Falls Prevention 2020

To understand the definition of a fall

Awareness of national & local falls statistics
How to risk assess for falls
The importance and relevance of getting a history
Why reporting falls is vital
Evidence based interventions to reduce risk
Signposts to appropriate information/training
Overview of the post fall protocol and training

Compiled by Claire Burcham and Jane Reddaway

Falls Prevention Leads
2010
National data, National Osteoporosis Society falls 2,700,000
Torbay & south Devon – 21,000

 NICE CG 161 clinical guidance 2016

 Falls in Older People, Nice quality standards, 2017
 National Outcomes Framework DOH key objectives 2012 -2013 & Falls Prevention
Package
 Royal College of Physicians Falls & bone health audits
 Patient Safety – Thermometer & Fall Safe monthly audit
 Age UK
 Public Health – Sustainable Transformation Plan

Over 400 plus risk factors identified

 A fall is ‘an event whereby an individual
unintentionally comes to rest on the ground or
another lower level’

 Excluding intentional change in position to rest in

furniture, wall or other objects

World Health Organisation 2007

If personalized interventions are put in
place at an earlier point in time there will
be a more effective reduction in falls and
independence will be maintained
 With an increasingly ageing population, there is now good evidence
to show how falls can be reduced.

 National Safety patient Agency (NSPA) 2007 identified the following risks as
most significant in hospital:

 Walking unsteadily
 Being confused
 Being incontinent/needing the toilet frequently
 Previous falls
 Taking sedatives

It is vital that prevention is implemented to

reduce the more injurious and more
detrimental falls and their impact on people’s
lives
 NICE Quality Standards 86
– better care and response for the person who has fallen

The National Institute for Health and Care Excellence (NICE) provides national
guidance and advice to improve health and social care

1. Identify people at risk of falling

2. Multifactorial Risk Assessment for older people at risk of falling
3. Multifactorial Intervention
4. Checks for injury after an inpatient fall
5. Safe manual handling after an inpatient fall
6. Medical examination after an inpatient fall
7. Multifactorial risk assessment for older people presenting for medical attention
8. Strength and balance training
9. Home Hazard assessment and interventions
1. Introduction to falls
2. Preventing a fall – thinking about the individual
3. Preventing a fall – using your senses
4. Preventing a fall – creating the right environment
5. Preventing a fall – the power of exercise and fitting footwear
6. How to cope after a fall
7. Top ten tips for falls prevention hospitals and care homes

Links to the films are in the Resource Section

Falls history
Gait, balance
*Mobility, muscle weakness
Strength & Balance Exercises
Osteoporosis risk
Perceived functional ability
Fear of Falling
*Visual impairment
Cognitive impairment
Neurological Exam
Continence
*Home Hazard
Cardiovascular exam
*Medication Review
Refer on as necessary
* Gold standard evidence base

These interventions have shown through

research to have the most effect in falls
reduction.
 Intentional rounding

1:1 special assistance

Cohort – a group of high risk patients x 1 carer

Is a structured and timely approach to

managing fundamental care needs
 Risk assessment must be completed before for all use of bed rails.
 Bed rail usage should be identified on safety brief/MDT meeting.
 Reassess if patient deteriorates or condition changes
 Bed based care – monitor patients – 1:1 Specials/intentional rounding/ Cohorting
 Consider other alternatives to rails i.e. moving to a more visible area, hi-lo
bed
 Ensure bank/untrained staff are kept up to date with changes
 Ensure carers/family understand the risks, receive the information leaflet and
who to inform and when there is change
 Bedrail assessment in care plan admissions booklet

The Bed Rail Policy

is in the resource section
 Good footwear Call bell in reach Offer assistance to toilet

Medication Review
Vision check – glasses
clean, current & correct
Strength & balance
TABS /Sensor alarms Bedrails assessment

Assess bed height/bed

rails. Use of ultra low beds
 Lighting
 New environment
 Environmental check
 Use of colour in environment,
(Dorset Foundation Trust)
 Signage
 Obstacles/clutter
From May 2018 :

 After every bed based fall on acute wards please use the Post Fall review
form (yellow) for each patient fall and place in medical notes. Also attach
to Datix - document section of the incident.
https://icon.torbayandsouthdevon.nhs.uk/areas/falls/Documents/Post%20Fall%20Review%20%281%29.pdf

 Post Fall review form acute - order through Agresso (Q00355662)

 Laminated A4 Post fall flow chart have been distributed to all areas acute
& community wards and community teams- please ensure you know this
minimum detail
https://icon.torbayandsouthdevon.nhs.uk/areas/falls/Documents/G2255%20Falls%20Poster%20ACUTE.pdf

 Post fall training now available: attend the one appropriate to your clinical
area: bed based care or community. Dates on the HIVE

 Please refer to post fall policy

https://icon.torbayandsouthdevon.nhs.uk/areas/falls/Documents/G2255.pdf
Patient Falls – Falls Training Bed based/Community
Follow local post fall procedures
Keep calm & assess the situation

Never rush to get someone up

Check injuries before moving
(ruling out fracture or spinal injury)
Query about a head injury Shape
Primary Survey
call (para)medics/start neuro obs Safety & protection
Danger Response
Assess appropriate equipment Hazards
ABC Assess the situation
History is key
Prioritise
Complete incident report
Environment
Learn from incidents

You will look at these in more detail on your Practical Induction Training
 Neck/back pain or tenderness
 Restriction in movement
 Loss of movement or weakness in trunks or legs
 Loss of sensation, electric shock type or burning sensation in trunk
and limbs
 Loss of bowel/bladder function
 Start neurological observations

 Assume spinal injury if patient is unconscious/unable to answer

 ALRT - the Assisted Lifting Response Team

ALRT available to non-injured fallers who call 999 and have been triaged by
SWAST, 2 community alarm providers & locality teams who are triaging to
ensure the patient is non-injured in the community

ALRT refer to locality teams for further falls assessments

Service operates Mon – Fri 7.30 – 4pm
 What happened? Characteristics, frequency, signs/symptoms, witness?
 When - time of day
 Where - place, what was patient doing/body/position/environment
 Why - anything else going on i.e bloods, medicines, illness
 How?
 Can they get up off the floor?
 Outcome – DATIX – you are the Expert Witness

No Harm – No harm Caused

Near Miss – Did not result in Injury, illness or damage – but had the
potential to do so – Eg Patient Lowered to the floor
 Induction Part 3 - Falls Awareness- how to get patients up from
the floor
 Falls Foundation Training - includes: information on falls,
osteoporosis and fracture prevention.
 Lying and Standing BP Competency Frame work – classroom & e
learning
 Falls Safe Study Course – 2 days for bed based care staff
 Post Falls Training – Community or bed based training to equip
staff in following best practice with those who have fallen.
 Advanced falls training Packages, medical risk, sensory loss,
functional, physical, multifactorial & Environment - e-learning
 Post Fall Training
Book the appropriate training through the HIVE
 Falls need to asked about and reported
 Falls history give vital clues as to causes
 Falls can be prevented with appropriate assessment
interventions and prevention measures in place
 Accurate falls risk assessment and interventions are key
 Acting early can prevent falls
 Strength & balance -- keeping fit

Everyone is responsible
For Falls information and Training please contact

 Claire Burcham, Lead Nurse, Falls.

Tel: 01803 655859
Claire.burcham@nhs.net

 Jane Reddaway, Falls Prevention Lead

Tel: 07776 207358
Jane.reddaway@nhs.net