1. Falls Prevention

2. Clinical Slips, Trips and Falls Protocol
Please can all staff attending this Falls Prevention Theory be aware that the Clinical Slips, Trips and Falls Protocol can be found on Leeds Health Pathways. This outlines the roles and responsibilities of staff and the procedures to be followed for patients identified as at risk of a fall or who have suffered a fall.

3. Learning Outcomes To: Define what a fall is.
Understand the risk factors for falls.
Demonstrate what assessments are required for patients at risk of falling.
Demonstrate the interventions required to prevent and manage falls.
Understand the care required after a fall.
This covers the requirement for in-patients there is a different pathway for patients attending A&E, the details can be found in the Trust Guidelines for the prevention and Management of Falls In Hospital.

4. What is a fall?
Question: Ask what do staff consider to be a fall, definition?

5. Definition
“An incident in which a person suddenly and involuntarily comes to rest on the ground, or other lower surface, with or without loss of consciousness”.
NPSA (2011)
Characteristics:
Sudden
Uncontrolled
Unintentional
Downward displacement of the body to the ground

6. Falls - the size of the problem
Leading cause of mortality resulting from injury in people aged > 75yr
Half of the individuals who have fallen will fall again within one year.
5% of falls result in a fracture: 1%
In a #NOF
152,000 falls reported to the NRLS annually
1/3 of individuals with hip fractures can no longer live independently and 25% die within 6 months
Recurrent falls have a significant impact on mortality, accelerated admission to care homes and lifestyle limitations

7. Falls - the size of the problem
Most common cause of injury in a hospital.
Nearly 4 million people aged 60 and over have fallen in the last 2 years.
Falls & their consequences cost the NHS & social care an estimated £6m per day.
63 falls resulting in fracture, head injury or death from April.
3389 patients fell whilst under our care in
Our primary aim is to reduce inpatient harm- we have to get everyone on board that it is happening to their patients.
The prevention and management of falls in older people is a key Government target in reducing morbidity and
mortality. This is outlined in the National Service Framework (NSF) for England, standard six for older people, which covers falls and specifically aims to:
‘reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for
those who have fallen’ (NSF 2001).
Depending on the group you could go to the intranet and see the results for your division or insert a slide to show you divisions results and what interventions there are in any local action plans to reduce the numbers.

8. Inpatient falls at LTHT
There were 3389 inpatient falls recorded in the Trust between April 2013 – March This graph represents the month on month trend for the whole of the Trust. Explain that individual CSU’s and wards can also be looked at.

9. Why focus on Falls?
Discuss CQUINS and the trusts aims of reducing falls .
“The very first requirement in a hospital is that it should do the sick no harm”

10. Environmental risk factors
Wet floors
Cluttered environment
Tripping hazards e.g. cables, wires
Changes in the level and uneven floors
Doors
Poor lighting
Breaks not in use on equipment
See LTHT Clinical Trips, Slips and Fall Protocol

11. Physical risk factors Previous history of falls
Impaired balance/restricted mobility
Reduced muscle strength
Bone density
Slower reaction times
Mobility aids/inappropriate use
Impaired vision
Cognitive impairment
Continence
Postural hypotension
Dizziness
Discuss some in more detail in later slides

12. Functional risk factors
Sleep disturbance
Pain
Alcohol /drug use / withdrawal
Neurological conditions
Parkinson's
Dizziness
Mobility
Fear of falling
Ask staff to give examples from their areas....
As there are many contributing factors it is therefore important that a MDT approach is used.

13. Clinical risk factors Neurological conditions Parkinson's Dizziness
Previous history of falls
Cardiac conditions
Medications - caused by almost any drug that acts on the brain, heart or circulation. Sedation or cardiovascular medications.

14. Confused or Disorientated Patients
Reversible causes such as medication, drugs or infection
Irreversible causes such as dementia, delirium or other neurological problems
Loss of awareness of the movement and posture required for mobilising which can affect balance
Loss of proprioception/awarness of your movement, can be affected if diabetic or Vit b12 Deficient.

15. Continence Needs
15% of hospital falls are linked to incontinence & patients needing the toilet.
Urge incontinence or diarrhoea are the greatest risk.
Dementia patients may be agitated as they need the toilet but may not be aware.
Toileting needs should be planned and tailored to patients needs.
Are the toilet at the right height, easy to find,
If patient has dementia ask and are looking for something ask them if they need the toilet

16. Assessment on Admission
Areas can add local example by using findings from investigations of falls in their speciality
Staff to make notes on the following, ’Think about’…… (10mins) and we will review results on the next few slides and will look at the factors to consider and then we will look at documentation available.
Staff to think about what documentation is available to support them..

17. Falls Prevention Care Plan
This is the pathway to identify which documentation and interventions are required.
Note to review screening on change of condition/weekly.
Screening for falls is now included in the nursing specialist assessment (Key used►)
The old documentation looked at a risk score to predict the likelihood of a patient falling, but still some patients fell though not deemed at risk.
There is now more emphasis on the ‘actions’ required to prevent falls rather than the likely risk.

18. Bed rails care plan

19. Falls prevention
Identification & communication of risk especially on transfer
Nurse call bell to hand
Intentional rounding
Bed on the lowest setting
Alarm sensors
Low care bed
Brakes applied to equipment
MDT assessment
Spillages cleaned up
Correct mobility equipment in reach
Glasses if needed
Patient involvement
Correct fitting appropriate footwear
Staying Safe Preventing Falls leaflet
Location on the ward
Lighting
Bed area free from clutter/wires
MDT assessment/review
Brakes on equipment

20. Post Falls
Falls Prevention Care Plan; Print Unit number: WUN1019 TO BE UPDATED WHEN NEW CAREPLAN IN CIRCULATION
Show examples…
Risk assessment and falls prevention plan highlight that intervention is the key. No harm is prevented by purely assessing risk. You must do something about it, includes initial and DAILY intervention.
In two parts first part covers first 24hrs, completed by nursing staff. Though many questions will link to other members of the MDT…
Discuss the following with the group and ask how each can affect a patients falls risk
Confused, blood glucose, urinalysis, lying & standing B/P (staff poor at completing this why?) eyesight, (meds review later) knows how to use call bell. Footwear later.

21. Incident Reporting
The description should outline as much factual detail as possible about the fall, including what the patient was doing
Action taken immediately following the fall and to further reduce risk e.g equipment
Previously IR1s have not been completed correctly, the post-falls proforma should help you identify the important information required when a patient has fallen. There are plans for this to be electronic and go directly on to datix.
PLEASE check that you have correctly completed the level of risk/score, if a patient is being sent for an x-ray then they may have a fracture and would be considered serious harm which would require a RCA.
Serious harm is defined as a fall that results in a fracture, serious head injury or death.

22. Post falls management Ensure patient safety Medical & MDT review IR1
Post falls proforma
Re-assessment of risk
Nursing Kardex
Inform relatives
RCA if moderate harm sustained
Investigations

23. Post falls investigations
Not all interventions apply to every fall
Full set of observations including lying & standing BP
Neuro observations CT
X-Ray
Blood capillary glucose
Urinalysis
ECG
Blood tests
Medication review – for patients who are on 4 or more medications

24. Areas for the MDT team to review
History of falling
History of relevant neurological disease
Number and type of medications
Mobility & Musculo-skeletal gait/balance
Balance /Hearing
Postural Hypotension
Vision
Alcohol
Nutritional deficits
Environmental Hazards ability to function in home setting
Psychological, cognitive function
Some of the areas of investigation/actions are shared among the MDT team.
Note this is a multi-professional problem requiring multi-professional intervention- docs/nurses/physios/pharmacists all have to do their bit to make a difference. but working together and doing simple interventions well reduces harm.

25. Planning for Discharge
Referral to the Community Falls Team (CFT) or LTHT Specialist Falls Assessment Clinic.
Give out patient leaflet ‘Stand Tall Avoid a Fall’ available to order from Public Health Resource Centre Leeds
With reference to the CFT & Specialist Falls Clinic,, the referral forms for both teams can be accessed via the Leeds Health Pathways. The OT would be able to advise the MDT regarding this.
Falls clinic based at Beckett Wing SJH is mainly for falls assessments for patients in the community as we should be resolving patients falls risk in hospital, but the GP can contact the falls clinic if required once the patient is back in the community. Falls clinic Beckett Wing –
New leaflet due out soon for inpatient from the falls group.

26. References LTHT Guidelines
Falls in Hospital Areas – Guidelines for the Prevention and Management of Falls in Hospital (2011)
NICE Falls: the assessment and prevention of falls in older people (2011)
The FallSafe care bundle – Royal College of Physicians 2011.
Arfken CL, Lach HW, Birge SJ,Miller JP (1994) The prevalence and correlates of fear of falling in elderly persons living in the community, American Journal of Public Health, 84(4):