Northamptonshire NHS Falls Service - Falls Risk / Action Plan (FRAP)

Resident’s Name…………………………………DOB …………………………………………………………

Name of home …………………………………………………………………………………..

Northamptonshire NHS Falls Service - Falls Risk / Action Plan (FRAP)

for use by Residential / Nursing Homes

Name of Resident : / Date of birth:
Date: / Ethnicity:
Contact Number: / Preferred language:
Marital Status / Religion:
Consent to share information with other healthcare professionals / YES / NO / Consent to intervention by the Falls Service / YES / NO
NOK details - Name / Contact number / Relationship

Aims

To assist staff to identify an individual’s falls risks and ensure that appropriate actions are taken
To educate staff and promote awareness of the wide variety of risks that contribute to falls so that they can minimise risks where possible within the Care Home setting for other residents

Guidance

The suggested actions are not an exhaustive list – there may by alternatives that you need to consider
This should be used in conjunction with the Care Home’s care plans, policies & procedures and Incident / accident reporting protocols

Falls History:

Why do staff think the resident has fallen? ………………………………………………………………………………………………………….

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Does the resident experience any warning signs before they fall? E.g. dizziness ……………………………………………………………..

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Have you reviewed the accident log looking for patterns? E.g. time, location, what was the resident doing just before they fell?

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1 / Certain Medical Conditions & Medicationincrease the risk of falling. E.g. Postural Hypotension (Dizziness on standing), Parkinson’s Disease, CVA/Stroke, UTI, Low Blood Pressure, Diabetes, Memory difficulties/ Confusion, Chest Infection, General deterioration in residents wellbeing / health. Many older adults need multiple medications to treat health conditions. Taking four or more medications significantly increases the risk for falling as there are a greater number of side effects.
Possible options:

Check or request check for postural hypotension

Teach resident to compensate for changes in blood pressure when changing posture and ensure all staff are aware of the need for this
Take / test urine sample
Ensure staff understand when and how medication should be taken
Review medical condition / medication with GP or nurse

Falls Risks identified:
Actions taken to address the above risks: / List of Medications / Date reviewed by GP
2 / Cognitive impairment increases the risk of falling. E.g. Confusion, lack of understanding of physical limitations / safety
Possible options:

Instigate more frequent checks on resident
Move resident’s room nearer to care station
Check for infections - UTI, constipation, ear infection
Consider use of chair / bed sensor mats
Consider review by CPN

Falls Risks Identified:
Actions taken to address the above risks:
3 / AnEnvironmentthat is unsuitable or cluttered can increase the risk of a fall. Simple alterations can often be made to help with this.
Possible options:

Night light left on to aid getting to the toilet safely
Consider assistive equipment e.g. Raised toilet seat / frame / grab rails
Commode for night time use
Room furniture rearranged / Appropriate flooring
Call bell always within reach of the resident every time they are left alone
Is furniture used by resident the correct height

Falls Risks Identified:
Actions taken to address the above risks:
4 / Reduced mobility/ unsteadiness increase the risk of falling
Possible options:

Review the residents’ moving and handling risk assessment and implement any changes
Is the walking aid appropriate for the resident’s current mobility and the correct height
Ensure walking aid is near the resident at all times
Replace worn ferrules and ensure frame is in good condition /clean
Encourage resident to remain active and mobile within their abilities

Falls Risks Identified:
Actions taken to address the above risks:
5 / Foot Problems can be painful altering balance and walking which increases the risk of falling
Poorly Fitting Footwear increases falls risks. Footwear needs to be supportive, well fitting and securely fastened. Hosiery should not restrict circulation as this slows healing and increasesswelling
Possible options:

Condition of feet checked regularly
Resident referred to podiatrist / chiropodist for assessment / treatment
Advise resident / family and request that appropriate footwear is supplied
Prompt resident to wear appropriate footwear (shoes rather than slippers for day time use)
Explore getting permission to purchase suitable footwear for your resident
Instigate the use of soft top socks

Falls Risks Identified:
Actions taken to address the above risks:
6 / Continence - rushing to get to the toilet increases falls risk. Using the toilet at night is often when people fall
Possible options:

Discuss continence issues with GP / Practice Nurse or District Nurse
Implement Day / Night time enabling toilet regime considering frequency, lighting, walking aids and toileting aids
Sensor mat
Clothing reviewed to facilitate ease of use when resident needs the toilet
Call bell always within reach of the resident every time they are left alone

Falls Risks Identified:
Actions taken to address the above risks:
7 / Poor Nutrition / Low Fluid Intakeincreases falls risk. Bones can be fragile and more likely to fracture. Not enough fluid intake increases the risk of urine infections and constipation
Possible Options

Assess oral hygiene and state of teeth. Look at alternatives such as electric toothbrush or help with brushing teeth
Instigate review at the dentist
Investigate denture fit and comfort during eating, consider denture fixatives
Monitor weight and fluid intake
Look at your resident’s food preferences and ability to feed/ drink unaided, including food consistency
Refer to dietician if needed
Ask GP re bone health if the patient has had a previous broken bone.

Falls Risks Identified:
Actions taken to address the above risks:
8 / Vision / Hearing may deteriorate as we get older and increases falls risks. Some conditions affect eyesight / hearing e.g. Glaucoma, Diabetes, Macular Degeneration, Cataracts
Possible options

Ensure the correct glasses are available and they fit properly
Implement daily cleaning of glasses
Investigate last eyesight check and initiate a review if necessary
Ensure lighting levels are appropriate
Ensure the resident is wearing their hearing aid and it is working correctly
Recently started wearing bifocals / varifocals or a change in prescription
Replace batteries regularly
Refer to Opticians / Audiology as required

Falls Risks Identified:
Actions taken to address the above risks:
OUTCOME

After implementing any actions identified from the FRAP, you feel you still require further advice or assessment, please complete the attached care home referral form and fax with the completed FRAP to 01933 235479.

If the FRAP is not received within 2 weeks of the referral being made, we will assume you have identified why your resident was falling and put actions in place to reduce further falls and we will discharge from care.

Countywide Falls Service

Tel: 01933 235870

Fax: 01933 235479

Examples of Assistive equipment:
Bed rails – These should be used with caution as injury and deaths have occurred as a result of inappropriate provision. A full risk assessment should be completed before potential use
Hi-Lo beds – These are beds that can be lowered to almost floor height and may be useful if a resident is persistently falling out of bed and bed rails are not a suitable option. They are often used in conjunction with a crash mat at the side of the bed
Bed and Chair Alarms –Thesedevicesmonitor when a resident gets up from bed or chair and vary in how they function. Their effectiveness is limited and needs to be assessed on an individual basis. Staff need to be aware of their responsibilities when a device is being used as these alarms will not prevent a resident from falling but alertthem that the resident is not where they left them
Hip protectors – Pants with padded areas covering the hip bone. These need to be measured to ensure correct and effective use. They may prevent hip fractures when people fall but a review of the latest research should be undertaken as evidence around their effectiveness varies