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[corporate governance]

Policy No: ##
Policy on the Management and Prevention
of Slips, Trips and Falls
Rehabilitation & Intermediate care staff Contents
Section 1: Introduction

Section 2: Risk assessment for the prevention and management of
slips, trips and falls
Potential risks and hazards in the care environment Assessment of patient/service users in a community/domiciliary Section 3: Document Consultation, Approval & Ratification
Section 4: Training, Distribution & Implementation
Section 5: Monitoring Compliance
Standards and Key Performance Indicators Policy on the Management and Prevention of Slips, Trips and Falls Page 2 of 24 Glossary of Terms
References
Useful Contacts
Appendices
Slips, trips and falls- Potential risks and solutions Drugs which increase risk of falls in older people Policy on the Management and Prevention of Slips, Trips and Falls Page 3 of 24 Section 1: Introduction
Introduction
Slips, trips and falls on level ground consistently account for 1 in 3 major injuries and 1 in 5 moderate injuries (absent for over 3 days) in work place areas throughout Great Britain, a total of at least 35000 injuries per annum. The Health and Safety Executive (HSE) state that the majority of these are Patient/service user and staff safety is a key priority within NHS Newcastle and North Tyneside Community Health. Falls can affect individuals of all ages with older people being especially vulnerable. Falls are a particular clinical concern because of the frequency at which they can occur and also because of the physical, psychological and social consequences. Falls are also a key focus within the National Service Framework for Older People with Standard 6 aiming to reduce the number of falls which result in serious injury as well as ensuring effective treatment and rehabilitation for Falls are a major cause of disability and nationally a leading cause of mortality. A fall can precipitate the need for long-term care; fear of falling can provide a significant limitation on daily activities and long-term psychological difficulties for the older person. More falls are reported to the National Patient Safety Agency than any other type of patient safety incident, (NPSA 2007) Slips, trips and falls can be minimised through planning and positive Policy on the Management and Prevention of Slips, Trips and Falls Page 4 of 24 management during re-furbishment and new build. Good housekeeping is an essential part of the prevention of slips, trips and falls. Both PCOs are committed to the safety of all staff, patients/service users and visitors and seeks to provide care in safe environments. Preventing, wherever possible, patients from falling and managing fall incidents appropriately, are recognised as being crucial to the safety of patients. The Health and Safety at Work Act 1974 (HSWA) requires employers to
ensure the health and safety of all employees and anyone who may be affected by their work. This includes taking steps to control slips and trip The Management of Health and Safety at Work Regulations 1999 build
on HSWA and include duties on employers to assess risks (including slip and trip risks) and where necessary take action to safeguard health and Policy Statement
It is the duty of each NHS body to establish and keep in place arrangements for the purpose of monitoring and improving the quality of health and social care provided by and for that body. NHS Newcastle and North Tyneside Community Health (NNTCH) is committed to this policy and the implementation of risk management strategies to reduce the risk of This policy applies to those members of staff that are employed by Newcastle and North Tyneside primary care organisations and for whom the PCOs have legal responsibility. However, it is recognised that primary care practitioners are also part of the organisations and as such this policy Policy on the Management and Prevention of Slips, Trips and Falls Page 5 of 24 is offered for use by them to adapt to their own practices and organisations as appropriate. The Quality and Safety Lead is available to offer help and support to primary care practitioners who wish to use and implement this To provide an understanding of potential causes of slips trips and falls and to outline a range of strategies that can be used to reduce the risk to staff, To provide a framework for the initial and ongoing assessment of the fall risks of individual patients/service users and the reporting and management of fall incidents and to ensure that falls (and the risk of falls) by patients/service users are effectively managed in a proactive way rather than simply by reacting to individual fall incidents. Duties and Accountability
Roles and responsibilities
Trust Board as an employer are responsible for fulfilling all duties assigned
to them in current Health and Safety legislation and are responsible for the successful implementation of this policy. Quality and Safety Department: is responsible for ensuring NNTCH
reviews and learns from reported slips, trips and falls by: • Regular reports sent to service managers/departmental leads. • Monitor trends in slips, trips and falls and report to the appropriate designated governance groups (See 1.4.2) Policy on the Management and Prevention of Slips, Trips and Falls Page 6 of 24 • Reporting of accidents and incidents as appropriate to the Health and • Monitoring action taken in response to any issues raised. Estates Department:
• Ensure the Department of Health’s guidance and advice referred to in HTM61 (Hospital Technical Memorandum) is followed with regard to flooring design, specification, procurement, construction, commissioning, cleaning and maintenance of flooring. • Ensure contractors and sub-contractors are aware of this policy and are effectively monitored in order to reduce slips and trips hazards they may • Ensure pathways and roads around Trust premises are suitably treated during adverse weather conditions (e.g. Snow and ice) in order to • Ensure an effective planned preventative maintenance programme for the repair of Trust pathways, car parks and floor surfaces in order to Domestic staff:
• Ensure that warning signs are prominently displayed when floors are • All cleaning staff to manage tripping hazards from cables when they are • Require cleaning staff to report any falls of their staff when working in • Require cleaning staff to make local staff aware of any potential tripping hazards they find during their work in PCT premises. Senior Managers/Heads of Service: It is the responsibility of managers to
Policy on the Management and Prevention of Slips, Trips and Falls Page 7 of 24 • All staff are trained appropriately • All slip, trip and fall incidents are reported. • Monitor any trends in reported accidents/incidents and take action to reduce the risk of slips, trips and falls. All Employees have a personal responsibility for maintaining health and
• Must be vigilant and ensure any slips and trips hazards that they are aware of are reported to their line manager as a minimum requirement. • Ensure they appropriately clear up any spillages or ensure action is taken to do so. E.g. Use warning cone and report to domestic services. • Ensure they complete the incident reporting form, where an incident or near miss occurs, as per the Accident and Incident Policy. • Position equipment to avoid cables crossing pedestrian routes • Ensure necessary risk assessments are undertaken and kept up to date • Wear suitable footwear for the environment and its risks. • Attend falls risk assessment and intervention training appropriate to their role and / or demonstrate appropriate level of competency / Accountability
The Quality and Safety Lead is responsible for ensuring that all incident reporting forms are reviewed and any slips trips or falls which have resulted in major or moderate injury are fully investigated and reported Quarterly reports on the numbers and trends of all accidents and incidents are submitted to the Governance and Risk Management Committee, Integrated Governance Committee and to Trust Board. Policy on the Management and Prevention of Slips, Trips and Falls Page 8 of 24 Definitions
There are many definitions of falls within the Healthcare setting. However, it is important to identify a practical definition that is workable in the clinical setting, as the current lack of conformity has led to vast differences in auditing and researching the numbers of falls (Cochrane 2001). The following definitions, can apply to patients, staff and visitors. FALL – A fall is an event which results in the person or a body part of the
person coming to rest inadvertently on the ground or other surface lower than the person, whether or not an injury is sustained. SLIP – A slip is to slide accidentally causing the person to lose their
balance, this is either corrected or causes a person to fall. TRIP – To stumble accidently, often over an obstacle, causing a person to
lose their balance, this is either corrected or results in a fall. Related Documents
This policy should be applied within the context of a number of other • Health, Safety and Wellbeing Policy • Accident and Incident Reporting Policies • Safer Handling Policy • Use of Restraint: Alternatives and Considerations (Newcastle PCT) (note the above list is illustrative, not exhaustive and all policies are Policy on the Management and Prevention of Slips, Trips and Falls Page 9 of 24 Equality and Diversity
All public bodies have statutory duties under the Race Relations (Amendment) Act 2000, the Disability Discrimination Act 2005 and the Equality Act 2006 to set out arrangements to assess and consult on how their policies and functions impact on race, gender and disability equality, in effect to undertake equality impact assessments on all policies/guidelines and practices. Best practice also suggests that Equality Impact Assessments (EIA); should be extended to include equality and human rights with regard to age, religion and sexual orientation and as such the three North of Tyne PCOs have adopted this best practice approach within its EIA as from the date of the adoption of the Policy for the Development The three North of Tyne PCOs are committed to providing services that meet the equality and diversity needs of staff and service users within the framework of current legislation. Current equality and diversity legislation includes, disability, gender, age, race, sexual orientation and religion. It is the responsibility of managers and staff to ensure that they act on this policy in a manner that meets the needs of people from these groups. It is always best to check with individual staff/service users what their needs are, but needs may include providing information in an accessible format, considering mobility and communication issues, being aware of sensitive This policy has been Equality Impact assessed recommendations from the assessment have been incorporated into the document and have been considered by the approving committee. A copy of the EIA summary is on Policy on the Management and Prevention of Slips, Trips and Falls Page 10 of 24 Section 2: Risk assessment for the prevention and
management of slips, trips and falls
Potential risks and hazards in the care environment
Service managers must ensure that within the care environment all slipping and tripping hazards are minimised and where ever possible rectified. Appendix 2 describes potential hazards and solutions as defined by the Assessment of in-patients
On admission to the ward an individual Falls Risk Assessment and Intervention Plan must be completed. Communication support for people with sensory or communication impairment and people that do not speak English should be provided for this assessment. The results of this assessment and intervention plan must be held in the individual patient’s record. Every time a patient/service user falls (or is found on the floor and a fall is suspected) the assessment and intervention plan should be re- evaluated to ensure that it remains appropriate and this should be noted in the patient’s/service users care plan. If there is an increase in the frequency of falls of any individual patient/service user this should trigger a full re-assessment. Again this re-assessment should be noted in the care Ward managers must also ensure that potential patient/service user factors in trips and falls are monitored and controlled. • Ensuring the patient/service user has appropriate footwear • Ensuring the patient/service user has appropriate walking aid(s) Policy on the Management and Prevention of Slips, Trips and Falls Page 11 of 24 • Checking that patients/service users have their own glasses • Reviewing the medication to see if it could be a contributing factor (Appendix 3 Drugs which may increase the risk of falls in older people) • Sensory and communication needs • Only issuing bed rails in line with guidance and where they are used checking that bed rails are appropriate to the individual patient and that • Assessing the potential fall risks posed by the use of special mattresses • Ensuring that nurse call systems and bed/chair alarms are properly • Paying special attention when patients/service users are attached to Action following a fall in an in-patient setting: • The patient/service user should be reassured by staff • An immediate physical assessment of injury should be carried out • The patient/service user should be assisted back to their bed / chair / feet as appropriate. Appropriate moving and handling equipment (e.g. hoist) should be used wherever possible. (See Safer Handling Policy). Patients should not be manually lifted from the floor. • An incident report form must be completed describing the circumstances of the accident and detailing action taken subsequently • The individual Falls Risk Assessment and Intervention Plan should be re-evaluated and a full reassessment undertaken whenever appropriate Assessment of patients/service users in a community/
domiciliary setting
A Falls Risk assessment accompanied by appropriate action to prevent falls must be carried out as part of the initial assessment process for all Policy on the Management and Prevention of Slips, Trips and Falls Page 12 of 24 new referrals. (Examples of documentation are available on the INFONET ) Every time a patient/ service user falls (or is found on the floor and a fall is suspected) the risk assessment and action plan should be re-evaluated to ensure that the intervention plan remains appropriate and this should be noted in the person’s care plan. If there is an increase in the frequency of falls of any individual patient/ service user this should trigger a full re- assessment. Again this re-assessment should be noted in the person’s Action following a patient/service user or carer fall in a community setting: • The patient/service user should be re-assured by staff • An immediate physical assessment of injury should be carried out. This should include asking the patient/service user to describe any injury • Whenever serious injury is suspected an ambulance should be called • Incident reporting form must be completed describing the circumstances of the accident and detailing action taken subsequently • The person’s GP should be informed • The patient/service user should be assisted back to their feet / chair / bed as appropriate. Manual handling equipment should be used (e.g. Hoist or Mangar Elk), patients should not be manually lifted from the floor. If necessary assistance and equipment should be sought from colleagues and/or community base. (See Safer Handling Policy) • A note of the incident and action taken should be made in the person’s Reporting Falls
All slips, trips and falls must be reported using the Trust’s standard Incident reporting form even if the person is unhurt. An incident form must also be completed when a person is found on the floor. Policy on the Management and Prevention of Slips, Trips and Falls Page 13 of 24 Slips, trips and falls will be reported externally as defined in the Accident Section 3: Document Consultation, Approval & Ratification
Consultation
This document has been produced by the Quality and Safety Lead, on behalf of NHS Newcastle and North Tyneside Community Health. In preparing the document for official ratification the stakeholders listed on the front sheet were consulted upon and their comments added to the Document Approval & Ratification
The Newcastle and North Tyneside Community Health Board is the committee with delegated authority for the approval and ratification of this document. The committee has ensured that a full and proper consultation has been carried out and has considered the content of the document in terms of current best practice, guidelines, legislation and mandatory and statutory requirements before formally approving and ratifying it on behalf of the Board. In considering the document for approval the committee also took into account the results and recommendations of the Equality Impact This policy was formally approved by the Newcastle and North Tyneside Community Health Board on [enter the date of approval]. Document Development
Policy on the Management and Prevention of Slips, Trips and Falls Page 14 of 24 The Governance and Risk Management Committee and nominated author is responsible for the development, review, implementation, performance management and distribution of this policy in accordance with the procedures set out in this document and the ‘Policy for the Development and Management of Approved Documents’. Version Control & Review
Version control of this document is the responsibility of the author in conjunction with the Corporate Affairs team. The author must ensure that timely reviews are completed and informed to the Corporate Affairs team who will in turn maintain a register of approved documents and issue index This policy will be reviewed every 3 years by the Governance and Risk Management Committee or as and when significant changes make earlier Section 4: Training, Distribution & Implementation
Training
All staff are required to attend Health and Safety training as part of Corporate and local induction. This includes risk assessment, hazard awareness and incident reporting. An annual update will also be provided as part of statutory and mandatory training. Policy on the Management and Prevention of Slips, Trips and Falls Page 15 of 24 All clinical staff working in an in-patient setting must receive training during their local induction period, in how to assess fall risks and use and develop Service managers must also ensure that staff identified as patient handlers are trained annually in patient/service user handling and the use of hoists or other moving and handling aids used on the ward/department or in the Additional specialist Falls training will be provided to clinical staff on request and/or in response to concerns identified through review of incident report Refer to the Learning and Development Policy for specific training Distribution
This policy is available for all staff to access via the Infonet/extranet. Staff without computer network access should contact their Line Managers for All staff will be notified of a new or revised document via the Chief This document will be included in the Publication Schemes for Newcastle and North Tyneside PCTs in compliance with the Freedom of Information Implementation
Policy on the Management and Prevention of Slips, Trips and Falls Page 16 of 24 It will be the responsibility of Quality and Safety Team to ensure Line managers have a role to play in ensuring staff are aware of this policy All staff have a responsibility to adhere to this policy. Key slips, trips and fall issues will be highlighted through quarterly reports to the Governance and Risk Management Committee, Integrated Section 5: Monitoring Compliance
Standards and Key Performance Indicators
Compliance with these standards is monitored by the Care Quality Commission on an annual basis. Reporting, monitoring and learning from accidents and incidents is included in Core standard C1a. ‘Health care organisations protect patients through systems that identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents’. ‘The organisation has approved documentation which describes the process for managing the risks associated with slips, trips and falls involving patients, staff and others.’ Policy on the Management and Prevention of Slips, Trips and Falls Page 17 of 24 National Standards Framework for Older People DoH 2001: Standard 6 ‘The NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older Older people who have fallen receive effective treatment and rehabilitation and, with their carers, receive advice on prevention through a specialised Monitoring Compliance
Monitoring of compliance is by review of all incident report forms received and through the quarterly reports of trends to Governance and Risk Management Committee, Integrated Governance Committee and Board. References
HSE Website- www.hse.gov.uk/slips/index.htm Department of Health (2001): National Service Framework for Older People National Patient Safety Agency (2007), Slips, trips and falls in hospital Luton and Dunstable Hospital NHS Foundation Trust Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 Workplace (Health, Safety and Welfare) Regulations 1992 Department of Health (2006) Health Technical Memorandum 61 Flooring Useful Contacts
Risk Manager - For advice on risk assessment and solutions – Telephone number: Spinal Awareness team - For advice and training on moving and handling – Policy on the Management and Prevention of Slips, Trips and Falls Page 18 of 24 Appendix 1
Slips, Trips and Falls- potential risks and solutions
The Health and Safety Executive outline 6 main contributory factors for slips, trip and falls, one or more may play a part in any situation or accident: Flooring
• The floor in a workplace must be suitable for the type of work activity that • Where a floor can't be kept dry, people should be able to walk on the floor without fear of a slip despite any contamination that may be on it. So it • The floor must be cleaned correctly to ensure that it does not become slippery or keeps its slip resistance properties (if a non slip floor) • The floor must be fitted correctly to ensure that there are no trip hazards and to ensure that non slip coatings are correctly applied. • The floor must be maintained in good order to ensure that there are no trip hazards e.g. holes, uneven surfaces, curled up carpet edges • Ramps, raised platforms and other changes of level should be avoided, if Obstacles
50% of all trip accidents are caused by bad housekeeping. So improving housekeeping would eliminate a large number of accidents Policy on the Management and Prevention of Slips, Trips and Falls Page 19 of 24 • Ensure there is a suitable walkway through the workplace • Keep it clear, no trailing wires, no obstructions. • Look at people’s workstations, are the floors tidy, do they have enough • What about other rooms? Are they tidy, are goods suitably stored, are there Good housekeeping doesn't cost money; it just takes a little personal effort. All staff should take responsibility.
Contamination and cleaning
Most floors only become slippery once they become contaminated. Prevent contamination to reduce or eliminate the slip risk. Contamination can be classed as anything that ends up on a floor, e.g. body fluids, oil, grease, cardboard, product wrapping, food, rainwater etc. the list is endless. It can be a by-product of a work process or be due to adverse weather conditions. First think about whether the problem can be eliminated, e.g • Ensure bodily fluids are collected correctly • Drip trays for leaks • Do not walk around the hospital with uncovered drinks, put lids on cups and • Good sized mats at building entrances to dry feet • Fit effective canopies to external entranceways to stop rainwater from entering a building. Fix leaking machines. Cleaning affects every work place and is not just a subject for cleaning managers and staff. Everyone in the workplace should keep their workspace clear and deal with their own spillages. People and Human Factors
How people act and behave in their work environments can affect slips and Policy on the Management and Prevention of Slips, Trips and Falls Page 20 of 24 • A positive attitude towards health and safety can reduce the risk of slip and trips accidents e.g. dealing with a spillage, instead of waiting for someone • Things that prevent you from seeing or thinking about where you are going, can also increase the risk of an accident e.g. rushing about, carrying large objects, becoming distracted whilst walking, e.g. using a mobile phone. • If individuals have a physical problem that stop them from seeing, hearing, or walking in a regular manner it can increase the likelihood of an accident e.g. vision, balance, age, disability that effects gait and ability to walk. There are also many medical factors (e.g. low blood pressure, on-going infection, slow heart rate, stroke disease) that may cause someone to fall. Factors in work, or created by the work activity can help stop or increase the • What tasks are taking place? Can they be improved? e.g. fewer/smaller boxes to carry so worker can clearly see route ahead. • Maintenance of equipment • Housekeeping systems • Provision of appropriate personal protective equipment • What footwear is worn can also make a difference e.g. wearing highheels at work will make you more vulnerable to a slip. Environment
Environmental issues can increase the risk of, or prevent slips and trips, so it is important to take them into consideration, e.g. lighting (natural or otherwise), loud or unfamiliar noises, the weather, humidity, condensation etc. Policy on the Management and Prevention of Slips, Trips and Falls Page 21 of 24 The following gives an indication of how they can affect slips and trips Too much light on a shiny floor can cause glare and stop people from seeing Too little light will also prevent people from seeing hazards on the floor and Unfamiliar and loud noises may be distracting If rainwater gets onto a smooth surface inside or outside of a building, it may create a slip hazard. Good entrance design (e.g. canopies) can help. Cold weather can cause frost and ice to form, which may create slippery It is vitally important to ensure that smooth floors are kept clean and dry Footwear
Footwear can play a part in preventing slips and trips. Where we can’t control the footwear it is vitally important that smooth floors are For work situations it is recommended that staff adhere to a sensible footwear policy i.e. Flat, with a sensible heel, with a sole and heel that provide some Policy on the Management and Prevention of Slips, Trips and Falls Page 22 of 24 Appendix 2
Drugs which increase risk of falls in older people
There are many side effects of drugs, which can increase the risk of falls in older people. The table below lists these and examples of drugs causing them. Other risk factors include polypharmacy and recent drug changes. Side Effect
Examples of drugs
Benzodiazepines e.g. temazepam, lorazepam & Antipsychotics e.g. chlorpromazine, resperidone, olanzepine Benzodiazepines e.g. temazepam, lorazepam & nitrazepam B blockers e.g. atenolol, bisoprolol, metoprolol, propranolol ACE inhibitors e.g. lisinopril, perindopril, ramipril, enalapril, captopril Diuretics e.g. bendrofluazide, frusemide, bumetanide Nitrates e.g. glyceryl trinitrate isosorbide mono & dinitrate Tricyclic antidepressants e.g. amitriptyline, imipramine Antipsychotics e.g. chlorpromazine, risperidone, olanzepine Typical antipsychotics e.g. haloperidol, trifluoperazine, chlorpromazine Atypical antipsychotics e.g. olanzepine, risperidone (less common) Prochlorperazine Antihistamines e.g. chlorpheniramine, hydroxyzine, promethazine Typical antipsychotics e.g. haloperidol, chlorpromazine Tricyclic antidepressants e.g. amitriptyline, imipramine Procyclidine & benzhexol Oral hypoglycaemics e.g. gliclazide, tolbutamide Policy on the Management and Prevention of Slips, Trips and Falls Page 23 of 24 Antipsychotics e.g. chlorpromazine, haloperidol, trifluoperazine, risperidone, olanzepine Levodopa including co-careldopa & co-beneldopa Procyclidine & benzhexol Cimetidine, ranitidine Spironolactone Policy on the Management and Prevention of Slips, Trips and Falls Page 24 of 24

Source: http://www.newcastlepct.nhs.uk/about-us/the-board/provider-board-agenda-and-minutes/5-january-2010/slips-trips-and-falls/Enclosure%2017%20-%20Falls%20PreventionpolicyFinalDec09.pdf

Doi:10.1016/s0195-668x(03)00003-4

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