Best Practice Guidelines BPG 8 Management and Prevention of Falls

Transcription

1 Best Practice Guidelines BPG 8 Management and Prevention of Falls 1 Version 3 draft Sept 2015

2 DOCUMENT STATUS: Approved DATE ISSUED: 10 th November 2015 DATE TO BE REVIEWED: 10 th November 2017 AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V1 March 2014 New Guideline V2 September Reviewed 2014 V3 September 2014 Reviewed REVIEWERS This document has been reviewed by: NAME TITLE/RESPONSIBILITY DATE VERSION Charlotte Hall Deputy Chief Nursing Officer March Karen Bowley Matron C of E, Stroke and September 2 Rheumatology 2014 Annette Lawrence Quality and Patient Safety Manager September APPROVALS This document has been approved by: GROUP/COMMITTEE DATE VERSION Quality & Safety Committee March Practice Development Group August Practice Development Group September DISTRIBUTION This document has been distributed to: Distributed To: Care and Nursing Home Staff and Managers Distributed by/when Care Home Managers Development events in April, July, Oct 2015 Paper or Electronic Paper Document Location Resource Folders Care Home Managers 26 th November 2015 Electronic/Paper WCCG Intranet DOCUMENT STATUS This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of the document are not controlled.

3 RELATED DOCUMENTS These documents will provide additional information: REF NUMBER DOCUMENT REFERENCE NUMBER TITLE 1. BPG 1 Pressure Ulcer Prevention & Management Final 2. BPG 2 Enteral feeding Final 3. BPG 3 Prevention and Management of Malnutrition Final 4. BPG 4 Infection Prevention Final 5. BPG 9 Medicines Management Final 6. BPG 10 Care Risk Assessment Final 7. BPG 11 Care of the deteriorating Resident Final 8. BPG 12 Care of resident with Diabetes Final VERSION RELATED REFERENCES Links to these documents will provide additional information: REFERENCES NPSA [2007] Slips, trips and falls in hospital NICE [2013] Clinical Guideline 161: The assessment and prevention of falls in older people NSF for Older People [2001] Standard 6: Falls Patient Safety First Reducing Harm From Falls [2009] NHSLA Standards 2012/13 National Patient Safety Agency Slips trips and falls data update NPSA:London Rapid Response Report NPSA/2011/RRR001, Essential care after an in-patient fall January 2011 Rapid Response Report NPSA/2011/RRR001 Essential care after an in-patient fall January 2011.Supporting information Patient Safety First 2009 The 'How to' guide to reducing harm from falls National Patient Safety Agency: London National Institute for Health and Clinical Excellence 2007 Head injury; triage, assessment, investigation and early management of head injury in infants, children and adults NICE (UK) 1.0 Introduction

4 Patient falls have both human and financial costs. Consequences for individual patients can range from distress and loss of confidence to injuries resulting in pain and disability or even, occasionally, death. Preventing patients from falling either at home or in a sheltered environment presents a particular challenge. A resident who is not permitted to walk without staff may become a resident who is unable to walk without staff. The purpose of this guidance is to ensure all reasonable steps to ensure the safety and independence of residents and at the same time, respects the rights of individuals to make their own decisions about their care. Falls are the single largest reported incident within all institutions and with differing degree of injury sustained. This guidance aims to: Reduce the number of resident falls Reduce harm resulting from a fall Support residents and staff to make individual decisions about appropriate falls prevention measures, balancing these with the need for rehabilitation and dignity Definitions A fall is defined as an event reported by a patient, relative or other witness resulting in the individual unintentionally coming to rest on the ground, or other lower level. [Rubenstein et al 1990]. Falls can be split into two very clear categories: - a fall from the same level - a fall from a height Both kinds of falls are equally dangerous and can cause serious injury or even death. Slips the slip is when your foot loses traction and slides forward, sideways or backwards. The slip could be caused by a number of hazards. The consequences of any of these hazards could be serious and could lead to serious injury. Trips a trip is when your foot is suddenly stopped from any forward movement by meeting an unexpected object. The consequences of a trip are serious and, as largely attributed to the environment, can be preventable. 1.1 Using the guideline The guidance details the four steps to reducing risks of falls: 1. Risk assessment of the resident 2. Information for residents and carers A simple falls risk assessment on admission to identify the most significant risk factors is required separately completed for every resident on admission and when the resident s condition changes (Appendix 1 assessment of falls risk)

5 1.2 Specialist Advice and Support The Royal Wolverhampton NHS Trust has a dedicated community falls prevention team based at West Park Hospital who are able to advise. GPs are able to access social and community services occupational therapists who may also be of assistance. The Clinical Commissioning Group (CCG) has a dedicated Quality Nurse Advisor Team who will support the implementation of this guideline and can offer specialist advice for any specific queries. Contact the Quality Nurse Advisor Team on or WOLCCG.Qualitynurseadvisorteam@nhs.net 1.3 Accountability 2.0 Detail The guideline applies to all staff in Care Homes. Care Home Managers are responsible for ensuring that the guideline is implemented and that staff follows best practice. In addition, the Care Home Managers must ensure staff access and attend appropriate mandatory training. 2.1 Care following a fall Falls frequently cause anxiety and stress naturally so if the resident falls reassurance must be given and help to get into the seated position if there are no obvious injuries. A registered practitioner (nurse, AHP or medical doctor) must undertake appropriate action in the event of a patient fall to identify, treat and monitor any resulting injury. Patient falls must be reported through the Care Home s incident reporting system including informing the person in charge and escalated to the manager of the home Report to CCG if fall results in a serious harm e.g. serious injury, fracture or death 2.2 On witnessing a fall, or finding a resident who has fallen: 1. An initial assessment to ascertain whether the resident is injured should be undertaken by a senior member of staff. 2. If emergency treatment is required follow individual care home policy and seek appropriate medical advice 3. If on initial assessment no serious injuries are found and the resident appears to be unaffected by the incident: Complete a risk assessment to decide upon appropriate action Decide action to be taken following the risk assessment this may include use of moving and handling techniques or equipment according to individual care home policy. 4. Ensure that the incident is fully documented and all actions carried out have a justifiable rationale. 5. Whenever possible, ascertain what caused the fall and take action to prevent further falls as necessary. 6. Record the fall in the appropriate accident/incident book or electronic reporting system

6 7. Notify the Incident Contact Centre if the relevant criteria under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) are met. 8. If serious harm occurs (serious injury, fracture or death) occurs please inform the CQC and Wolverhampton Clinical Commissioning Group Quality Team. A copy of the Root Cause Analysis document for a fall causing serious harm can be found at Appendix Obvious signs of injury following a fall may include but are not exclusive to; Bruising, fracture, bleeding, loss of teeth, swelling, pain, loss of consciousness It is important to ask the resident if they have hurt themselves following the fall and to look for obvious signs of injury. The classic signs of a fracture of the hip is external rotation of the leg (away from the body) and pain/difficulty weight bearing. However all residents should be reviewed by either a registered practitioner or GP following a fall where they have caused pain or injury. Falls that are un-witnessed are difficult to manage because staff are unable to ascertain what the resident may have injured. Where a patient has fallen un-witnessed, i.e. found on the floor, the worst outcome should be assumed and measures of observation taken to ensure the safety and welfare of the resident. The resident should be removed from immediate danger, if they feel able to get up from the floor they should be assisted to a chair and then returned to bed if they feel shaken or unwell. A set of observations should be taken with specific observation of their neurological status in case of head injury. Consideration of their blood sugar should be given if diabetic and routine physiological observations conducted including temperature, pulse, blood pressure, respiration to ensure they are within normal parameters. It may be necessary in some instances to call 999 for emergency assistance. 2.4 Possible signs of head injury Residents who have either, known to or potentially have banged their head, may be at higher risk of a cerebral bleed caused by the bang to their head. This may manifest as gradual sleepiness over a period of hours as inter cranial pressure increases, nausea or vomiting and eventual stupor. This can be life threatening and medical attention should be sought. Local policy should be adhered to following a resident fall. 2.5 Monthly safety thermometer and quality indicator returns Please record falls on the monthly safety thermometer and quality indicator returns. Links to both can be found here: Survey Monkey Questionnaire for Care Homes: Link to NHS Safety Thermometer (HSCIC): 2&area=&size=10&sort=Most+recent 3.0 Dissemination The care home manager is responsible for ensuring this guideline is disseminated to all staff and can evidence that staff have read it. This can be done via team or individual meetings.

7 4.0 Monitoring Arrangements Implementation will be monitored utilising Wolverhampton CCG quality monitoring framework e.g. Internal audits Quality Indicators returns Quality monitoring visits 5.0 Appendices

8 Appendix 1 Falls Risk Assessment To be completed by the healthcare professional Assessment Yes History of falls within the past 12 months? Patient or relatives / carers are anxious about falls? Patient tries to walk along but is unsafe / unsteady? Patient confused? Clinical condition which predisposes to falls, i.e. Parkinson s, postural hypotension, vertigo etc. If answered yes to any of the above, has an environmental risk assessment been reviewed following a fall? Print name & designation Signature Date

9 Appendix 2 ROOT CAUSE ANALYSIS FOR A FALL

10 Table of Contents RCA / Investigation Team 3 Summary 3 Investigation 4 Contributory Factors 4 Conclusion 4 Findings 4 Lessons Learnt 5 Action Plan 6 10 Version 3 draft Sept 2015

11 RCA / Investigation Team Date Investigation Started: Date Investigation Completed: Investigation Team Members: Summary Date of Incident: Time of Incident: Consequences of Incident:

12 Investigation Contributory Factors YES NO Comment Reporting Factors Witnesses Fall Not witnessed fall Outcome of medical investigation recorded (e.g. x-ray) Type of injury Environmental Factors Incident form completed Classification of incident (state) Patient buzzer/bell available within reach before fall If fall from bed, whether bedrails were in use Floor wet Floor dry Floor talcum powder Safe footwear Walking aid in use Walking aid in reach Bed area uncluttered Appropriate lighting (night lights) Patient Factors Toilets/bathrooms with grab rails available at appropriate height Did the patient have a falls risk assessment? Did the patient have a bed rails assessment? Did the patient have a risk assessment post fall? Is this first fall this admission? Is this a repeat fall? Was a Falls Care Bundle in place? Is the patient able to mobilise safely unaided? Is the patient easily observable? Medication e.g. sedatives, psychotropic or medication causing drowsiness

13 Was the patient confused or disorientated? Has the patient been or is the patient being treated for cardiovascular illness? Does the patient suffer from incontinence or urgency? Does the patient have problems with their eyesight?

14 Critical problems / issues Example: Staff were not aware patient was confused Main contributory factors / root causes Examples: Poor completion of assessment documentation No regular staff training in detecting and managing confusion Wolverhampton Clinical Commissioning Group Best Practice Guideline Template 14

15 ACTION PLAN Recommendation Action required Lead Priority (H,M,L) Time Scale (Completion date) Monitoring Wolverhampton Clinical Commissioning Group Best Practice Guideline Template 15