CPOL72 Adult Falls Prevention and Management Policy by Provide Community

Adult Falls Prevention and Management Policy

Version: V5

Ratified By: Quality & Safety Committee

Date ratified: 28/09/2017

Job Title of Author: Ward Matron Therapy Staff Practice Development Nurse

Reviewed by Sub Group or Expert Group: Other Expert Group

Equality Impact Assessed by: Ward Matron Therapy Staff Practice Development Nurse

1. Introduction

Each year around 282,000 patient falls are reported to the National Patient Safety Agency (NPSA) from hospitals and mental health units. A significant number of these falls result in death, severe or moderate injury including around 840 fractured hips, 550 other types of fracture, and 30 intracranial injuries.

The (NPSA) has carried out extensive research into patient falls in both acute and community settings.

This policy;

• Takes this research into account and is compliant with the recommendations and guidance issued by the NPSA, (slips trips and falls in hospitals)

• Takes into account the recommendations made in the Rapid Response notice NPSA/2011/RRR001 and is compliant with the alert

• Recognises the need to manage patients appropriately post fall and sets out what staff must do following all patient falls

• Sets out for all staff the use of bed rails in falls prevention and when the use of bed rails is appropriate.

2. Purpose

The purpose of this policy is to:-

• Ensure that when assessing patients for falls risk the appropriate tools and pathways are incorporated

• Establish a multidisciplinary approach to falls prevention and management to ensure effective, timely, and multi-factorial interventions when necessary

• Reduce environmental risk factors where possible by using effective assessment, management, and intervention

• Support patients to remain independent, empowered and achieve their health and well-being goals as safely as possible

• Support person centred planning to reduce the risk of a fall

3. Definitions

Inpatients: Inpatients are all those occupying a bed where services are delivered by Provide CIC

Outpatient: Patients attending a clinic held by any Provide CIC service or patients attending an outpatient clinic hosted by Provide staff.

Domiciliary Patient: A patient being cared for by a Provide CIC service within their place of residence.

Bedrail: The term bedrails is used within this policy to describe rails attached to the sides of adult beds. Bedrails may also be referred to as ‘side rails’, ‘bed guards’ or ‘safety rails’.

Fall: An unexpected event in which a person comes to the ground or other lower level with or without loss of consciousness.

Slip: A slip is to slide accidentally causing the individual to lose their balance; this is either corrected or causes an individual to fall. May occur when liquid has been spilt or when the sole of the footwear and floor are unsuited.

Trip: A trip is to stumble accidentally often over an obstacle or uneven surfaces causing the individual to lose their balance, this is either corrected or causes an individual to fall.

Falls Alarms: an early alert device to notify staff a patient is leaving their bed, chair, toilet or commode ; whereby there is a risk a patient may fall if unaccompanied or without use of specialist equipment. Restraint free, discreet placement monitor to promote dignity and privacy. These should be risk assessed prior to use to ensure appropriate for the patient and not likely to cause distress. The falls alarms can also be used with pagers to create a silent alert.

4. Duties

Provide recognises its responsibilities to all service users and the importance of providing a care environment that is safe. Provide will protect all service users with a proactive approach to the prevention of falls using a multifactorial approach to reducing the risk. Provide also recognises the need for a coordinated approach to the assessment and treatment of patients following a fall. This policy sets out the pathway that all staff will follow to both prevent patient falls and the actions required following a fall.

Chief Executive Officer

The Chief Executive officer is ultimately responsible for ensuring that Provide has systems to collect aggregate and analyse data in relation to falls and be able to respond to findings.

Provide Board

Provide Board is responsible for reviewing data and associated processes and learning in order to be satisfied that appropriate measures have been implemented to mitigate risk as far as is reasonably practicable.

Quality & Safety Committee

The Quality and Safety Committee is responsible for reviewing and monitoring all themes and issues in relation to patient falls, this is assurance for the organisation and this information is shared with the Board.

Head of Quality Assurance

The Head of Quality Assurance is responsible for reviewing all incident data and reporting to the Quality and Safety Committee.

Ward Managers and Matrons

Are responsible for implementing actions required following a patient fall, ensuring that risk assessments are updated and that all identified measures required are carried out in line with this policy.

Employees

All staff working within Provide will ensure that they work within the standards as set out in this policy and that any training requirements are raised with their line manager.

5. Consultation and Communication

Consultation for review of this document was held with the Senior Clinical Manager for Community Wards, Ward Matrons, and Therapy Staff.

This policy will be reviewed at least every two years or sooner if the evidence base requires it, e.g. new legislation is passed. The Assistant Director with responsibility for the wards will nominate the appropriate clinicians to review this policy.

Any new statutory provisions affecting this document will automatically take precedence.

Provide C.I.C will

• Monitor the operation of this policy

• Measure its effectiveness by reviewing the Datix submitted, analysing data entered onto a falls dashboard and auditing the completion of inpatient falls assessments

Once ratified, the policy and associated matrices will be placed and maintained within the governance process for procedural documents and made available to all staff.

6. Monitoring

Provide will monitor the operation of this Policy in order to: -

• Comply with Provide’s legal obligations

• Comply with best practice in line with National Guidance

• Highlight practical issues and seek solutions

Compliance of falls risk assessments for inpatients and community settings is audited By Provide Quality and Safety Team and reported to service commissioners.

Incident Review Group

The harm free care panel will review any severe or moderate fall which has occurred on the inpatient wards. This will ensure that falls taking place in Provide care are not as a result of the care in place and that there is assurance that every measure has been taken in relation to prevention.

Any fall reported in to Datix which requiresreview at Incidentreview group will be organised and supported by Quality and safety team

Provide see this as a positive way of engaging with clinicians and assuring safe levels of care are in place to inform improvement as required.

7. Procedure for Falls Prevention and Management

All patients admitted to Provide inpatient wards:

• Must have multifactorial falls risk assessment carried out as part of the initial assessment on admission within 6 hours

• A multifactorial risk assessment has multiple components that aim to identify a person’s risk factors for falling

The falls risk assessment will need to be reviewed every 7 days or sooner if the service user:

• Experiences a fall

• Condition deteriorates

• Condition improves

• Medication changes are made which could increase the likely hood of the patient falling

• If transferred to another clinical area within Provide

For older people in contact with non-inpatient clinical services who are identified at risk of falls, the staff member should undertake relevant actions to reduce the risk of falling which may include referral to other services.

When assessing a patients risk of falls staff will consider the following:

Floor surfaces - Wet, slippery or uneven

Flooring patterns - Can cause an illusion of slopes or steps to a patient with impaired eyesight

Lighting - Sudden changes from dim to bright light, accessibility of light switches

Door handles/Grab Rails – Design and ease of use to aid stability

Trip Hazards – Wires, cables and general clutter

Patient bed position – Position for ease of regular observation

Distance - particularly to bathrooms and increase of need to use a bathroom

Call Bell – Must be within reach and able to be used, if not consider how the patient can alert a staff member that they need assistance

Equipment - Ensure that equipment and furniture is stable and brakes are functional

Organisation – Appropriate positioning of supplies and equipment to reduce time spent collecting

Spillages – Immediate clearing up and use of hazard signs

Beds - must be to their lowest level unless this would reduce mobility or independence, when in use with brakes applied

Care Plans - must clearly demonstrate that the patient and family where appropriate, were included and agree with the strategies implemented

Falls risk information - With the patient’s permission relatives and carers should be made aware of the risk of falls and the care that had been implemented to mitigate this. The patient, relatives and carers need to be made aware that while we are doing all we can to reduce the risks of falling it is impossible to entirely remove this risk

Leaflet - All patients and relatives will be given the leaflet, helping prevent patient falls, on admission as recommended by the NPSA

Bed rails – See bed rails matrix – Appendix 1

1:1 Nursing - Where a patient is at very high risk of falling and all other interventions have been instigated but there is still a significant risk then 1:1 nursing should be considered and implemented if appropriate. If this is required discussions must be held with the Senior Nurse on duty

Mental Capacity - If a patient lacks capacity and requires a 1:1 nursing a deprivation of liberty (DOL’s) must be completed and safeguarding team involved. Where patient lacks in mental capacity an MCA must be in place if using alarm devices or more nursing interventions.eg 1:1

Footwear – Must be checked before mobilising to ensure well-fitting and appropriate

Eyesight - Spectacles should be clean and worn when mobilising

Hearing - If a patient requires a hearing aid it should be correctly fitted and checked to ensure it is working

Mobility Aid - Staff will ensure that it is suitable, safe and fit for purpose. It should be marked for the individual and kept close at hand for the patient at all times

Mobility Concerns - Any concerns about a patient’s mobility must be referred to a physiotherapist or occupational therapist for advice and guidance

In order to be able to carry out a full risk assessment for a patient at risk of falling, staff must be aware of the patient’s medications and the side effects of these. Some medications such as hypnotics, anti- depressants, anti-psychotics, diuretics, antihypertensive and anxiolytics may lead to an increased risk of falls. All medications should be reviewed by the Doctor on admission.

All patient handovers, Board Rounds and Multi-Disciplinary Team meetings MDT’s must include information around falls when appropriate and any new strategies used for individual patients.

Use of Bedrails in Relation to Falls Prevention

• Bed rails are used extensively in hospitals and may also be known as cot sides or safety rails though to avoid confusion the preferred title should be bed rails. They can be either integral to a hospital bed or attached and detached as required. There are many types of bed rail that can be applied to a bed

• Bed rails should be used to reduce the risk of a patient accidentally slipping, sliding, falling or rolling out of bed. Bed rails used for this purpose are not a form of restraint

• It is important to note that bed rails will not prevent a patient leaving their bed and falling elsewhere, and should not be used for this purpose. Bed rails are for use in prevention patients falling out of bed and not for use to stop patients getting out of bed and falling

• When bedrails are to be used a risk assessment must be carried out to show that the patient has been individually assessed and why bed rails are appropriate

• If a patient or relative requests the use of bed rails, full nursing/therapy and risk assessments must be carried out. If bedrails are identified as not being required, this decision must be explained to the patient and relatives and an appropriate alternative to bedrails be sought and used. This should be documented within the patient record

• Any patient who has bed rails in use must be reassessed on a daily basis to ensure their individual needs are still being met.

•

8. Medical Responsibilities

Post Fall Actions

See Appendix 2 Post Falls Flowchart

In the event of a patient sustaining a fall the following actions must be taken:

• On finding the patient the member of staff should ensure that they are safe and not at risk of further harm

• Potential hazards should be removed and if there is any life threatening concerns then the resuscitation protocol should be implemented

• The patients’ privacy and dignity should be maintained at all times. It may be necessary to ask other patients/relatives to leave the area whilst an assessment is made to determine the severity of the fall

• Complete post fall assessment

• Observations must include a neurological assessment using the 15 point Glasgow coma scale

• Observations every 30 minutes for 2hrs then hourly until medical review, GCS = 15 or NEWS = 0 or within patient own parameters

• Moving a patient who has sustained a spinal injury or fracture using a hoist can be fatal; staff will consider the use of any lifting equipment after a fall and will not employ this method where there is any concern about fracture or spinal injury. In this case the patient MUST not be moved until emergency services arrive

• If the patient has no apparent injuries after an assessment has been carried out the patient should be stood up with support using recognised manual handling techniques. Once upright assess again for pain or discomfort or injury and at this point the patient’s ability to mobilise should be assessed

• In all cases following a patient fall a Datix must be completed

• The information gained from this process will help to develop falls protocols for the future and will inform the training and development needs across the organisation

• With the patient’s permission the patient’s family should be informed about the fall, this is regardless of injury

• All information regarding a patient fall must be recorded in the patients notes and care plans reviewed

• All details about a patients fall must be shared with the whole team to protect patient’s safety. This will include all relevant health professionals involved in the patients care and in some cases may include professionals involved in discharge planning

• A patient who falls but has not received an injury which required immediate medical attention must be seen by a Doctor within 24 hours of the fall and all details accurately documented in the patients’ medical notes

It is important that staff safeguard their own wellbeing at all times when dealing with patients who have fallen.

9. References

NICE Guidance on Falls March 2017 www.nice.org.uk/guidance/QS86

National Patient Safety Agency (NPSA)

Rapid Response Report NPSA/2011/RRR001 - Essential care after an inpatient fall 13th Jan 2011 www.npsa.nhs.uk

NHS England

Letter re: Safer use of bedrails review in Residential Homes, Care Homes and Sheltered accommodation.

NICE Guidance on Head Injury 2014 www.nice.org.uk/guidance/CQ176

MHRA – Safe use of bed rails Dec 13 www.gov.uk/.../medicines-and-healthcare-products-regulatory-agency

NICE Guidance Falls in Older people: assessing risk and prevention June 2013 www.nice.org.uk/guidance/CG161

Royal College of Physicians Falls Care Bundles www.rcplondon.ac.uk/guidelines-policy/fallsafe-resources-original

Appendix 1: Bedrails Assessment Matrix

Appendix 2: Post Falls Flowchart

Observations to be recorded If

Minimum

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 1: ‘Screening’

Name of project/policy/strategy (hereafter referred to as “initiative”):

Adults Falls Prevention and Management Policy

Provide a brief summary (bullet points) of the aims of the initiative and main activities:

Project/Policy Manager:

Date:

This stage establishes whether a proposed initiative will have an impact from an equality perspective on any particular group of people or community – i.e. on the grounds of race (incl. religion/faith), gender (incl. sexual orientation), age, disability, or whether it is “equality neutral” (i.e. have no effect either positive or negative). In the case of gender, consider whether men and women are affected differently.

Q1. Who will benefit from this initiative? Is there likely to be a positive impact on specific groups/communities (whether or not they are the intended beneficiaries), and if so, how? Or is it clear at this stage that it will be equality “neutral”? i.e. will have no particular effect on any group.

Q2. Is there likely to be an adverse impact on one or more minority/under-represented or community groups as a result of this initiative? If so, who may be affected and why? Or is it clear at this stage that it will be equality “neutral”?

Q3. Is the impact of the initiative – whether positive or negative - significant enough to warrant a more detailed assessment (Stage 2 – see guidance)? If not, will there be monitoring and review to assess the impact over a period time? Briefly (bullet points) give reasons for your answer and any steps you are taking to address particular issues, including any consultation with staff or external groups/agencies.

Guidelines: Things to consider

• Equality impact assessments at Provide take account of relevant equality legislation and include age, (i.e. young and old,); race and ethnicity, gender, disability, religion and faith, and sexual orientation.

• The initiative may have a positive, negative or neutral impact, i.e. have no particular effect on the group/community.

• Where a negative (i.e. adverse) impact is identified, it may be appropriate to make a more detailed EIA (see Stage 2), or, as important, take early action to redress this – e.g. by abandoning or modifying the initiative. NB: If the initiative contravenes equality legislation, it must be abandoned or modified.

• Where an initiative has a positive impact on groups/community relations, the EIA should make this explicit, to enable the outcomes to be monitored over its lifespan.

• Where there is a positive impact on particular groups does this mean there could be an adverse impact on others, and if so can this be justified? - e.g. are there other existing or planned initiatives which redress this?

• It may not be possible to provide detailed answers to some of these questions at the start of the initiative. The EIA may identify a lack of relevant data, and that data-gathering is a specific action required to inform the initiative as it develops, and also to form part of a continuing evaluation and review process.

• It is envisaged that it will be relatively rare for full impact assessments to be carried out at Provide. Usually, where there are particular problems identified in the screening stage, it is envisaged that the approach will be amended at this stage, and/or setting up a monitoring/evaluation system to review a policy’s impact over time.

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 2:

(To be used where the ‘screening phase has identified a substantial problem/concern)

This stage examines the initiative in more detail in order to obtain further information where required about its potential adverse or positive impact from an equality perspective. It will help inform whether any action needs to be taken and may form part of a continuing assessment framework as the initiative develops.

Q1. What data/information is there on the target beneficiary groups/communities? Are any of these groups under- or over-represented? Do they have access to the same resources? What are your sources of data and are there any gaps?

Q2. Is there a potential for this initiative to have a positive impact, such as tackling discrimination, promoting equality of opportunity and good community relations? If yes, how? Which are the main groups it will have an impact on?

Q3. Will the initiative have an adverse impact on any particular group or community/community relations? If yes, in what way? Will the impact be different for different groups – e.g. men and women?

Q4. Has there been consultation/is consultation planned with stakeholders/ beneficiaries/ staff who will be affected by the initiative? Summarise (bullet points) any important issues arising from the consultation.

Q5. Given your answers to the previous questions, how will your plans be revised to reduce/eliminate negative impact or enhance positive impact? Are there specific factors which need to be taken into account?

Q6. How will the initiative continue to be monitored and evaluated, including its impact on particular groups/ improving community relations? Where appropriate, identify any additional data that will be required.

Guidelines: Things to consider

• An initiative may have a positive impact on some sectors of the community but leave others excluded or feeling they are excluded. Consideration should be given to how this can be tackled or minimised.

• It is important to ensure that relevant groups/communities are identified who should be consulted. This may require taking positive action to engage with those groups who are traditionally less likely to respond to consultations, and could form a specific part of the initiative.

• The consultation process should form a meaningful part of the initiative as it develops, and help inform any future action.

• If the EIA shows an adverse impact, is this because it contravenes any equality legislation? If so, the initiative must be modified or abandoned. There may be another way to meet the objective(s) of the initiative.

Further information:

Useful Websites www.equalityhumanrights.com Website for new Equality agency www.employers-forum.co.uk – Employers forum on disability www.disabilitynow.org.uk – online disability related newspaper www.efa.org.uk – Employers forum on age

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage One: ‘Screening’