1. How to find your way around …
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2. How to find your way around …
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3. Slips, Trips and Falls
For all inpatient nursing staff, occupational therapists (except head OT’s) and Physiotherapy staff.
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4. Objectives
On completion of the Falls, Risk Management & Monitoring course, you will gain an awareness and understanding of the risks of falling, the possible causes and the methods of minimising those risks.
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5. Introduction
There will always be a risk of falls in hospital, given the nature of the patients that are admitted, and the injuries that may be sustained are not trivial. However, there is much that can be done to reduce the risk of falls and minimise harm. Whilst at the same time allowing patients freedom and mobilisation during their stay in hospital (NPSA 2007).
A patient falling is the most common patient safety incident reported to the National Patient Safety Agency (NPSA) from inpatient services. This course is based on research and evidence from The Third Report from the Patient Safety Observatory Slips, Trips and Falls in Hospitals PS0/3 published by the NPSA.
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6. Introduction
Although the majority of falls are reported to result in no harm, even falls without no apparent injury can be upsetting and lead to loss of confidence, increased length of stay and an increased likelihood of discharge to residential or nursing home care with the added distress and anxiety caused to the patient, relatives and carers.
Over 200,000 falls were reported to the NPSA's National Reporting and Learning System (NRLS) in a 12 month period, with reports of falls coming from 98% of organisations that provide in-patient services. 36,000 were in Mental Health Units and 30,000 in Community Hospitals.
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7. Key Areas for Focus
Prevention - Understanding the causes and circumstances of previous incidents. Identifying and assessing vulnerable patients and implementing interventions.
Reducing Harm - Promptly and effectively treating any injury resulting from a slip, trip or fall.
Learning from the circumstances of falls - Continually reviewing and learning from risk management systems to understand where, when and why patients are most vulnerable to falls.
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8. Definition of a Fall
When someone falls, it is rarely easy to be sure if it was a simple trip or slip, or whether they were dizzy and fainted or collapsed.
Falls can be defined as ‘ an event whereby an individual unintentionally comes to rest on the ground or another lower level, with or without the loss of consciousness’.
Older people are more vulnerable to falls.
Slightly less than a quarter of all types of patient safety incidents are reported from mental health settings.
Learning from the circumstances of falls can help NHS organisations to direct their resources to where they are most needed. However some accident reports of falls are too brief to support local or national learning.
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9. Fall Statistics
More falls are reported to the NRLS than any other type of patient safety incident. Rates are higher in community hospitals!
Although most falls are reported as causing no or low harm, some falls result in significant injury and death and can lead to additional healthcare costs or litigation.
The most commonly recorded injuries are grazes, cuts and bruises. NRLS suggests 840 patients may fracture their neck of femur in hospital each year, 550 other types of fracture and 30 intracranial injuries. 26 deaths have been reported as relating to falls during 1 year.
Falls are the most common adverse incident in hospitals and care homes
They almost always affect frail elderly people
They occur at an average of 3 per month per 20 bed ward
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10. Importantly 30% of falls result in significant physical injury
3-5% result in fracture
Hip fractures result in death within 6 months in 20% of patients and 50% will never regain previous levels of independence
60-90% of hip fractures are related to direct trauma to the hip
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11. Question
What percentage of falls result in significant physical injury?
15%
25%
30%
40%
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12. Fall Causes
Causes are complex. Hospital patients are vulnerable due to medical conditions, including delirium, cardiac conditions, side effects of medication and problems with balance, strength or mobility.
Falls can sometimes happen because of a single factor, tripping or fainting, affecting an otherwise fit and healthy person. However, most falls, particularly in older people, are due to a combination of several factors. For example:
- poor mobility;
- confusion;
- environmental hazards (e.g. wet floors or steps)
Patients are most likely to fall when:
- walking;
- whilst using the toilet or commode;
- in bed, which may be more likely to lead to serious injury and litigation.- 1 in 200
patients fall out of bed.
Patients most vulnerable to falls are:
- older patients, particularly those over 80;
- relative to the proportion of men and women in hospital, there are more reported falls of men than women (the reason for this is
unknown).
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13. Environmental Risk Factors
Environmental factors are largely controllable and require regular observation and awareness by all involved in care. Removal and modification of environmental risks is everyone's role.
These include:
Spills both liquid and solids such as food
Trailing cables
Portable electrical equipment such as vacuum cleaners
Furniture
Inadequate lighting
Worn or damaged flooring
Commodes
Beds
Bed rails

14. Overall Risk Factors
The risk factors that appear to be most significant in hospital patients are:
Walking unsteadily or with poor balance.
Being confused and agitated;
Being incontinent or needing to use the toilet frequently;
Having fallen before;
Any medication that acts on the brain or circulation leading to sedation, low
blood pressure (hypotension), irregular or excessive heart beats per minute
(bradycardia, tachycardia) or periods of heart beat gaps (asystole)
Dementia increases the risk of falling because patients find it difficult to recognise environmental hazards, find it hard to save themselves when they become off-balance, and may be unaware of any limitations to their own mobility.
Dementia is also associated with changes in walking patterns and low blood pressure on standing.
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15. Question Patients are most likely to fall when they are? Walking
Sitting watching TV
Asleep
Eating
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16. Personal Risk Factors
Certain personal risk factors pose a greater risk particularly those involving multiple medications, previous episodes of falling, difficulties with balance and episodes of dizziness and not allowing the person to adjust after movement e.g. getting up from sitting - postural hypotension, when blood pressure lowers.
Medication – more than 4 drugs particularly increases risk
Postural and balance problems
Sleeping tablets and anti-depressants particularly in combination with drugs affecting circulation, and lowering blood pressure
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17. Personal Risk Factors In addition: Eyesight problems Footwear
History of Parkinson’s Disease, CVA and similar problems which result in
difficulties with mobility
Inappropriate walking aids
Long term anti-psychotic medication
Poor cognition – inability to recognise or anticipate hazards
Muscle weakness
Hearing loss – unable to discern instructions and act on them
Alcohol
Malnutrition

18. Times of Greater Risk
Greater risk occurs at certain times when movement is taking place or balance becomes difficult such as putting on or taking off clothing, sitting to standing and walking to the toilet.
Times of increased risk also occur at the following times:
Agitation and restlessness
Change in medication/ beginning new medication
Altered sleep patterns
Meal times
Needing the toilet at night
Use of bed rails for the first time
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19. Question Which of the following is NOT a personal risk factor?
Medication of more than four drugs
Postural and balance problems
Sleeping tablets and anti-depressants
Watching too much TV
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20. Witness of a Fall
Only a minority of falls are witnessed by staff. Even when a member of staff witnesses a fall, they are unlikely to be able to stop the patient from falling.
Recommendations for the Trust
Make sure that the circumstances of the fall are described completely and
meaningfully on local incident forms
Datix Analyse and use reports of falls to learn at ward and board level
When staffing/observation levels are low
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21. Risk Assessments Falls Pathway - Patient Falls Should :
Be simple and easy to use
Identify main categories of risk
Produce instant action and changes if necessary
Enable implementation of falls care plan
Falls Pathway - Patient Falls
When a patient falls the following steps apply and are taken from the Procedural Guidelines CLP 58 Appendix 6 found on the intranet where a flowchart describes the way forward.
The following flowchart can be found displayed prominently on all wards and can by accessed via the intranet
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22. Falls Pathway – Patient Falls
Step 1
Medical staff should informed
Patient is physically examined to determine if an injury has occurred
Decisions made as per Rapid Response Protocol depending on level of injury
Step 2
Details for incident report: - Time of incident
Where fall occurred
Circumstances surrounding fall
Strategies in place prior to fall
Staffing levels at time of fall
Strategies to be put in place to prevent further falls occurring including individual care plan
Step 3
Incident report completed
Low risk identified
Circumstances surrounding fall documented in Care Plan
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23. Falls Pathway – Patient Falls
Step 4
Medium risk Identified
Patient Re-assessed using Falls Assessment Tool
Details of fall document in Fall Log Book on ward
Implement individual care plan
Step 5
High risk identified
Patient’s next of kin informed
Implement individual Care Plan
Equipment and services to support independent living are in place before / within 3 weeks
Assessments to enable repair, improvement and adaptation to be implemented where necessary
At all stages refer to Rapid Response Protocol
Follow indications for all risk categories and implement as necessary
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24. IF YES TO ANY OF THE QUESTIONS ABOVE,
Individually targeted falls care plan
On admission or after a fall the following should be considered:
Has there been a history of falls since admission
Was there a history of falls before admission
Does the patient have a fear of falling
Does the person try to walk but is unsteady and unsafe
Has the patient's relatives expressed concern about falls
Has medication review been carried out.
Does the patient have Osteoporosis
There is evidence to support that when a person is afraid of falling they limit their mobilisation and often shuffle rather than taking well defined steps, therefore, increasing their risk of falling.
IF YES TO ANY OF THE QUESTIONS ABOVE,
COMPLETE A CARE PLAN
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25. Conclusion In Summary:
You should now be aware of the risks, factors causing falls and the
prevention techniques available.
To have the tools to analyse the issues and make changes to practice.
Make yourself familiar with the falls pathway, updating care plans and play
your part in bringing falls levels and harm from falls to a minimum
throughout the trust.
Remember what you have learned is no substitute for professional insight
and knowledge.
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26. Remember, if you want to find more information / evidence about this subject or anything else which is relevant to your work or study, join your local healthcare library.
For staff in Essex contact Basildon Healthcare Library.
EX3594 
It may be that you work in a different area,
for example Luton.
Details of all the Health Libraries in the East of England can be found at this site…
You are welcome to join any of these.
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27. Review of Objective(s)
Before completing the test, please ensure you have acquired the relevant knowledge against the modules objective(s) below:
“On completion of the Falls, Risk Management & Monitoring course, you will gain an awareness and understanding of the risks of falling, the possible causes and the methods of minimising those risks.”
If not, please take this opportunity to revisit the presentation content.
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28. You now need to take the test!
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