Transcript Slide 1

Completing
Community
Falls Risk
Assessments
Learning & Development
2014-15
You’ll need to read these...
The relevant documents are in the Trust’s
Documents Library, accessible from the
Trust intranet home page if you search for
‘falls’:
• Management of Falls - CORP/POL/042
• Use of the Falls Risk Assessment Form
– CORP/PROC/126
• Falls Service North Business Continuity Plan
– CHS/PLAN/001
• Slips Trips & Falls Prevention for Staff &
Others – CORP/POL/156
You should see these...
You’ll find sample copies of the forms below in the
‘Use of the Falls Risk Assessment Form’ document
mentioned on our previous screen:
Falls Risk
Assessment
Form
Fracture Risk
Assessment
Form
Let’s look at the Falls form
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We’ll take each
section in turn, front
and back:
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n
Let’s look at section 1...
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Use the left-hand box
for documenting
abbreviations
In the right-hand box print
patient details in black, or
use an Addressograph label
from their notes
Let’s look at section 2...
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• Ask the four trigger questions;
• If ‘Yes’ to any, go on to complete the full assessment,
making sure you date and sign the form;
• If risk is medium or high:
 Complete a Fracture Risk Assessment Form
 Consider referral to GP;
 Consider referral to osteoporosis CNS, if appropriate.
Now let’s look at section 3...
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SEX
(Circle one only)
Male
Female
1
2
• This is the first
of the nine more
specific sections
on the form and
aims to establish
the likely risk of
someone falling,
with women
being at a higher
risk, which is why
they score 2
instead of 1.
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SENSORY DEFICIT
(Circle all that apply)
Sight/wears glasses
Hearing/wears aid
Balance problems
Not applicable
2
1
2
0
• Any problems with
seeing, hearing, or
balance?
• Circle more than
one, if applicable.
• Establish if they
have appropriate
aids.
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MEDICAL HISTORY
(Circle all that apply)
Diabetes
Dementing type illness/confusion
Fits
Transient Ischaemic attack/CVA
Incontinence
Parkinsons/neurological disease
Not applicable
1
1
1
1
1
1
0
• Are there any pre-existing conditions or illnesses
that could impede movement?
• Score 1 point for each that applies.
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AGE
(Circle one)
Under 60
61 – 70
71 – 80
81 +
0
1
2
3
• The older the
person, the
greater the risk of
falling.
• The greater the
age, the higher
the score.
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FALL HISTORY
(Circle one)
None
Indoor fall
Outdoor Fall
Both
0
1
2
3
• Do they have a
known history of
falling?
• Are they known
to the falls team?
• Do they need
referring, if
applicable?
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MOBILITY
(Circle one)
Full
Uses aid
Restricted
Bed bound
1
2
3
1
• Are there any pre-existing
mobility problems?
• Do they use a walking-stick
or frame?
• Are there any restrictions,
such as limps or wounds?
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BALANCE/GAIT
(Circle all that apply)
Steady
Hesitant
Poor transferring
Unsteady
0
1
3
3
• Are they steady on their feet?
• On mobilising, do they feel unsure?
• Do they need help transferring? If not,
is there a known reason?
• Is there anything they can use to make
things easier for them?
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MEDICATION
(Circle all that apply)
Sleeping tablets
Tranquilisers
Blood pressure Tablets
Water Tablets
Not applicable
1
1
1
1
0
Are they on any medications that could:
• Alter their perception?
• Interfere with their balance?
• Cause dizziness, or make them dizzy and
unstable on their feet?
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CURRENT LIVING SITUATION
(Circle one only)
Lives alone/Is Carer
Lives with carer/partner/spouse
Carer package support
Residential care/Hospital
3
1
2
3
• What are their
current living
arrangements?
• Do they receive
any services?
• Do they have
someone to help
them at home?
• Do they have
stairs to climb?
Let’s look at section 4, on the
back of the form...
m
m Add up all the scores...
3-8 LOW RISK
9-15 MEDIUM RISK
16+ HIGH RISK
DATE
SCORE
ASSESSORS SIGNATURE
... and don’t
forget to sign
and date this
section.
Let’s look at section 5, also on
the back of the form...
n
the Action
n Complete
Checklist where appropriate:
(Put an X for No and a Y for Yes in the relevant boxes, plus
L&M for Lancaster & Morecambe or W&R for Wyre & Fylde.)
• Do any referrals need to be made?
• Does any advice need to be given?
• Date any action that has been taken.
the total is medium to
n If
high (>9 but <15):
• Do they need monitoring of their observations?
• Complete the Fracture Risk Assessment Form.
high risk patients
n For
(scores of 16+):
Consider environmental protectors, such as:
• Are they on the ground-floor?
• Do they have handrails?
• Are there any sharp corners they could hurt
themselves on?
Also: Look at any referrals , or OT assessments etc, that
might need making.
Other factors to consider:
• All risk groups MUST receive diet
and lifestyle advice.
• Develop an individual action or care
plan based on the assessment form;
• Make referrals to the appropriate
services, as indicated on the Action
Checklist;
• Consider any safeguarding actions;
• Does an Untoward Incident Report
need to be completed?
• Enter results in patient or client
notes.
Congratulations!
You have completed
this e-Learning course.
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