INPATIENTFALLS MANAGEMENT POLICY
Policy Number:
INPATIENT FALL MANAGEMENT POLICY
Document History
Version Date: / April 2011Version Number: / 1
Status: / Approved
Next Revision Due: / April 2013
Developed by: / Falls Implementation Group
Policy Sponsor: / Pathways & Clinical Outcome Manager
EQIA completed: / Dec 2010
Approved by: / Quality committee
Date approved: / 11th April 2011
Revision History
Version / Revision date / Summary of ChangesTo support inclusive access of this policy (guideline etc), it has been left-aligned and is available in alternative formats. To obtain a copy of the policy in large print, audio, Braille (or other format) please contact Communications team, by Tel: 01773 525099 or email
Table of Contents
1.FULL DETAIL OF POLICY
1.1Hospital Admissions
1.2Training and development for falls prevention and management
2.References and Associated Documentation
3.Appendices
Appendix 1Falls prevention in hospitals Flow chart
APPENDIX 2PATIENT FALL FLOW CHART
appendix 3
appendix 4
appendix 5
appendix 6
4. AIM
5.Background
5.1Table - Objectives
6.Area for Implementation
7.Organisational Accountability/Responsibilities i.e. CEO, Directors, Managers, Staff
8.Intended Users
9.Definition
10.Indications for Use
11.Contra-indications
12.Equality Impact Statement
13.Monitoring and Performance Management of the policy
14.Support and Additional Contacts
Equality & Diversity Impact Assessment : Level I Screening
inpatientfalls management Policy
1.FULL DETAIL OF POLICY
This policy is to assist staff to reduce the risk, incidence and severity of in-patient falls within the Community Hospitals of Derbyshire Community Health Services (DCHS). The policy should be read in conjunction with the policies for The Management and Prevention of Slips, Trips and Falls and the Safe and Effective use of Bedrails in Community Hospitals. Clinical Policies page
1.1Hospital Admissions
All clinical staff working in DCHS community hospitals must follow the ‘Falls Prevention in Hospitals’ Flow chart (see Appendix 1).
1.1.aRisk Assessment
Patients admitted to a DCHScommunityHospital require a Falls Risk Assessment completing within 4 hours of admission ‘Risk assessment for the Prevention and Management of Falls’
1.1.b Treatment Plan
A treatment plan reflecting each individual’s falls risk assessment will be generated, identifying the goals, interventions and risks agreed with the patient and their carers if and when appropriate. This should be completed within 24 hours of admission. Please click on the link to access the documentation site for ‘high’ 0310, ‘medium’ 0309 and ‘low’ 0308 treatment plan templates
1.1.cEvaluation and Reassessment
The frequency of review of the Falls Risk Assessment must be documented and undertaken (see ‘Risk assessment for the Prevention and management of Falls’). The risk of falls will be reassessed in accordance with each individual’s risk assessment – ‘high’ - daily, ‘medium’ – every 4 days and ‘low’ – every 7 days, (therefore at a minimum of every 7 days), or if any changes occur. The treatment plan will be updated following each reassessment of falls risk, (changing to relevant treatment plan if appropriate), and the patient’s records updated.
1.1.dFall
If a patient falls or a fall related near miss occurs, the ‘Patient Fall Flow Chart’ will be followed and actioned, see Appendix 2.
IF A SEVERE INJURY IS EVIDENT OR SUSPECTED DIAL 9 999 FOR TRANSFER TO ACUTE SERVICES.
All incidents must be reported including patient details, time, location and circumstances of the falls, and details of any injury or if non apparent, by completing an Incident Form.
All incidents which have level 3 or 4 harm will be evaluated using root cause analysis by the Patient Safety Team.
1.1.eDischarge to Own Home
Patients at risk of falls at home needs to be established. Refer to Community Falls Management Policy Section 1.1a, 1.1b screening and risk assessment tools.
Referrals onto community or day service based specialist falls services for specialist falls interventions will be made if indicated.
1.1.fDischarge to Care Home
Patients at risk of falls in care home settings need to be established. Refer to Community Falls Management Policy Section 1.1a, 1.1b screening and risk assessment tools.
Referral onto community falls service will be made if indicated by multi-disciplinary team.
1.2Training and development for falls prevention and management
Within DCHS there will be 3 levels of training for falls prevention and management:
Level 1 - ALLDCHS staff regardless of location, should have basic awareness training in relation to falls prevention and their roles and responsibilities therein. This will include an understanding of the potential causes of falls including intrinsic and extrinsic factors.
All DCHS staff assessing patients, again regardless of location, will be made aware of and trained in the use of the relevant falls prevention and management tools and associated processes. They will also undertake further fall prevention and management training on areas relevant to their profession.
All Level 1 staff will access the Falls Training DVD and line managers must keep a record of the staff who have undertaken this training and forward the details to the Learning Team to ensure the electronic staff record (ESR) is updated. Falls Awareness and Prevention will be included in essential training, all new staff induction and preceptorship competency frameworks.
Level 2 - All wards/ departments should have an identified ‘Falls Champion’ who will be expected to lead and ensure the process is in line with the policy and to lead the local scrutiny of monthly falls reports. Identified champions and other key clinical leaders will receive training on the falls policy, risk assessments decision algorithms.
Level 3 - All staff providing a specialist falls service or performing specialist falls assessments will require evidence based training and skills updating. This training will require individuals to access ‘learning beyond registration’ funding to apply for accredited courses delivered by external providers.
2.References and Associated Documentation
DCHS Management and Prevention of Slips, Trips and Falls Policy
DCHS Record Keeping Policy
DCHS Incident reporting Policy
DCHS Joint Derby and Derbyshire Health & Social Care Policy for the Safe Use of Bed Rails in the Community.
DCHS Policy for the Safe and Effective Use of Bed Rails within the CommunityHospital
Do Once Share Pathway web site accessed November 2010:
Fonda D et al. (2006) Reducing serious fall related injuries in hospital. Medical Journal of Australia 184: 379-382
Haines TP et al (2004) Effectiveness of targeted falls prevention programmes in a sub acute setting. A randomised controlled trial. British Medical Journal 328: 676-679
Healey F et al. (2004) Using targeted risk factor reduction to prevent falls in older hospital inpatients A randomised controlled trial Age and Ageing 33: 390-395
Help the aged (2008) Falling Short Help the Aged London
NHS Institute for Innovation and Improvement (2009) High Impact actions for Nursing and Midwifery
National Institute for Health and Clinical Excellence (2004) Falls-The assessment and prevention of falls in older people. Available at:
Department of Health (2001) National Service Framework for Older People
Medicines and Healthcare products Regulatory Agency Device Alert 2007/001. Reporting Medical Device Adverse Incidents and Disseminating Medical Device Alerts. Available at:
Oliver D et al. (2005) Prevention of falls in hospitals and care homes and in persons in those settings with cognitive impairment or dementia. Department of Health Accidental Injury Prevention Programme
Oliver D et al. (1997) Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. British Medical Journal 315: 1049-1053. Available at:
Oliver D et al. (2004) Risk factors and risk assessment tools for falls in hospital inpatients: a systematic review. Age and Ageing. 33: 122-130
The Patient Safety First Campaign have recently issued a ‘How to’ Guide for reducing harm from falls.
Prevention Package for Older People
Royal College of Physicians (2008) NationalFalls and Bone Health in Older People accessible via (Accessed 9th November 09).
3.Appendices
Appendix 1 – Falls Prevention in Hospital Flow chart
Appendix 2 – In-Patient Fall Flow Chart
Appendix 3 - Risk Assessment for the Prevention and Management of Falls
Appendix 4 – Falls High Risk Treatment Plan
Appendix 5 – Falls Low Risk Treatment Plan
Appendix 6 – Falls Medium Risk Treatment Plan
Appendix 1Falls prevention in hospitals Flow chart
APPENDIX 2PATIENT FALL FLOW CHART
Check for signs of physical injury
- Deformity of limbs
- Loss of sensation to limbs
- Pain
- Bleeding
- Head injury
appendix 3
SURNAME / NHS No / _ _ _ / _ _ _ / _ _ _ _ / HOSPITALFORENAME / MALE / FEMALE
WARD
ADDRESS / D.O.B / GP/Consultant
RISK ASSESSMENT FOR THE PREVENTION & MANAGEMENT OF FALLS
Date of Admission: _ _ / _ _ / _ _ _ _Barthel Transfer Score / Date
Patient unable to transfer/immobile / 0
Major help needed (one/two people, physical aids) / 1
Minor Help Needed (verbal or physical) / 2
Independent / 3
Barthel Mobility Score
Patient immobile / 0
Independent with the aid of a wheelchair / 1
Walks with help from one person / 2
Independent / 3
Total
Adapted from STRATIFY:
1 / Is the patient aged 65 years or over? / Yes = 1
No = 0
2 / Did the patient present at hospital with a fall? Or has the patient fallen on the ward since admission? / Yes = 1
No = 0
3 / Is the patient agitated or confused? / Yes = 1
No = 0
4 / Is the patient visually impaired to the extent that every day function is affected? / Yes = 1
No = 0
5 / Has the patient a combined Barthel mobility and transfer score >3 / Yes = 1
No = 0
TOTAL
Signature:
RISK ASSESSMENT / Date & Time
Low Risk 0 - 1 Medium Risk 2 High Risk > or = 3
COMPLETE SCREENING PLAN FOR ALL PATIENTS
© Copyright 2009 Quality & Integrated Governance Team, Derbyshire Community Health Services
Version NumberPage 1 of 21Policy date
INPATIENTFALLS MANAGEMENT POLICY
appendix 4
SURNAME / NHS No / _ _ _ / _ _ _ / _ _ _ _ / HOSPITALFORENAME / MALE / FEMALE
WARD
ADDRESS / D.O.B / GP/Consultant
FALLS HIGH RISK TREATMENT PLAN
Date &Time / ProblemNo / Problem / Need / Initials / Stop Date
…………………………. has been assessed under the DCHS falls risk assessment and is at HIGH risk of falls.
Date/
Time / Goals Agreed With Patient / Initials / Achieved
Yes (Y)
No (N) / Date /Time & Initial
To minimise the risk of falling.
Treatment Plan
Has the person got capacity to consent to this Treatment Plan?
Yes □ No □ If “No” complete Capacity Assessment
Consent obtained? Yes □ No □ If “No” document reason/action ………………………………………
Date and Time / Treatment Plan / Treatment
to be
Performed
By / Initials of Prescriber
Considering any cognitive impairment will have an impact upon calling for assistance ensure the nurse call bell is in reach and implement additional strategies as required to minimise the risk of falling
Considering any cognitive impairment will have an impact to orientation around the bed area /ward
Highlight the layout of the ward including toilet areas to patients who may require to use the toilet more urgently. Implement additional strategies as required to minimise the risk of falling
Ensure that personal effects (e.g. glasses, hearing aids etc) including mobility aids are within easy reach and that the environment is not cluttered.
Is ……………………in the best location on the ward in relation to visual observation from the staff base
Record postural blood pressure and report any abnormalities to appropriate clinician.
Assess, plan and document management of night time activity.
Report to appropriate Clinician to review all medication if more than 4 prescribed.
Date requested ………………………………………….
Consider nursing on a high/low bed at its lowest level with crash mat at the side
Consider 1:1 nursing or request family assistance
Consider use of sensor alarms if available to bed and/or chair
Required yes / no Please circle
Date applied ……………………………………………………..
Check footwear is correctly fitted and if not inform relatives
Date informed ……………………………………
Ensure Manual handling plan is up to date
MDT review Has the level of risk changed ? If no continue ,if yes complete a new risk assessment and plan
Discharge . Is follow up required Yes / No (please circle)
Document any actions taken
Other actions to be considered
Treatment Plan to be evaluated/reviewed minimum weekly or as changes occur
appendix 5
SURNAME / NHS No / _ _ _ / _ _ _ / _ _ _ _ / HOSPITALFORENAME / MALE / FEMALE
WARD
ADDRESS / D.O.B / GP/Consultant
FALLS LOW RISK TREATMENT PLAN
Date &Time / ProblemNo / Problem / Need / Initials / Stop Date
…………………………….. has been assessed via the DCHS falls risk assessment and is at LOW RISK of falls.
Date/
Time / Goals Agreed With Patient / Initials / Achieved
Yes (Y)
No (N) / Date /Time & Initial
To minimise the risk of falling.
Treatment Plan
Has the person got capacity to consent to this Treatment Plan?
Yes □ No □ If “No” complete Capacity Assessment
Consent obtained Yes □ No □ If “No” document reason/action …………………………………….……
Date and Time / Treatment Plan / Treatment
to be
Performed
By / Initials of Prescriber
Considering any impairment if present, to cognition ensure the nurse call buzzer is in reach and………………………….can understand how to use it..
Considering any impairment if present to cognition, ensure orientation to the ward and its layout
Highlight the toilet areas to patients who may require access more urgently
Ensure that personal effects (e.g. glasses, hearing aids etc) including mobility aids are within easy reach and the environment is not cluttered.
Report to appropriate Clinician to review medication if more that 4 medications prescribed
Date requested………………………………………………………
Check footwear is correctly fitted and if not inform relatives
Date informed (applicable)…………………………………………….
MDT review – Has level of risk changed?
If no continue, if yes complete a new risk assessment and plan.
Ensure Manual Handling plan is up-to-date.
Any other actions to be considered
Treatment Plan to be evaluated/reviewed minimum weekly or as changes occur
appendix 6
SURNAME / NHS No / _ _ _ / _ _ _ / _ _ _ _ / HOSPITALFORENAME / MALE / FEMALE
WARD
ADDRESS / D.O.B / GP/Consultant
FALLS MEDIUM RISK TREATMENT PLAN
Date &Time / ProblemNo / Problem / Need / Initials / Stop Date
………………………. has been assessed under the DCHS falls risk assessment tool and is at MEDIUM risk of falls.
Date/
Time / Goals Agreed With Patient / Initials / Achieved
Yes (Y)
No (N) / Date /Time & Initial
To minimise the risk of falling.
Treatment Plan
Has the person got capacity to consent to this Treatment Plan?
Yes □ No □ If “No” complete Capacity Assessment
Consent obtained? Yes □ No □ If “No” document reason/action ………………………………………
Date and Time / Treatment Plan / Treatment
to be
Performed
By / Initials of Prescriber
Considering any cognitive impairment will have an impact upon calling for assistance, ensure the nurse call buzzer is in reach and implement additional strategies as required to decrease risk of falling.
Considering any cognitive impairment will have an impact to orientation around the bed area/ward.
Highlight the layout of the ward including toilet areas to patients who may require to use the toilet more urgently. Implement additional strategies as required to decrease risk of falling.
Ensure that personal effects (e.g. glasses, hearing aids etc) including mobility aids are within easy reach and that the environment is not cluttered.
Is ………….. …in the best location on the ward in relation to visual observation from the staff base
Record postural blood pressure and report any abnormalities to the appropriate clinician.
Assess, plan and document night time activity.
Report to appropriate Clinician to review all medication if more than 4 prescribed.
Date requested ………………………………………………..
Check footwear is correctly fitted and if not inform relatives
Date informed (if applicable) …………………………………
Ensure Manual Handling Plan is up to date
MDT review – Has the level of risk changed ?
If no continue ,if yes complete a new risk assessment and plan
Discharge – Is follow up required Yes /No (please circle)
Document any follow up actions
Other actions to be considered
Treatment Plan to be evaluated/reviewed minimum weekly or as changes occur
4. AIM
The aim of this Policy is to manage the risk of, and reduce the incidence of, and thereby reducing the harm from; older people experiencing falls in DCHS Community Hospitals. The Policy provides a framework with quality standards to:
- identify people who have fallen and or who are at risk of falling again
- assess the level of risk for individuals
- generate, implement and evaluate appropriate treatment plans
- identify the need and scope for and of a specialist falls intervention.
There is an expectation that clinicians will use the framework within everyday practice within DCHS.
It recognises that falls are a multi-dimensional problem which requires a partnership approach across the localities and between health, social care and voluntary organisations. DCHS will deliver a service/pathway which will be based upon evidence-based practice as stated in key national guidelines (NICE). Our services will use, as part of the framework, validated tools to support the assessment and treatment process.
5.Background
A patient falling is the most common patient safety incident reported to the National Reporting and Learning Service (NRLS) from inpatient services. Over 200,000 falls were reported to theReporting and Learning System (RLS) in the 12 months from September 2005 to August 2006, with reports of falls coming from 98 per cent of organisations that provide inpatient services.
Historically the National Service Framework, gave organisations key guidance in the identification and treatment for patients who have fallen.
NICE guideline CG21 “Falls: the assessment and prevention of falls in older people” was issued in 2004 to provide guidance on key areas of risk, assessment, interventions, participation and education for the health care community.
The Department of Health (DH) issued the Prevention Package for Older People which builds on the National Service Framework and NICE guidance. The Falls and Fractures, effective interventions in health and social care package outlines four key objectives shown in Table 1.0 (July 2009).
5.1Table - Objectives
See below