Transcript Document

SEPT - MANDATORY TRAINING
How to Find Your Way Around…
1. You can
play the
PowerPoint,
and find the
Test here
SEPT - MANDATORY TRAINING
2. You can
minimise this
column and
make the main
page bigger by
clicking this
icon.
Click it again to
bring it back.
SEPT - MANDATORY TRAINING
3. Always
click this
‘Home’ icon
to save your
progress and
log off.
This is very
important!
SEPT - MANDATORY TRAINING
SLIPS, TRIPS AND FALLS
SEPT - MANDATORY TRAINING
Course 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.
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 2007 - Slips, Trips and Falls in Hospitals PS0/3 published by the NPSA.
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.
Over 200,000 falls were reported to the NPSA's National Reporting and Learning System (NRLS) in the 12
months from September 2005 to August 2006, with reports of falls coming from 98% of organisations that
provide in-patient services.
SEPT - MANDATORY TRAINING
Learning's
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.
Fall Definition
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 therefore be defined as 'an event whereby an individual unintentionally comes to rest on the ground
or another lower level, with or without loss of consciousness'.
Older people are more vulnerable to falls. Patients with dementia are at least twice as vulnerable to falls.
Slightly less than a quarter of all types of patient safety incidents are reported from mental health settings.
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 530 patients may fracture
their neck or femur in hospital each year. 26 deaths have been reported as relating to falls during 1 year.
SEPT - MANDATORY TRAINING
Statistics
• 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
• In 2004-2005 275,000 falls were reported in UK hospitals
Importantly
• 30% of falls result in significant physical injury
• 3-5% 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
Fall Causes
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.
• 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).
SEPT - MANDATORY TRAINING
Overall Risk Factors
The risk factors that appear to be most significant in hospital patients are:
• walking unsteadily;
• being confused and agitated;
• being incontinent or needing to use the toilet frequently;
• having fallen before;
• taking sedatives or sleeping tablets.
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.
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
SEPT - MANDATORY TRAINING
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.
Medication – more than 4 drugs particularly increases risk
Postural problems
Sleeping tablets and anti-depressants
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 hazards
• Muscle weakness
• Hearing loss – unable to discern instructions and act on them
• Alcohol
• Malnutrition
SEPT - MANDATORY TRAINING
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 cot sides for the first time
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;
Analyse and use reports of falls to learn from ward and board level.
When staffing/observation levels are low
SEPT - MANDATORY TRAINING
Risk Assessments
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
Risk assessment chart for use of hip
protectors
•
•
Risk screening flow chart when assessing for use of
hip protectors
This flowchart can be found on the intranet by
following this link
Falls pathway - Patient Falls
When a patient falls the following steps apply and are taken from the Procedural Guidelines found on the
intranet where a flowchart describes the way forward: This flowcart can be found by clicling on this link
Step 1
• Medical staff should informed
• Patient is physically examined to determine if an injury has occurred
• In Secure & Adult Services, if no injury, log book only may be used to document fall
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
SEPT - MANDATORY TRAINING
Step 3
• Incident report completed
•
Low risk identified
• Circumstances surrounding fall documented in Care Plan
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 pathway (see link above)
• Follow indications for all risk categories and implement as necessary
SEPT - MANDATORY TRAINING
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 person try to walk but is unsteady and insafe
Has the patient's relatives expressed concern about falls
IF YES TO ANY OF THE QUESTIONS ABOVE, COMPLETE A CARE PLAN
Conclusion
In Summary
You should now be aware of the risks, factors causing falls and the prevention techniques available.
Make yourself familiar with the falls pathway, updating care plans and play your part in bringing falls levels to a
minimum throughout the trust.
Remember what you have learned is no substitute for professional insight and knowledge.
SEPT - MANDATORY TRAINING
SEPT - MANDATORY TRAINING
Now You need to take the Test.
Please click
the ‘Test’ icon
in the left
column, and
then click for
Questions.
Remember to click the
‘Home’ icon when you
finish the Test to save
your results