Policy relating to the prevention and management of slips, trips and falls for patients Incorporating the guidance on the safe and effective use of bedrails
Policy Title: Executive Summary: Policy relating to the prevention and management of slips, trips and falls. Incorporating the guidance on the safe and effective use of bedrails This policy will provide guidance for all staff regarding the prevention of slips, trips and falls in the Trust. The policy contains documents required for the effective assessment of patients in the Trust and incorporates the guidance for the safe use of bed rails. Supersedes: This policy should be read in conjunction with the Policy Schedule and the compliance monitoring tool. Falls & restraint policy Description of Review Amendment(s): This policy will impact on: Trust wide impact on all clinical staff. Policy Area: Clinical Practice Document Reference: Version Number: 2 Effective Date: July 2012 Issued By: Author: Consultation: Director of Nursing and Performance Matron Intermediate Care (falls lead) APPROVAL RECORD Committees / Group Deputy Director of Nursing and Performance Heads of Nursing Acute and Community Clinical Lead for Falls Matrons Associate Directors Review Date: July 2015 Date June 2012 Approved by Committee: Risk Management Group September 2012 Approved by Director Received for information: Director of Nursing and Performance OMT August 2012 2
Contents Page: 4 Policy Statement 4 Aims & Objectives 5 Scope 5 Organisational Responsibilities 7 Planning & Implementation 9 Monitoring & Audit 9 Review Appendix 10 (1) Prevention and management of in patient slips, trips and falls including the guidance on the safe use of bed rails 16 (2) Falls risk assessment 18 (3) Falls care plan 19 (4) Flow chart for the use of bed rails 20 (5) Alternatives to bed rails 21 (6) Risk assessment contraindications to the use of bed rails 22 (7) Check list for the use of bed rails 23 (8) References 24 (9) Equality Impact Assessment 3
1.0 Policy Statement East Cheshire NHS Trust is committed to patient safety and is actively working to reduce the number of patient falls (including falls from height) sustained in the Trust. Although the majority of falls may lead to no harm, even falls without injury can lead to loss of confidence, and increased length of hospital stay. There is clear guidance that all health care settings must work towards reducing the number of falls, which result in serious injury and ensure that there is effective treatment and rehabilitation for those who have fallen (NSF 2001).The Trust accepts that although achieving zero falls is not realistic (as not all falls are preventable) it is committed to reducing the number of preventable falls year on year via a process of risk assessment, staff training and education and the use of other falls prevention methods as appropriate. The Trust also recognises that any prevention/risk management needs to be balanced with the goals of promoting independence and rehabilitation of patients wherever possible. Falls prevention within the Trust is a multidisciplinary issue involving the patient, their family/carers, nurses, doctors and allied health professionals. It is the responsibility of all staff to familiarise themselves with this policy and assist the Trust in the reduction of the number of slips, trips and falls experienced by it s patients every year. Also by following the guidance contained in this policy it is envisaged that the Trust will avoid the inappropriate use of bed rails. 2.0 Aims & Objectives The aim of this policy is to reduce the number of patient falls in the Trust, in both bedbased services and across the community settings, to prevent serious injury and ensure effective treatment for those who have fallen. This policy will also ensure that the Trust complies with the requirements of the National Service Framework for Older People, Standard 6: Falls. The aim of this policy is also to give assurance to the Trust Board and Trust Stakeholders, that the Trust has systems in place, which will minimise the risk of slips, trips and falls experienced by it s patients, and thereby protect its reputation amongst the population it serves, risks to its finances by minimising claims for compensation, and the potential for harm to patients suffering injury The implementation of this policy will aim to: - Reduce the risk of falls to patients by undertaking a comprehensive falls assessment. - Incorporate a falls risk assessment tool and care plan into the processes underpinning the admission or assessment of patients entering the care of the Trust. - Target interventions for high risk patients to minimise the risk of falling. - Develop the skills and competence of practitioners with regard to falls assessment and management. - Reduce the number of falls that result in harm including serious injury or death. - Evaluate and measure the impact of falls interventions and approaches. With regards to the safe and effective use of bed rails the aims are: - To reduce harm to patients caused by falling from beds or becoming trapped in bedrails; - To support patients and staff to make individual decisions around the risks of using and of not using bedrails 4
- To ensure compliance with Medicines and Healthcare related products Agency (MHRA) and National Patient Safety Agency (NPSA) advice. 3.0 Scope This policy is relevant for all staff caring for patients in East Cheshire NHS Trust. It relates to all situations where the use of bed rails is being considered to prevent a fall from a bed. 4.0 Organisational Responsibilities 4.1 Chief Executive The Chief Executive is the Accountable Officer of the Trust and as such has overall accountability and responsibility for the implementation and monitoring of the policies in use in the Trust. The Chief Executive has delegated overall responsibility for the prevention and management of falls to the Director of Nursing Performance and Quality. 4.2 Director of Nursing and Performance and Quality The Director of Nursing, Performance and Quality is responsible for: Ensuring that effective systems are in place to support appropriate risk assessment and care planning to manage those risks as far as is reasonably practicable. Monitoring overall performance in relation to falls incidents ensuring that trends, themes and contributory factors are identified and reported appropriately 4.3 Director of Corporate Affairs and Governance Has Trust Board responsibility for all aspects of risk management including the management of risk register and setting the framework for the reporting and the management of incidents, ensuring the Trust complies with national, regional and local reporting arrangements 4.4 Deputy Director of Corporate Affairs and Governance Will monitor the systems in place for giving assurance to the Trust Board that the there are appropriate controls in place for reducing the potential risk of slips, trips and falls within the Trust. 4.5 Clinical Risk Manager Is responsible for the initial processing and escalation of incident reports on datix as per the incident management policy and will provide data as requested for the analysis of patient slips, trips and falls within the Business Units. 4.6 The Head of Estates Operations Will ensure that any provisions made for the control of environmental issues related to patient slips, trips, falls and hazards are implemented in the new or refurbished premises and will monitor their upkeep to ensure ongoing control. 4.7 Associate Directors Associate Directors will ensure (via delegation to service managers, matrons and ward managers) that all falls are fully investigated and appropriate measures are taken to prevent recurrence. They will ensure that action plans developed after Serious Incidents and Root Cause Analyses are implemented in a timely manner and will have systems in place for giving assurance to the Trust Board that there are systems in place for reducing the risk of slips trips and falls within the services for which they are responsible 5
4.8 Service managers Will ensure that that all falls are fully investigated and appropriate measures are taken to prevent recurrence and appropriate risk assessments and controls have been put in place to reduce the likelihood of patient Slips trips and falls in the services for which they are responsible 4.9 Team Leaders/Ward Managers Team leaders and ward/department managers are responsible for Ensuring that the policy is adhered to in the clinical setting and that there is a clear process of dissemination ensuring that the appropriate assessment and documentation relating to falls is used for all patients in their areas. Ensuring that if a patient falls, this is reported on the recognised incident reporting tool ( datix) in accordance with Incident Reporting Policy. Ensuring falls incidents are investigated appropriately. Reviewing incident trends in relation to patient falls. Addressing local issues related to patient falls. Ensuring that all staff are encouraged and released for training as per the training needs analysis. Monitoring compliance with the Falls Policy in their clinical areas using the Patient Metrics Audit Tool. Preparing Root Cause Analyses reports for Serious Falls. 4.10 Registered nurses Registered nurses in acute (in-patient) areas are responsible for: Undertaking a falls risk assessment for all adult inpatients within 6 hours following admission Undertaking an initial bedrail assessment for all patients where bed rails are considered to reduce the likelihood of falls and update it when there is a change in clinical condition, following any fall or weekly if no change Initiating hourly comfort rounding for patients at high risk of falling Repeating a falls risk assessment on any inter-hospital ward transfer, when there is a change in clinical condition, following any fall or weekly if no change Ensuring that the multidisciplinary team is aware of patients at risk of falls or who have fallen by using handovers and Safety Briefings. Reporting patient falls using the recognised incident reporting tool (datix) in accordance with the Trust Incident Reporting Policy Ensure all new patients are oriented to ward layout, and how to use the call-bell system, on admission. Patients / relatives must be advised regarding appropriateness of footwear for the hospital environment on admission if problems have been identified, so that alternatives might be provided as necessary. Ensure ongoing environmental checks are undertaken to minimise hazards that could increase falls risk e.g. suitable levels of lighting, obstacles, wet floors etc. Ensure compliance with agreed preventative measures is ongoing, and that any deviations are documented. In relation to Registered Health Professionals in community areas: 6
It is at the discretion of the health care professional with responsibility for the care/management of the patient to identify if a Falls Risk Assessment is required to be undertaken on admission to caseload Undertaking an initial bedrail assessment for all patients where bed rails are considered to reduce the likelihood of falls and update it when there is a change in clinical condition, following any fall or weekly if no change Reporting patient falls using the recognised incident reporting tool (datix) in accordance with the Trust Incident Reporting Policy Patients/relatives must be advised regarding appropriateness of footwear for the community environment on admission to caseload if problems have been identified, so that alternatives might be provided as necessary. Ensure environmental checks are undertaken to minimise hazards that could increase falls risk e.g. suitable levels of lighting, obstacles, wet floors etc. 4.11 The Trust Lead for Falls Will ensure that policy and guideline development on reducing falls rates is matched to national standards Will oversee project work in reducing the incidents of patients falling. Will review existing data and monitor the improvements in falls rates after relevant improvement work. Will identify and address any ongoing communication issues linked to the management of falls Agree training needs for all relevant staff enabling them to reduce the risk of patients falling, including the content and materials for a suitable and effective training programme. Will raise awareness about reducing and preventing patient falls. Will review Root Cause Analysis for Serious Falls, identify key learning issues and ensure that these are cascaded and/or incorporated into policy development. Is responsible for the assessment of equipment used within the Trust to reduce the risks of patient falls and offer expert advice regarding safety and compatibility issues that may arise. 5.0 Planning and Implementation Appendix 1 details the processes in place for the assessment of patients in the Trust and what actions are to be taken post fall as well as guidance on the use of bed rails 5.1 Acute/in patient areas (adults) 5.1.1 All adult in-patients will have an individual Patient Falls Risk Assessment Tool undertaken on admission (Appendix 2) 5.1.2 The risk assessment should be reviewed weekly as a minimum, or after a fall, change in condition or ward move and care planned will be fully documented in the patient records. 5.1.3 All adult patients where bed rails are considered will have a bed rails risk assessment completed (and other related documents see appendix: 4, 5, 6, 7) and this will be updated when there is a change in clinical condition, following any fall, on any ward move or weekly if no change 5.1.4 All patient assessed as high risk will be commenced on hourly comfort rounding 7
5.1.5 All patients identified as at risk will be given the Trust Falls Prevention in Hospital leaflet 5.1.6 Additional assessments/referrals may be required for individual patients e.g. Occupational Therapy, Physiotherapy, vision assessments, suitability of footwear, continence, nutrition, risk of osteoporosis. These additional assessments and subsequent interventions will be documented. Consideration will be given to the risk of patient falls from height in respect of potential falls from chairs. Therapy staff will be able to assist in assessing the patients for a suitable chair/seating system. 5.1.7 The patient s next of kin/carers must be made aware of the findings of the Patient Falls Risk Assessment, and advised of any issues that require attention while the patient is an in-patient e.g. the provision of suitable footwear, availability of spectacles etc. 5.1.8 Patients assessed to be at risk of falls must be reviewed for their need for a home assessment prior to discharge from hospital. In some cases it may not be appropriate to provide a home or environmental assessment. This is a clinical decision which is made by the Occupational Therapy team depending on individual patients' needs. 5.1.9 The Discharge Summary sent to the patient s General Practitioner (GP) on their discharge must clearly identify when a high risk of falls is identified during the hospital stay, so that the patient can receive additional support in the community as required. 5.1.10 Bed rails should be used with extreme care and only after all alternatives have been excluded, a full risk assessment (and other related documents see appendix: 4, 5, 6, 7) carried out, and a checklist completed and signed by the member of staff responsible for the assessment. 5.1.11 It is important to ensure that any in-patient who falls in the Trust is assessed by a suitably qualified practitioner as soon as possible after the event. It is also important that patient s relatives/next of kin are informed that a fall has taken place and informed of the condition of the patient post fall 5.1.12 Patients may be at risk from falls from height (beds/chairs/commodes/toilets) and these areas of risk must be considered as part of the risk assessment and care planning process. 5.1.13. On discharge from hospital the level of falls risk should be communicated to the patient, family and relevant others and documented on the discharge summary 5.2 Community areas: 5.2.1 It is at the discretion of the health care professional with responsibility for the care/management of the patient to identify if a Falls Risk Assessment is required to be undertaken on admission to caseload (appendix 2) 5.2.2 The risk assessment should be reviewed at the discretion of the health care professional with responsibility for the patient dependent on the individual needs/condition of the patient. There is an expectation that a repeat risk assessment would be undertaken if there is a significant change/deterioration in the patient s condition of if the patient experiences a fall 5.2.3 The patient s next of kin/carers must be made aware of the findings of the Patient Falls Risk Assessment, and advised of any issues that require attention e.g. the provision of suitable footwear, availability of spectacles etc. 8
5.2.4 Additional assessments / referrals may be required for individual patients e.g. Occupational Therapy, Physiotherapy, vision assessment, suitability of footwear, continence, nutrition, risk of osteoporosis. These additional assessments and subsequent interventions will be documented. Consideration will be given to the risk of patient falls from height in respect of potential falls from chairs. Therapy staff will be able to assist in assessing the patients for a suitable chair/seating system. 5.2.5 All adult patients on caseload where bed rails are considered will have a bed rails risk assessment (and other related documents see appendix: 4, 5, 6, 7) completed and this will be updated when there is a change in clinical condition, following any fall or weekly if no change 5.2.6 Bed rails should be used with extreme care and only after all alternatives have been excluded, a full risk assessment (and other related documents see appendix: 4, 5, 6, 7) carried out, and a checklist completed and signed by the member of staff responsible for the assessment. 5.2.7 It is important to ensure that any patient who falls in the community is assessed by a suitably qualified practitioner as soon as possible after the event. Consideration should be given by community staff to contacting of the patients GP to request a home visit or calling the emergency services for assessment/transportation of patients to hospital as appropriate. 5.2.8 It is also important that patient s relatives/next of kin are informed that a fall has taken place and the post fall condition of the patient. 5.2.9 Community patients may be at risk from falls from height (beds /chairs/commodes/toilets) and these areas of risk must be considered as part of the risk assessment and care planning process. 5.3 All staff involved in the management of patients at risk of a fall or fracture will have access to information and support to enable them to comply with the policy. This policy is available on the trust intranet 5.4 Staff are able to contact the Trust Lead for Falls (currently the Matron for Intermediate Care) for advice regarding the management of complex cases 5.5 Training will be provided to staff on the prevention and management of slips trips and falls as per the training needs analysis. 5.6 Children (see appendix 1) 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 bed rail assessment included in the appendices of this policy. There may also be children who are particularly vulnerable to falling due 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 6.0 Monitoring and Audit Please see the compliance monitoring tool for more information 7.0 Review This policy will be reviewed on a three yearly basis by the Trust lead for falls 9
Appendix 1 Prevention and Management of Patient Falls in East Cheshire NHS Trust including the guidance on using bedrails safely and effectively 1. Procedure for the assessment of patients (this will consider the risk of falls from height: bed, chair, commode, toilet): (a) In-patients: Patient admitted to Trust 4 Screening questions asked on admission/within 6 hours Screening questions = no Any 1 or more screening question = yes File assessment in records, monitor patient during their stay Change in condition (increased risk) or patient falls (b) Community patients Patient admitted to caseload Complete full risk assessment (appendix 2) Complete falls care plan Review/update RA & care plan: post fall/if condition changes or weekly The action to consider section of the falls risk assessment identifies all the interventions that should be considered in order to reduce the risk of further falls. The action plan informs the care plan and should be referred to in the care plan Falls risk assessment carried out Appropriate controls put in place as applicable Appropriate advice given to relatives/carers Review/update RA & care plan: post fall/if condition changes or as indicated on care plan 10
(c) Children Child admitted to the ward Admission document reviews child s mobility status Any mobility issues identified (that may or may not impact on the patients falls risk) are discussed with parents Care plan developed to address care needs and risks to the patient 2. What to do in the event of a patient fall 2.1 The fall should be recorded in the patient s medical notes and the doctor in charge of the patient s case informed at the earliest opportunity. 2.2 For community patient s assessment should be undertaken for the presence of actual or potential injury and then consideration given to contacting the patients GP to request a home visit or calling the emergency services for assessment /transportation of patients to hospital as appropriate. The details of the fall and the outcome of assessment should be recorded in the patient records. Any unresolved risk factors should be discussed with the doctor/ambulance service. 2.2 After the usual checks to eliminate any injury, tests to establish any contributory factors should be done (infection, postural hypotension, hypoglycaemia and medication) and eliminated as a cause. 2.3 Falls in patient areas or witnessed falls in a community setting should be clearly documented and reported on an incident report via datix 2.4 If a falls risk assessment has not been completed, it should be done. If the assessment had been completed, it should be reviewed and updated. 2.5 Patient relatives/nok should be informed 3.0 The safe and effective use of bed rails 3.1 Bedrails should only be used to reduce the risk of a patient accidentally slipping, sliding, falling or rolling out of a bed (preventing falls from height). Bedrails used for this purpose are not a form of restraint. Restraint is defined as the intentional restriction of a person s voluntary movement or behaviour. Bedrails will not prevent a patient leaving their bed and falling elsewhere, and should not be used for this purpose. Bedrails are not intended as a moving and handling aid. 3.2 Patients in hospital or community settings may be at risk of falling from bed for many reasons including poor mobility, dementia or delirium, visual impairment, and the effects of their treatment or medication. 3.3 Decisions about bedrails need to be made in the same way as decisions about other aspects of treatment and care. This means: 11
The patient should decide whether or not to have bedrails if they have capacity. Capacity is the ability to understand and weigh up the risks and benefits of bedrails once these have been explained to them Staff can learn about the patient s likes, dislikes and normal behaviour from relatives and carers, and should discuss the benefits and risks with relatives or carers. However, relatives or carers cannot make decisions for adult patients (except in certain circumstances where they hold a Lasting Power of Attorney extending to healthcare decisions under the Mental Capacity Act 2005); If the patient lacks capacity, staff have a duty of care and must decide if bedrails are in the patient s best interests. 3.4 East Cheshire NHS Trust does not require written consent for bedrail use, but discussions and decisions should be documented by staff. 3.5 Bedrails used for community patients are supplied by the approved supplier of community equipment, it is the responsibility of the supplier to ensure that the bedrails are compatible with the bed in use and that they are safe, fit for purpose and maintained appropriately. 4.0 Individual patient assessment for bed rails 4.1 There are different types of beds, mattresses and bedrails available, and each patient is an individual with different needs. 4.2 Bedrails should not usually be used: if the patient is agile enough, and confused enough, to climb over them; if the patient would be independent if the bedrails were not in place. 4.3 Bedrails should usually be used or considered: if the patient is being transported on their bed; in areas where patients are recovering from anaesthetic or sedation and are under constant observation. 4.4 However, most decisions about bedrails are a balance between competing risks. The risks for individual patients can be complex and relate to their physical and mental health needs, the environment, their treatment, their personality and their lifestyle. Staff should use their professional judgement to consider the risks and benefits for individual patients: If bedrails are not used, how likely is it that the patient will come to harm? Ask the following questions: How likely is it that the patient will fall out of bed? How likely is it that the patient would be injured in a fall from bed? Will the patient feel anxious if the bedrails are not in place? If bedrails are used, how likely is it that the patient will come to harm? Ask the following questions: Will bedrails stop the patient from being independent? Could the patient climb over the bedrails? Could the patient injure themselves on the bedrails? Could using bedrails cause the patient distress? Use bedrails if the benefits outweigh the risks. 4.5 Decisions about bedrails may need to be frequently reviewed and changed. For example, a patient admitted for surgery may move from being independent to semi- 12
conscious and immobile whilst recovering from anaesthetic and then back to being independent in the course of a few hours. Even stable patients in rehabilitation or mental health settings can have rapidly changing needs when physical illness intervenes. Therefore decisions about bedrails should be reviewed whenever a patient s condition or wishes change, but as a minimum reviewed every day. 4.6 Alternatives to bedrails must always be considered prior to use and the alternatives to bed rails document must be completed (appendix 5). The document contraindications to the use of bed rails (appendix 6) must be used during the assessment and the document filed in the nursing notes. 5.0 Documentation The documentation currently in use in the Trust consists of: Falls risk assessment appendix 2 Falls care plan appendix 3 Flow chart for the use of bed rails appendix 4 Alternatives to bed rails appendix 5 Risk assessment contraindications to the use of bed rails appendix 6 Check list for the use of bed rails appendix 7 The decision to use or not use bedrails should be recorded as a standard part of East Cheshire NHS Trust s patient documentation and kept at the patient s bedside/in the patients home. Once a decision to install bed rails is made, this checklist (appendix 7) must be completed and filed with the nursing notes for ease of reference. A review date must be included and re-assessments carried out as planned Exceptions include ITU/HDU, A&E, and theatres or during transport/transfer where bedrail use is standard practice. In these settings only exceptions to normal practice need be documented. 6.0 Using bedrails 6.1 East Cheshire NHS Trust has taken steps to comply with MHRA advice through ensuring that: all unsafe have been removed and destroyed; all bedrails or beds with integral rails have an asset identification number and are regularly maintained types of bedrails, beds and mattresses used on each site within the organisation are of compatible size and design, and do not create entrapment gaps for adults within the range of normal body sizes except for 6.2 Whenever staff use bedrails they should carry out the following checks: For all types of bedrail: Are there any signs of damage, faults or cracks on the bedrails? If so, do not use and label clearly as faulty and have removed for repair; Is the patient an unusual body size? (e.g. hydrocephalic, microcephalic, growth restricted, very emaciated). If so, check for any bedrail gaps which would allow head, body or neck to become entrapped. If using detachable bedrails: the gap between the top end of the bedrail and the head of the bed should be less than 6cm or more than 25cm; the gap between the bottom end of the bedrail and the foot of the bed should be more than 25cm; the fittings should all be in place and the attached rail should feel secure when raised; 7.0 Reducing risks 13
7.1 For patients who are assessed as requiring bedrails but who are at risk of striking their limbs on the bedrails, or getting their legs or arms trapped between bedrails, bed rail bumpers should be used 7.2 If a patient is found in positions which could lead to bedrail entrapment, for example, feet or arms through rails, halfway off the side of their mattress or with legs through gaps between spilt rails, this should be taken as a clear indication that they are at risk of serious injury from entrapment. Urgent changes must be made to the plan of care. These could include changing to a special type of bedrail or deciding that the risks of using bedrails now outweigh the benefits. For community patients bed rails should not be used unless the patient is supervised. 7.3 If a patient is found attempting to climb over their bedrail, or does climb over their bedrail, this should be taken as a clear indication that they are at risk of serious injury from falling from a greater height. The risks of using bedrails are likely to outweigh the benefits, unless their condition changes. 7.4 The safety of patients with bedrails may be enhanced by frequently checking that they are still in a safe and comfortable position in bed, and that they have everything they need, including toileting needs. However, the safety needs of patients without bedrails who are vulnerable to falls are very similar. All patients in hospital settings will need different aspects of their condition checked, for example, breathlessness, anxiety and pain. Consequently, observing patients with bedrails should not be treated as a separate issue but as an important part of general observation within each ward/department. 7.5 Beds should usually be kept at the lowest possible height to reduce the likelihood of injury in the event of a fall, whether or not bedrails are used. The exception to this is independently mobile patients who are likely to be safest if the bed is adjusted to the correct height for their feet to be flat on the floor whilst they are sitting on the side of the bed. 7.6 Beds will need to be raised when direct care is being provided. Patients receiving frequent interventions may be more comfortable if their bed is left raised, rather than it being constantly raised and lowered. 8.0 Supply, cleaning, purchase, and maintenance 8.1 East Cheshire NHS Trust aims to ensure bedrails, bedrail covers and special bedrails can be made available for all patients assessed as needing them. 8.2 Bedrails and bumpers are available on all wards. 8.3 The manager of the ward/department should be told of any shortfall. They will endeavour to release bedrails from patients who no longer need them. If bedrails cannot be obtained, staff should explore all possible alternatives to reduce the risk to the patient, and report the lack of equipment via the incident reporting system. 8.4 Metal/plastic bedrails should be cleaned if visibly contaminated by using soap and water 8.5 They should be cleaned between patients by using soap and water 8.6 Bedrail bumpers should be cleaned by using soap and water 8.7 Detachable bedrails no longer needed should be removed from beds and stored in an area of the ward that has been deemed (by the ward manager) as a safe area to do so 14
8.8 New beds, bedrails or mattresses can introduce new risks if they are not fully compatible with existing stock. To reduce this risk, all purchases orders for beds, bedrails, or mattresses of designs not already in use within East Cheshire NHS Trust will be forwarded by the Trust s stores/purchasing department for authorisation by the falls coordinator/medical devices coordinator before the Trust s stores/purchasing department will process the order. 8.9 When special mattresses are hired, the requisition form requires the make and model of bed/bedrail to be stated, and the company renting the mattress will be asked to confirm the mattress is compatible with the bed and bedrail. 8.10 Bedrail maintenance for in patient areas is the responsibility of the Estates Department and all bedrails are asset identified (or are an integral part of beds which are asset identified 8.11 Bedrails used for community patients are supplied by the approved supplier of community equipment, it is the responsibility of the supplier to ensure that the bedrails are compatible with the bed in use and that they are safe, fit for purpose and maintained appropriately. 9.0 Education and Training The Trust Falls Lead will ensure that staff are informed with regards to preventing and reducing the number of slips, trips and falls (including the risk of falls from height) in the Trust. This will be done via: participation in national falls week education and training for staff as per the training needs analysis 15
APPENDIX 2 FALLS RISK ASSESSMENT Affix patient label Date Has the patient had a fall in the past 12 months? Yes No Yes No Is the patient taking 4 or more medications? Does the patient have difficulty mobilising? Does the patient have balance problems? If the answer to any of these questions is yes complete further assessment below Date Initial Sex (circle one only) Male 1 Female 2 Age (Circle one only) Under 60 0 60-70 1 71-80 2 81plus 3 Gait (circle all that apply) Steady 0 Hesitant 1 Poor transfers 2 Unsteady 3 Sensory Deficit (Circle all that apply) Poor eyesight/wears glasses 2 Balance problems 2 Poor Hearing/Wears hearing aid 1 Falls History (circle one only) None 0 Indoor fall 2 Outdoor fall 1 Both 3 Medication (circle all that apply) Sleeping tablets 1 tranquilizers 1 Blood pressure tablets 1 Water tablets 1 4 or more medications per day 1 No medications 0 Medical History (circle all that apply) Diabetes 1 Dementia/acute confusion 1 Fits 1 TIA/CVA 1 Incontinence 1 Neurological disease/parkinsons 1 Mobility (circle one only) Restricted 3 Uses aid 2 Fully Mobile/Bedbound 1 Social Circumstances (circle one only) Lives alone or is main carer 3 Is in residential care 3 Has care package/social support 2 Lives with carer/spouse 1 Total 3-8 =Low Risk 9-15 = Medium Risk 16+= High Risk Action Checklist On initial Review Review Review Review assessment Date Date Date Date Risk Risk Risk Risk Risk Medications reviewed by doctor Footwear supportive and well fitting Falls prevention leaflet given Glasses/Hearing aid to hand if required Plus below for medium and high risk patients Observations recorded Consider referral for osteoporosis risk and treatment Refer to physio Refer to OT Plus below for high risk patients Nurse patient in observable area Record lying and standing BP Consider use of falls alarm Assess need for 1-1 nursing Sign if yes Sign if yes Sign if yes Sign if yes Sign if yes If you are considering nursing the patient on the floor a full risk assessment must be completed. Explain to the patient and inform their relatives at the earliest opportunity and document in the nursing notes 16
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Appendix 3 Core Care Plan Care plan to be reviewed on a daily basis by registered health care professional Care Plan Name of Staff Commencing Care Plan Number 1 Care Element At risk of falls Desired Outcome To maintain safety, reduce the risk of falls and minimise harm Care / Action Plan MEDIUM RISK Complete falls risk assessment and update weekly, more frequently if required Place in easily observable part of the clinical area Maintain bed at lowest level Keep curtains open when not in use or when patient unattended Request provision of appropriate, well fitting footwear Liaise with physiotherapy and occupational therapy for aids, exercises 2 hourly comfort rounding Provide falls leaflet HIGH RISK OF FALLS or POST FALL Visual identification / communication e.g falling leaves sign Hourly comfort Rounding Use of commode tagging Liaise with Pharmacy for medication review Lying and Standing BP to be recorded as directed Use falls monitor Use glide and lock sheets when sitting in a chair If bed rails an option, then risk assessment to be completed Reassess for need for High/Low bed Encourage family members to participate in their care Ensure information is communicated at safety brief Track and Trigger monitoring as planned Required Yes / No Patient ID Label Discontinued Date / Sig Recommenced Date / Sig 18
Appendix 4 Summary Flow Chart - Use of Bed Rails * Patient at high risk of falling out of bed Consider alternatives to bed rails see appendix 4 Alternative found No alternative found Document in the Care Plan, inform relatives and patient Are there any contraindications to bed rails? see appendix 5 Yes No Bed rails may NOT be fitted Complete Checklist see appendix 6 Fit rails and document in the Care Plan * Bed rail / bed side rail / cot sides / side rails / safety rails Review daily 19
Appendix 5 Alternatives to Bed Rails Patient Name:.. Ward:. Date:.. Cushioning on the floor/crash mats Mattress on the floor Bed that lowers to the floor/ lowest bed available Body positioning devices/mattress wedges Increased supervision/ frequent observations Bed in observable position Call bell to hand Regular toileting Movement sensors Investigate causes of agitation Review medications Night lighting Offer to tuck the sheets in if patient is afraid of falling out of bed Increased risk of bed rails discussed with relatives Other alternatives: please state Considered Yes No Not available Consider placing the bed against the wall away from heat source but this has other implications Bed rails are not the same as bed grab handles (bed leaver), which are aids to movement. Bed grab handles are not designed to prevent patients falling from the bed and should not be used for this purpose 20