - available to down load from Insight; Refer service users onto the falls care pathway in the community as appropriate; Provide falls advice and health education information to patients over 65 years; Falls environmental risk assessments will be for In Patient areas to identify improvements if required. 6.1.2 Falls screening tools SHSC Multi Factorial Falls Screening Tools are available to down load from Insight and a copy can also be found in Appendix B of this policy: The falls osteoporosis screening tool is available for Acute In Patient areas, Resource Centres and Community teams; On admission, patients will be screened for falls using the Falls and Osteoporosis Screening Tool. This will then help identify appropriate actions to take. 6.1.3 and Exercise guidelines and Exercise guidelines: Consider a referral to a physiotherapist for assessment of gait and balance; Service users should be given advice and information regarding falls prevention; Falls Health Promotion groups or 1-1 advice and information; Maintaining physical activity is important for general health reasons. Exercise is recommended for service users to improve balance and strength. This can be undertaken in groups or 1-1 sessions; Walking groups are available in the community, consider referral. 6.1.4 General principals for slips, trips, and falls risk assessments staff, service users and others Risk assessment process specific for slips, trips or falls (also see Appendix C): Local risk assessments should identify any potential hazards; The risk assessment should consider staff, service users, contractors and visitors who may be affected by the risks identified; The risk assessment should also consider falls from heights, eg step ladders. (Use the Trust Risk Management Strategy guidance to completing a Risk Assessment). Ensure that the Trust 'Falls and Osteoporosis Screening Tool' is appropriately implemented and used throughout all clinical services in relation to individual service users; Ensure that any environment contributory factors relating the Slips/Trip/Falls risk assessments are recorded via the local risk assessment / risk register process; Slip, Trip, Falls Policy (Version 5 2013) Page 7 of 25

Check that control measures to reduce or eliminate the risk as far as reasonably practicable are identified; Assess adequacy of control measures and a residual risk grading; Identify remedial actions required where appropriate and implement; Appropriate action plans and remedial actions are to be developed and managed via the risk assessment / risk register process; Risks which are identified to have a residual risk grading at Moderate or above, using the Trust risk assessment tool, are reported via the Trust Risk Management Processes and are recorded on the Directorate Risk Register; Ensure that staff working in inpatient areas or within community services caring for service users at risk from slips trips and falls, are familiar with the Protocol in Appendix A 'Treatment of a Suspected Fracture'; Ensure that processes are in place to raise awareness regarding fall prevention/ reduction including the risks involved in working at height, in all areas and for all staff and service user groups. 6.2 Actions to be taken by staff to prevent slips, trips, and falls Actions to prevent slips trips and falls (also see Appendix D): Be vigilant and ensure any slip/trip/fall hazards that they become aware of are reported to their line manager or the person in charge as a minimum, ensuring that the immediate area is safe and that appropriate warnings are in place. Any defects should be reported to estates hot line; Ensure that any spillages are reported and cleaned up also that appropriate signage is used to warn people of the hazards (e.g. Wet Floor). For blood or bodily fluid spillages refer to infection control policies and guidance; Ensure appropriate assessments are in place especially for service users identified as at risk of falls regarding bed/chair height and condition Ensure that for all service users identified as at risk of falls, an appropriate assessment of their needs and the environment they are being cared for is completed; Equipment and assistive technology will be provided when identified by the clinical area; Ensure they wear suitable footwear for the task they are carrying out (refer to trust dress code or local risk assessment including need to wear PPE); Encourage service users to wear suitable footwear (i.e. well fitting slippers/shoes with a back) and if they have been identified as having mobility problems, and ensure such service users are adequately supervised when walking; Ensure that all patient and staff traffic areas are kept free from obstruction and clutter i.e. equipment, trailing cables, packaging and disposal bags for laundry and waste; Maintain high standards of housekeeping to ensure that all areas are free from potential trip hazards and clutter; Ensure that any equipment being used does not present a potential trip hazard i.e. trailing cables. 6.3 Organisational arrangements to train staff inline with the Trusts Training Needs Analysis (TNA) The Trust provides suitable training for staff in relation to slips, trips and falls that affect staff, patients and others (including falls from height) and is included in the Training Needs Analysis (TNA). Slip, Trip, Falls Policy (Version 5 2013) Page 8 of 25

The training needs for staff groups have been analysed and detailed in the Trusts TNA. Managers have delegated responsibility and accountability to ensure their staff complete mandatory training identified in the TNA. All staff are required to attend appropriate training programmes identified in the TNA and as identified by their line manager. For further information also see Mandatory Training Policy. 6.4 Organisational arrangements for raising awareness about preventing and reducing the number of slips, trips and falls involving staff, service users and others The following mechanisms are used by the Trust for raising awareness about preventing and reducing the number of slips, trips and falls involving staff, others and patients: Training, Induction and refresher courses provided for clinical and non-clinical staff via mandatory and ad-hoc training; The Trusts Falls webpage; Falls Newsletter quarterly; Falls Resource packs available for In Patient areas and Community Teams; Internal initiatives and campaigns to reduce harm and risk, e.g. via the Trust CQUINs targets; The Trust Falls Group will communicate relevant information to managers and staff; Health and Safety Committee will analyse incidents and risks, and agree and disseminate information; Incident statistics, risk assessments and investigation outcomes/lessons learnt disseminated to managers for discussion/review at team meetings; Good practice information is published on the intranet; Dissemination of external safety alerts/guidance e.g. NPSA, MHRA, DH Estates and Facilities, Health and Safety Executive, IOSH Healthcare Group; Availability of the Falls Environmental Checklist. 6.5 Reporting incidents of slips, trips and falls Reporting incidents of slips trips and falls: If a slip, trip, or fall occurs in relation to a service user then it shall be recorded as a Patient Safety Incident (PSI) and reported as such, inline with the Trust Incident Reporting and Investigation Policy; If a slip, trip, or fall occurs in relation to a staff member then it shall be reported using the Trust Incident Reporting and Investigation Policy; If a slip, trip or fall occurs where significant environment factors contribute to or cause the incident then these shall be recorded on the Trust Incident Reporting Form when reporting the incident. In addition the environment factor causing the slip/trip/fall should immediately be reported to the manager or person in charge and the area made safe. Once the area has been made safe the problem should be reported to the Facilities Directorate Direct Link line for remedial actions to be completed. 6.6 Actions to be taken by the Facilities Directorate The Directorate will: Ensure liaison with Service Directorates to provide advice on current good practice to be followed when introducing new or refurbished premises or other environment design adaptations. To include floor surfaces and orientation aids to assist service users with cognitive or visual impairments Ensure facilities staff and contractors are effectively monitored in order to reduce slips trips and falls hazards that may be created by the work they undertake Ensure that Trust roadways and pathways especially service user traffic areas, receive appropriate treatment during adverse weather conditions (i.e. Slip, Trip, Falls Policy (Version 5 2013) Page 9 of 25

snow and ice) in order to reduce the risk of slips, trips and falls Ensure that regular inspections of Trust car parks, roads, paths, and any other staff or service user traffic areas are undertaken by a competent person and that appropriate remedial actions are taken should any hazard be identified Ensure there is appropriate levels of lighting in general areas is in order to reduce the risk of individuals misjudging flooring or not seeing contaminates 7. Dissemination, storage and archiving Links to an electronic copy of the policy shall be circulated via a trust-wide email. An electronic copy of the policy shall be accessible via the Trust Intranet. An archive copy of the previous policy and the new updated policy shall be stored with the Integrated Governance Department for reference. 8. Training and other resource implications for this policy Training associated with this policy is outlined in the Trust s Mandatory Training Policy and is identified within the Trust s Training Needs Analysis. This stipulates that all staff will receive awareness training around prevention and reduction of slips, trips and falls as part of their core mandatory induction training programme. Refresher training is provided as defined within the Training Needs Analysis. Any ward, team based training should include the use of the Trust s screening tools for falls, where these cover community and in-patient areas. All training on falls should include the use of the Protocol 'Treatment of a Suspected Fracture' (Appendix A). Staff who are required to assess the environment for Slip Trip and Falls risks will receive appropriate training as outlined in the Trust s Mandatory Training Policy and included in the Training Needs Analysis. 9. Audit, monitoring and review Monitoring of slip, trips and falls should be through the directorate and information reported to the directorate's service governance group Information regarding slip, trip and fall incidents and accidents reported through the Trust reporting process will be available from the Integrated Governance department. Directorates will be asked to provide a quarterly monitoring report to the Integrated Governance department so that information can be supplied to the Quality and Risk Group and the Trust Board as appropriate. Quality & Risk Group Safety Sub-group will assist the Trust Falls Group and support managers in raising awareness about preventing and reducing incidences of slips, trips or falls. It is the responsibility of all Managers (those managing staff and/or environments) to ensure that appropriate risk assessments of the work place environment are in place and that including working height they are regularly reviewed and updated. Slip, Trip, Falls Policy (Version 5 2013) Page 10 of 25

It is the responsibility of all Ward Managers, Team/Clinical Nurse Managers to ensure that appropriate risk assessments for the work place and any environment where care is provided, are in place and that they are regularly reviewed and updated It is the responsibility of all Ward Managers, Team/Clinical Nurse Managers to ensure that a falls assessment as part of the service user admission process to any service and that they are actively aiming to reduce falls in their particular environment. Audit- Aim is to reduce service user falls within the Trust: Falls are reported via the serious incidents reporting mechanism and information collated and disseminated through the Directorates for reviewing and learning; The SHSC Trust is part of the National Audit on Falls; The screening tools are reviewed in line with national guidance and practice based evidence. Policy to be reviewed in 3 years or earlier should any changes in local or national requirements or guidance or lessons learned. NHSLA Risk Management Standards - Monitoring Compliance Template Minimum Requirement Duties Process for Monitoring Appraisals/ Supervision Responsible Individual/ group/ committee Line managers Frequency of Monitoring Annual Review of Results process (e.g. who does this?) Line managers/ Appraisees Responsible Individual/group/ committee for action plan development Line managers/ Appraisees Responsible Individual/group/ committee for action plan monitoring and implementation Line managers How the organisation assesses the risk of slips, trips and falls involving staff and others How the organisation trains staff in line with the training needs analysis How the organisation raises awareness about preventing and reducing the number of slips, trips and falls involving staff and others Review of department risk assessments Review of training compliance Review of all awareness arrangements Ward/Team managers Department Department / Health and Safety Risk Adviser Annual Annual Annual Ward/Team managers, Directorate Governance Groups Department Department / Health and Safety Committee Directorate Governance Groups Group Group / Health and Safety Committee Directorate Governance Groups, Health and Safety Committee Group Group / Health and Safety Committee Slip, Trip, Falls Policy (Version 5 2013) Page 11 of 25

NHSLA Risk Management Standards - Monitoring Compliance Template Minimum Requirement Duties How the organisation assesses the risk of slips, trips and falls involving patients (including falls from height) How the organisation trains staff in line with the training needs analysis How the organisation raises awareness about preventing and reducing the number of slips, trips and falls involving patients Process for Monitoring Appraisals/ Supervision Audit and review of department risk assessments Review of patient specific risk assessments Audit & review of training compliance Review of all awareness arrangements Responsible Individual/ group/ committee Line managers Ward/Team managers Department Department / Health and Safety Risk Adviser Frequency of Monitoring Annual Annual Ongoing patient assessments Annual Annual Review of Results process (e.g. who does this?) Line managers/ Appraisees Ward/Team managers / Directorate Governance Groups / Falls Group / Falls Leads Department Department / Health and Safety Committee Responsible Individual/group/ committee for action plan development Line managers/ Appraisees Directorate Governance Groups / Falls Group, Group Group / Health and Safety Committee Responsible Individual/group/ committee for action plan monitoring and implementation Line managers Directorate Governance Groups / Falls Group Service User Safety Group Group Group / Health and Safety Committee 10. Implementation plan To be disseminated to appropriate managers throughout their directorates within 2 weeks of ratification. All staff working in any inpatient area or within community service caring for clients at risk from slips trips and falls should attend appropriate in-house training regarding the prevention of slips, trips as part of a planned programme. Where directorates run ongoing refresher training programmes then consideration should be given to including a session on the prevention of slips, trips and falls. Slip, Trip, Falls Policy (Version 5 2013) Page 12 of 25

Action / Task Responsible Person Deadline Progress update Put new policy onto intranet Health and safety Risk 19/04/2013 and remove old version Adviser Make team and Directors aware of new policy Inform all trust staff of the revised policy via Trust-wide email Reference revised policy in Risk Management related training Health and safety Risk Adviser Health and safety Risk Adviser Health and safety Risk Adviser & and Training Department 19/04/2013 19/04/2013 19/04/2013 11. Links to Other Policies Risk Management Strategy Health and Safety Policy Incident Reporting and investigation Policy Control of Infection Policy (Cleaning up of spillages) Trust Dress Code (Footwear) SHSC Trust multi-factorial Falls Screening Tools - available on Insight 12. Contact details Title Name Phone Email Trust Falls Lead Joint Elaine Hall Elaine.hall@shsc.nhs.uk Professional Lead Occupational Therapist (Chair of Falls Steering John John.tomlinson@shsc.nhs.uk Group) Tomlinson Professional Lead Occupational Elaine Hall 18754 Elaine.hall@shsc.nhs.uk Therapist (Chair of Falls Steering Group) Health & Safety/Risk Joel Gordon 30 50761 Joel.gordon@shsc.nhs.uk Adviser Clinical Risk Manager Carol O Neill 16371 carol.oneill@shsc.nhs.uk Senior Nurse - Patient Safety Facilities Directorate Direct Link line Charlie Turner 63377 Charlie.Turner@shsc.nhs.uk 18181 Occupational Health 0114 271 4161 Slip, Trip, Falls Policy (Version 5 2013) Page 13 of 25

13. References The Health and Safety at Work etc Act 1974 HSE, L21 Management health and Safety at Work Regulations 1999 Approved Code of Practice and Guidance HSE, L24 Workplace (Health, Safety and Welfare) Regulations 1992 Approved Code of Practice and Guidance NICE Guidelines (2004), DH - Screening and multi factorial assessment CQC, Core standards NHSLA Risk Management Standards (2012/13), Standard 3 - Criterion 3 & 4 DH (2006), Health Technical Memorandum 61: Flooring HSE (2003), Slips and trips in the health services. Health services information sheet No.2 (HSIS2) HSE, INDG 225 Preventing slips and trips at work Court of Appeal case (2007), Ellis v Bristol City Council: suitability of flooring. Slip, Trip, Falls Policy (Version 5 2013) Page 14 of 25

Appendix A Management of Person Found on Floor (In-Patients) LEAVE ON FLOOR CALL FOR HELP Check level of consciousness: Alert; Responds to Voice; Pain; Unresponsive Check condition: Airway, Breathing Circulation If unresponsive / unconscious Send helper to call an emergency ambulance Try to ascertain what has happened Is there bruising or other injury? Is the person in pain? Could they have hit their head? Consider potential for spinal injury. DO NOT ATTEMPT TO MOVE THE PERSON UNTIL FULLY ASSESSED SUSPECTED FRACTURE There may be: Pain or tenderness Loss of power (eg cannot move fingers) Swelling and / or bruising Deformity (out of shape) Irregularity (shortening of limb) Unnatural movement Crepitus (grating) Open wound If suspected or if in doubt send helper to call ambulance give specific details e.g. suspected fracture of the upper leg Tell person to keep still Steady the limb with your hands above and below fracture site Continue to monitor response and breathing Be aware of possible shock Do not give anything to eat or drink Do not move unnecessarily SUSPECTED HEAD INJURY If conscious carry out observations using the Early Warning Score (EWS) and/or Glasgow Coma Scale (GCS). Consider contacting a doctor or if concerned consider emergency ambulance 30 MINUTES AFTER BEING FOUND Carry out observations using EWS/GCS Is there deterioration? Increased confusion? Agitation? Dizziness? Vomiting? If concerned consider emergency ambulance Continue with 30 minute observations (until GCS is equal to 15) 2 HOURS AFTER BEING FOUND Look for any changes in the person s condition. Carry out observations as above and continue hourly thereafter until reviewed by doctor. Look for signs of head injury e.g. vomiting, persistent headache. If in doubt consider Accident & Emergency Department If there is NO INJURY assess the best way to help the person from the floor. If there is any pain or change in condition when moving STOP and reassess. Continue to monitor for any deterioration. COMPLETE AN INCIDENT FORM AND OTHER RELEVANT DOCUMENTS Slip, Trip, Falls Policy (Version 5 2013) Page 15 of 25

Appendix B Client Name: DOB.. NHS no Professional Name Multifactorial Falls Risk Assessment. LEVEL 2 Sheffield Integrated Falls Pathway. Name of Professional: Signature Date. Designation: Base / Service: Contact no. Information collected from: Patient / Carer Consider mental capacity / best interests when explanation of assessment given & consent obtained. Client Name: Address: Cons: Hospital no. NHS no. GP: Address: DOB: Ward: Tel no: Signature.. Date. History of Falls: How many falls in last 6 months? Activity at time? When? Where? Pattern? Tel: Unexplained further assessment required Explained and further assessment required Any signs of infection? Eg ear, chest, UTI Ref to Doctor Date: Any black outs or loss of consciousness before falling? Ref to Doctor / Specialist services Any dizziness before falling? Taking BP: Lie patient flat for 5 mins and record. Then repeat at 1 & 3 mins in standing. Any dizziness on standing or turning? Lying BP = Standing 1 min = 3 min = Symptomatic on standing? Ref to Dr (name) Taking four or more medications and no recent review? Taking drugs associated with increased falls risk? Started on any new drugs / dose? Ref to Doctor / Pharmacist for review name eg sleeping tabs, antidepressants, antihypertensives, antipsychotics, antiparkinson s, diuretics when?... Bone Health: Known to have Osteoporosis? Any bone fracture since the age of 40? Ref to Doctor for further assessment / investigation / Calcium and Vit D Taking oral steroids or have done previously? therapy. Concern of Falling: FES I (short) Score = Ref to : - Client concerned about falling or has poor confidence Therapy services..... with mobility? Citywide Care Alarms + / or Telecare Cognitive Impairment / Mental Capacity: Any memory problems? Any Anxiety / Depression? Known to Mental Health (MH) Services Vision: Wears glasses? Any change in vision? Has related pathology? Hearing: Wears hearing aid /s? MMSE = HADS: A = D = Ref to MH Services / Doctor.. Check glasses are clean. Recommend annual vision check. Brincliffe House have list of domiciliary opticians (Tel: 2263114) Check hearing aid works. Check for ear wax. Ref to Audiology / Hearing Services Slip, Trip, Falls Policy (Version 5 2013) Page 16 of 25

Continence Is there a problem? Day / Night Has appropriate aids? Access to commode / toilet / night light? Hydration Any signs of dehydration? Any dizziness? Any UTI? Nutrition Any reduced appetite / intake? Any difficulties eating? eg dentures Any special dietary needs? Alcohol Is intake above recommended units? Feet / footwear Foot problem inhibiting gait / balance Unstable, loose, or poorly fitting shoes worn? Pain If Urinary / Faecal continence assessment needed:- Ref to nurse or specialist service. Referral for commode. Recommend 8 (250mls) glasses of water per day. Referral to Doctor... Give healthy eating advice. Ref to Dietetic Services S&LT for swallowing Dental Services Equipment to facilitate eating Provide sensible drinking advice. Consider ref to local specialist support service. If yes for either / both: Ref to Podiatry / Orthotic services for treatment Advice given re suitable footwear Check analgesics taken correctly. Date: Is pain affecting mobility? Where is the pain?.. Functional ability Problem with PADL? Problem with DADL? Need for Home Assessment identified? Problem with mobility? Ref to Doctor for analgesia review. Consider referrals to service for: - Therapy - Social Services - Equipment / Adaption Elderly Mob Scale = Home Hazards Home environment checked? Any problems with stairs? Any other identified issues? Gait and Balance Is there a problem with balance? Is there a problem with muscle strength / joint ROM? Is there a problem with gait? Is mobility aid appropriate & used safely? Strategies following a Fall Able to move about & get up from the floor independently? Able to summon help? Know how to keep warm / relieve pressure if have a long lie? Following this Level 2 assessment does the cause of falls remain unclear? (Ref to Level 3 Specialist Services by GP/Cons) Additional Information: Ref for Equipment: Aids & adaptions: Ref to Stay Put: Other TURN180: Steps= Touches = Otago level = Timed Up and Go = secs Ref to Physiotherapy for assessment, Otago Exercises or Assessment for mobility aid Teach Backward Chaining Method or refer to Physiotherapy: Consider referral to CWCA/Telecare: Advice & strategies discussed: Consider: referral to Community Geriatrician / liaison with GP or ward medical staff Multifactorial Assessment completed on Date: Signature:.. If referring on to other services on the pathway send a copy of this Level 2 Multifactorial Assessment & any other relevant documents / assessments / outcome measures. Ensure any referrals made are documented. Slip, Trip, Falls Policy (Version 5 2013) Page 17 of 25

Appendix C Slip and trip risks assessments (not patient specific) (Source: HSE guidance document: INDG 225 Preventing slips and trips at work) All employers have to assess the risks to employees and others who may be affected by their work, eg visitors and members of the public. This helps to find out what needs to be done to control the risk. It is also needed to satisfy the law. HSE recommend a five-step approach to risk assessment, and slip and trip risks should be among the risks examined. Step 1 Look for slip and trip hazards around the workplace, such as uneven floors, trailing cables, areas that are sometimes slippery due to spillages. Include outdoor areas. Step 2 Decide who might be harmed and how. Who comes into the workplace? Are they at risk? Do you have any control over them? Remember that older people and people with disabilities may be at particular risk. Step 3 Consider the risks. Are the precautions already taken adequate to deal with the risks? Step 4 Record your findings if you have five or more employees. Step 5 Regularly review the assessment. If any significant changes take place, make sure existing precautions and management arrangements are still adequate to deal with the risks Slip, Trip, Falls Policy (Version 5 2013) Page 18 of 25

Appendix D Simple steps to reduce slip and trip risks NB: The Trusts Health & Safety Inspection Checklist must still be completed as required) There are many simple steps you can take to reduce risks. You will find a few examples below. (Source: HSE guidance document: INDG 225 Preventing slips and trips at work) Hazard Spillage of wet and dry substances Suggested Action Clean spills up immediately, if a liquid is greasy, make sure a suitable cleaning agent is used. After cleaning the floor can be wet for some time; dry it where possible. Use appropriate barriers to tell people the floor is still wet and arrange alternative bypass routes. If cleaning is done once a day, it may be possible to do it last thing at night, so it is dry for the start of the next shift. Trailing cables Miscellaneous rubbish, eg plastic bags Rugs/mats Poor lighting Slippery surfaces Change from wet to dry floor surface Changes of level Slopes Smoke/steam obscuring view Unsuitable footwear Position equipment to avoid cables crossing pedestrian routes, use cable covers to securely fix to surfaces, restrict access to prevent contact. Consider use of cordless tools. Remember that contractors will also need to be managed. Keep areas clear, remove rubbish and do not allow it to build up. Ensure mats are securely fixed and do not have curling edges. Improve lighting levels and placement of light fittings to ensure more even lighting of all floor areas. Assess the cause and treat accordingly, for example always keep them dry if wet causes the problem. In certain situations you may have to treat them chemically and use appropriate cleaning method etc. Provide suitable footwear, warn of risks by using signs, locate doormats where these changes are likely. Try to avoid. If you can t, improve lighting, add high visible tread nosings (ie white/reflective edge to step). Improve visibility, provide hand rails, use floor markings. Eliminate or control by redirecting it away from risk areas; improve ventilation and warn of it. Ensure workers choose suitable footwear, particularly with the correct type of sole. If the type of work requires special protective footwear, the employer is required by law to provide it free of charge. Slip, Trip, Falls Policy (Version 5 2013) Page 19 of 25

Supplementary Section A - Stage One Equality Impact Assessment Form Please refer back to section 6.5 for additional information 1. Have you identified any areas where implementation of this policy would impact upon any of the categories below? If so, please give details of the evidence you have for this Grounds / Area of impact People / Issues to consider Type of impact Description of impact and reason / evidence Negative (it could disadvantage) Race People from various racial groups (e.g. contained within the census) No No Gender Male, Female or transsexual/transgender. Also consider caring, No No parenting responsibilities, flexible working and equal pay concerns Disability The Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a substantial and longterm effect on a persons ability to carry out normal day-to-day activities. This includes sensory impairment. Disabilities may be visible or non visible Positive (it could advantage No Yes This policy will make sure that both patients and staff with disabilities are assessed and appropriate control measures are put in place to minimise the risk of harm and reasonable adjustment. Sexual Orientation Lesbians, gay men, people who are bisexual No No Age Children, young, old and middle aged people No Yes This policy will make sure that the elderly, who are at increased risk of falls are assessed and appropriate control measures are put in place to minimise the risk of harm. Religion or belief People who have religious belief, are atheist or agnostic or have a philosophical belief that affects their view of the world. Consider faith categories individually and collectively when considering possible positive and negative impacts. No No 2. If you have identified that there may be a negative impact for any of the groups above please complete questions 2a-2e below. 2a. The negative impact identified is intended OR 2b. The negative impact identified not intended 2c. The negative impact identified is legal OR 2d. The negative impact identified is illegal OR (see 2e) (i.e. does it breach antidiscrimination legislation either directly or indirectly?) 2e. I don t know whether the negative impact identified is legal or not Slip, Trip, Falls Policy (Version 5 2013) Page 20 of 25

(If unsure you must take legal advice to ascertain the legality of the policy) 3. What is the level of impact? HIGH - Complete a FULL Impact Assessment (see end of this form for details of how to do this) MEDIUM - Complete a FULL Impact Assessment (see end of this form for details of how to do this) X LOW - Consider questions 4-6 below 4. Can any low level negative impacts be removed (if so, give details of which ones and how) N/A 5. If you have not identified any negative impacts, can any of the positive impacts be improved? (if so, give details of which ones and how) No 6. If there is no evidence that the policy promotes equality and equal opportunity or improves relations with any of the above groups, could the policy be developed or changed so that it does? No 7. Having considered the assessment, is any specific action required - Please outline this using the pro forma action plan below (The lead for the policy is responsible for putting mechanisms in place to ensure that the proposed action is undertaken) Issue Action proposed Lead Deadline Slip, Trip, Falls Policy (Version 5 2013) Page 21 of 25

8. Lead person Declaration: 8a. Stage One assessment completed by :. (name). (signature) (date) 8b. Stage One assessment form received by Patient experience and Equality Team..(date) 8c. Stage One assessment outcome agreed. (sign here).... (Head of Patient Experience and Equality) OR (date agreed) 8d. Stage One assessment outcome need review.. (sign here).... (Head of Patient Experience and Equality).. (date returned to policy lead for amendment) (if review required please give details in text box below) If a full EQIA is required the stage 1 assessment form should be retained and a completed EQIA report submitted to the relevant governance group for agreement by the chair. The chair will forward the completed reports to the Patient Experience and Equality team for publication. Any questions relating to the completion of this form should be directed to the Head of Patient Experience and Equality. Slip, Trip, Falls Policy (Version 5 2013) Page 22 of 25

Supplementary Section B - Human Rights Act Assessment Form and Flowchart You need to be confident that no aspect of this policy breaches a persons Human Rights. You can assume that if a policy is directly based on a law or national policy it will not therefore breach Human Rights. If the policy or any procedures in the policy, are based on a local decision which impact on individuals, then you will need to make sure their human rights are not breached. To do this, you will need to refer to the more detailed guidance that is available on the SHSC web site http://www.sct.nhs.uk/humanrights-273.asp (relevant sections numbers are referenced in grey boxes on diagram) and work through the flow chart on the next page. 1. Is your policy based on and in line with the current law (including caselaw) or policy? Yes. No further action needed. No. Work through the flow diagram over the page and then answer questions 2 and 3 below. 2. On completion of flow diagram is further action needed? No, no further action needed. Yes, go to question 3 3. Complete the table below to provide details of the actions required Action required By what date Responsible Person Slip, Trip, Falls Policy (Version 5 2013) Page 23 of 25

Human Rights Assessment Flow Chart Complete text answers in boxes 1.1 1.3 and highlight your path through the flowchart by filling the YES/NO boxes red (do this by clicking on the YES/NO text boxes and then from the Format menu on the toolbar, choose Format Text Box and choose red from the Fill colour option). Once the flowchart is completed, return to the previous page to complete the Human Rights Act Assessment Form. 1.1 What is the policy/decision title?.. 1 1.2 What is the objective of the policy/decision?.. 1 1.3 Who will be affected by the policy/decision?.. 1 Will the policy/decision engage anyone s Convention rights? YES Will the policy/decision result in the restriction of a right? 2.2 YES 2.1 NO NO Flowchart exit There is no need to continue with this checklist. However, o Be alert to any possibility that your policy may discriminate against anyone in the exercise of a Convention right o Legal advice may still be necessary if in any doubt, contact your lawyer o Things may change, and you may need to reassess the situation Is the right an absolute right? 3.1 YES NO 4 The right is a qualified right Is the right a limited right? YES 3.2 Will the right be limited only to the extent set out in the relevant Article of the Convention? 3.3 NO YES 1) Is there a legal basis for the restriction? AND 2) Does the restriction have a legitimate aim? AND 3) Is the restriction necessary in a democratic society? AND 4) Are you sure you are not using a sledgehammer to crack a nut? YES NO Policy/decision is likely to be human rights compliant BUT Policy/decision is not likely to be human rights compliant please contact the Head of Patient Experience, Inclusion and Diversity. Get legal advice Regardless of the answers to these questions, once human rights are being interfered with in a restrictive manner you should obtain legal advice. You should always seek legal advice if your policy is likely to discriminate against anyone in the exercise of a convention right. Access to legal advice MUST be authorised by the relevant Executive Director or Associate Director for policies (this will usually be the Chief Nurse). For further advice on access to legal advice, please contact the Complaints and Litigation Lead. Slip, Trip, Falls Policy (Version 5 2013) Page 24 of 25

Supplementary Section C - Record of consultation Name of Policy Slip, Trip Falls Policy Date Name of Policy Lead Joel Gordon Contact Details Consultation Plan: This policy will be issued to those who will play a significant part in the prevention of slips, trips, falls within the Trust. Typically these are: NICE Guidelines Falls Group, nominated Risk Leads, Estates Managers/Head of Departments, Senior Nurse / Patient Safety, Clinical Risk Manager. Is this a big change to a current policy or a new policy? NO If NO If YES Consultation via email and discussion at relevant governance groups is sufficient Consider a wider consultation process eg with focus groups, attendance at team or directorate meetings RECORD OF CONSULTATION (interactive) Group or individual consulted Date of consultation/ response received Comments on draft policy Your response (say if policy amended if not, say why not) NICE Guidelines Falls Group & Health and Safety Committee. February 2013 Needs clearer reference to the use of the Multifactorial Falls Risk Assessment Policy amended. Slip, Trip, Falls Policy (Version 5 2013) Page 25 of 25