Falls Prevention and Management Resource Pack

Transcription

1 Managing falls and fractures in care homes for older people Falls Prevention and Management Resource Pack Falls Prevention Service Wilson Hospital Cranmer Road, Mitcham CR4 4TP Tel: Fax:

2 Contents Introduction 3 Tools for Staff 1. Care home resident falls and fracture risk/intervention tool 4 2. Resident environment and orientation check 5 Tools for Managers 1. Care homes falls questionnaire 6 2. Care homes multifactorial falls risk assessment and management tool 7 3. Care homes falls prevention monitoring form Care homes generic falls environmental risk assessment form Care homes monthly falls overview form Care homes post fall/incident report form 21 Additional information Annex A Care homes post fall pathway 25 Annex B Care homes had a fall poster 26 Annex C Medicines associated with falls 27 2

3 Introduction What is this resource pack about? This resource pack provides the answers to many of the questions care home managers have in relation to the prevention and management of falls and fractures and can act as an excellent educational tool for new or existing care home staff. Managing falls and fractures in care homes for older people provides the direction, advice and support that staff in a care home need to make a difference in this area of care. The resource which is research-based not only gives the guidance required, but offers tools which can be used in a care home to help improve or change practice. Why should I use it? Falls are an inevitable part of ageing. In many cases, taking the right steps at the right time can prevent falls and enable an older person to continue a physically active life. Care home staff have a key role to play in falls prevention, but they need to have knowledge and understanding. Older people living in care homes are three times more likely to fall than older people living in their own homes, with the result of a fall often being much more serious; there are ten times more hip fractures in care homes than in other environments. Many factors can contribute to this heightened risk, such as physical frailty, the presence of long term conditions, physical inactivity, taking multiple medications and the unfamiliarity of new surroundings. For this reason, it is important that all care homes for older people implement a person centred process to manage and reduce falls and fractures. This will help to improve the overall quality of care for an individual and will have a huge impact on a person s independence and participation in life. How should I use it? The resources are split into groups to make them easier to navigate. There is a section for all staff to use to ensure the home environment and people living in it are safe and risk is minimised and managed where falls are inevitable. There is a section for managers to monitor falls in the home and develop more proactive management plans for reducing the incidence of falls. This resource pack has been adapted from the Managing falls and fractures Resource Pack as developed by, and with kind permission of, the Care Inspectorate. The full resource can be downloaded at: 3

4 Tools for Staff 1. Care home resident falls and fracture risk/intervention tool Care home resident falls and fracture risk/intervention tool Instructions for use: refer to each area of risk in turn. Consider the suggested actions to help write a personalised action plan for a resident. Mobility/ Balance Is the resident unsteady or have mobility problems? Does the resident they have a fear of falling? Confusion/ cognitive impairment Is the resident cognitively impaired? Is the resident more confused than normal? Falls history Medication Continence Have there been previous falls? If so, how many; what were the causes & consequences? Is the resident taking benodiazepines, psychotropics 4 or more meds; or any other high risk drugs? Are there any continence issues: incontinence, frequency or urgency? Foothealth and footwear Is footwear suitable? Are there foot health problems? Dizziness/ blackouts Does the resident appear dizzy or have fainting attacks? Vision/ hearing Does the resident have impaired hearing or sight? Environment Poor nutrition Is the environment safe and suitable? Is the resident underweight or have poor food intake? Bone health Does the resident have osteoporosis or are there osteoporosis risk factors? Moving & handling assessment. Supervision plan. Encouraging safe activity with use of approp. walking aids. Referral to physio. Assessment for hip protectors. Monitoring alcohol intake. Current health eg pain, dehydration, constipation. Ruling out infection/ delirium. Seeking advice from GP/CPN. Optimising environmental safety. Telehealthcare Promoting safe exercise and activity. Assessment for hip protectors. Pre-admission strategies. Supervision plan, using Walking aids where required. Encouraging safe activity. Referral for further assessment eg physio, GP or falls service, if high risk, unexplained falls or several recent falls. Assessing for hip protectors. Asking about and observing for symptoms of dizziness/ drowsiness. Checking BP (lying/standing). Medication review by GP. CPN review. Checking for infection. Toileting regime. Positioning near toilet. Referral to DN or continence service. Appropriate clothing. A commode or urinal. Using night lights. Discussing with resident and family suitable footwear. Introducing a footcare regime. Referral to podiatry. GP review, including medication review. Checking lying/ standing BP. Referral to Falls Clinic. If still a problem - consider referral to falls clinic Ensuring glasses and hearing aids in place and in good state of repair. Ensuring good lighting. Check for ear wax. Referral to optician/audiology. Orientating resident to environment. Using the Environment Assessment tool. Aids, appliances and/or signage. Referral to GP or dietician. Starting a food record chart (as advised by GP or dietician). Food supplements. (as advised by GP or dietician). Encouraging good fluid intake. Taking osteoporosis medications and/or calcium and vitamin D as prescribed. Discussing bone health with GP. Lifestyle advice eg calcium rich diet, safe sunlight exposure, sensible alcohol intake, smoking cessation, weight-bearing activity. Risk factors identified Date and initials Action plan Date and initials Adapted from a tool developed by Lynn Flannigan, NHS Lanarkshire Version no: 1 January 2015 Also known as Tool 6: Care home resident falls and fracture risk/intervention tool Unique identification no: NR527a 4

5 Tools for Staff 2. Resident environment and orientation check Resident environment and orientation check This tool can be used as a prompt to consider environmental risks relating to the individual and their own room Footwear/ clothing Walking Aid/ wheelchair Flooring Lighting Bathroom Surrounding area Furniture Bed Is footwear lightweight and nonslip? Are clothes non-slip and correct length? Liaising with next of kin and discussing with resident the importance of suitable footwear and clothing. Checking footwear monthly. Provision of equipment eg long handled shoehorn, helping hand if required. Do they require a walking aid? Is their walking aid/ wheelchair clean and in a good state of repair? Referral to local physio department. Checking condition of walking aid, replace ferrules if required. Checking condition of wheelchair, arrange wheelchair repair if required. If lap belts are being used appropriately. Is the flooring in good condition and non-slip? Are all thresholds flush? Is there adequate space, free from clutter? Reporting and recording any problems. Rearranging furniture if required. Encouraging good housekeeping. Is the lighting suitable for the resident s needs? Night light. Bedside light. Accessibility to resident. Additional lighting if required. Timer lighting if required. Is the bathroom suitable for the resident/ staff needs? Can the resident find it easily? Position of buzzer. Position of soap/hand towels. Using a raised toilet seat/toilet frame. Is there space for walking aid/ moving and handling equipment? Signage. Grabrails. Lightweight door. Contrasting colours. Position of bed. Are the hallways well lit and well signposted for resident? Is there easy access? Additional lighting. Additional signage. Floors different colour from walls. Adequate handrails. Clutter free. Reporting and recording any issues. Is there adequate space for walking aid/ moving and handling equipment? Rearranging furniture. Removing unnecessary furniture. Are footstools able to be moved and stored safely? Accessibility to: buzzer electrical equipment wardrobes and drawers. Is the bed suitable for resident s needs? Height. Mattress suitability. Position in room. Accessibility and ability to use buzzer. Grab rails. Need for bed rails. Adapted from a tool developed by Lynn Flannigan, NHS Lanarkshire Version no: 1 January 2015 Also known as Tool 4: Resident environment and orientation check Unique identification no: NR527b 5

6 Tools for Managers 1. Care homes falls questionnaire Falls Questionnaire Resident s name: Please take a few moments to complete the following questions. Once completed please return it to a member of staff who will discuss it with you to develop a care plan suited to your needs. 1. How many falls have you had in the past 12 months? 2. If so, where were you when you fell and what were you doing at the time? 3. Have you had any injuries due to a fall? 4. Do you use any of the following to help keep you safe? Walking aid Raised toilet seat Bed rails Sensor mats Hospital bed Manual wheelchair Electric wheelchair This is completed by the individual or principal carer as part of the pre-admission assessment. Adapted from a questionnaire developed by Lynn Flannigan, Linda Laffery, Denise Stewart and colleagues in Lanarkshire. Also known as Tool 3: Falls Questionnaire Version no: 1 January 2015 Unique identification no: NR527c 6

7 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) Multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) 1/ 7 Name of resident: DOB: Name of assessor: Date of assessment: Record all risks and actions in the resident s care plan. Risk factor (Tick if applicable, then link with recommended actions) 1. History of falling: Has the resident had one or more falls in the past 12 months? Room no.: Recommended actions (Select appropriate interventions and record in care plan) a. Obtain details about past falls, including how many, causes, activity at time of fall, injuries, symptoms such as dizziness, and previous treatment received. Determine any patterns and consider throughout assessment. Ask about/ observe for fear of falling. b. Discuss falls risk with family. c. Flag in care plan and at handover if resident is high falls risk. Consider: d. Contacting GP or falls prevention services to review resident s falls risks if at high risk or there have been unexplained falls or several falls in a short period of time. Give details of specific concerns. e. If recent falls, and the resident has a temperature (fever), consider checking for infection (with urine, sputum and stool samples). f. Assess for postural or orthostatic hypotension (a drop in BP when standing up). Record in resident s progress notes and inform GP if hypotension found. g. Consider how the resident can be observed/supervised more easily. Date and sign 7

8 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) Risk factor (Tick if applicable, then link with recommended actions) 2. Balance and mobility: Is the resident unsteady/unsafe walking? Does the resident have difficulty with transfers (getting on and off the toilet/bed/chair)? 3. Osteoporosis: Does the resident have osteoporosis (check transfer notes or ask GP) If not: Is the resident at risk of osteoporosis? Ask the following: Has he/she had fracture after a minor bump or fall, over the age of 50? Is there a family history of osteoporosis or hip fracture? Has he/she been on steroids for 3 months or more? Is there loss of height and an outward curve of the spine? Recommended actions (Select appropriate interventions and record in care plan) a. Ensure mobility aid and rails are used correctly and consistently. Prompt, place within reach, and use visual cues if appropriate. (Seek advice if unsure of correct use of mobility aids). b. Provide supervision when walking or transferring if required. Record what assistance is required. c. Record and hand-over recommendations from physiotherapist regarding mobility and transfer status (eg if supervision is needed) d. Review bathroom grab rails. Are they appropriate and in good condition? Refer to maintenance if necessary. e. Ensure brakes are on bed at all times. Ensure correct height of bed and chairs. f. Ensure that frequently used items are within easy reach ie glasses, drinks, walking aid. g. Ensure buzzer is within easy reach and the resident is able to use it. h. Ensure residents with poor mobility, who are known not to ask for assistance, are not left unattended on commodes, toilets, baths and showers (consider/ discuss the balance between safety and dignity). i. Increase opportunity for appropriate exercise through Activities of Daily Living (ADL) and the activities programme. Consider: j. If required, discuss concerns with the GP or physiotherapist to identify need for assessment of balance, walking and transfers, assessment for/ review of mobility aid. Record concerns in the resident s notes. k. Hip protectors - discuss suitability and funding with resident s care manager and family. a. If osteoporosis is diagnosed check the resident is taking medication for osteoporosis as prescribed. b. If at high risk speak to GP about osteoporosis risk and further investigation and/or treatment. Date and sign 2/ 7 8

9 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) Risk factor (Tick if applicable, then link with recommended actions) 4. Medication: Is the resident taking 4 or more medications? Is the resident taking any of the following? Sedatives Anti-depressants Anti-Parkinson s Diuretics (water tablets) Anti-psychotics Anti-coagulants Anti-hypertensives Has there been a recent change in medication that may effect falls risk (eg changes involving any of the above?) 5. Dizziness and fainting: Does the resident experience: dizziness on standing a sensation of the room spinning when moving their head or body fainting attacks palpitations? 6. Nutrition: Has the resident lost weight unintentionally or do they have little appetite? Recommended actions (Select appropriate interventions and record in care plan) a. Check medications have been reviewed with respect to falls risk (within the last 12 months is good practice). b. Report side-effects/symptoms of medication to GP. c. Read patient information leaflet which comes with the medication or speak to local pharmacist for information on medication side effects and interactions. d. Anticipate side-effects and take appropriate measures: Sedatives: toilet and prepare for bed before giving night sedation. Monitor at all times, but especially overnight and supervise in the morning. Anti-psychotics: can cause sedation, postural hypotension and impaired balance. Anticipate and compensate and report to GP. Inform GP if the resident is excessively drowsy or mobility has deteriorated. Diuretics: anticipate immediate and subsequent toileting. Ensure easy access to toilet and assist if required. e. Write in progress notes and alert staff at handover. f. Report changes in alertness or mobility. g. Assess for postural hypotension before and one hour after morning medications, for 3 days. h. Anticipate side-effects and take appropriate measures. a. Carry out a lying standing blood pressure reading to check for postural or orthostatic hypotension if staff trained to do so b. Refer the resident to the GP for review of dizziness/fainting/blackouts/palpitations. c. If postural/orthostatic hypotension prompt resident to move ankles up and down before rising, then rise slowly and with care from lying to sitting, and sitting to standing. Date and sign a. Refer to GP or dietician. b. In consultation with GP or dietician: commence food record chart. consider food supplements. 3/ 7 Does the resident spend little time outside in daylight? Refer to GP for assessment of vitamin D levels. 9

10 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) 4/ 7 Risk factor (Tick if applicable, then link with recommended actions) 7. Cognitive impairment: Is the resident confused, disorientated, restless or highly irritable or agitated? Does the resident have reduced insight and/or judgement and/or are they uncooperative with staff? 8. Continence: Do continence issues contribute to the resident s falls risk? Recommended actions (Select appropriate interventions and record in care plan) a. If there is a new change in cognitive status monitor for pain, signs of infection or constipation. b. Monitor behavioural issues and discuss chart with GP. c. Include behavioural issues in care plan and follow with regard to falls prevention. d. Ensure the resident s GP has reviewed this condition. Report fluctuations and patterns to treating GP. e. Do not leave the resident unattended on commodes, in toilets, baths or showers. f. Optimise environmental safety- remove clutter and hazards. g. Use visual cues (eg signs and symbols) as reminders or to aid orientation. h. Use routine practices when instructing/assisting the resident. i. Record useful practices in care plan. j. Investigate the resident s previous patterns and incorporate into care plan (eg usual time of showering or preferred side of bed). k. Ask family/relatives to visit at particular times of day to assist with management and care when able. l. Consider the need for falls prevention equipment in keeping with local policies and in discussion and agreement with family and principal carer. a. If no toileting routine is in place, carry-out a continence assessment and/or review of continence chart. b. Agree a toileting regime and use of continence products as appropriate. c. Optimise environment safety - remove clutter and hazards, consider night lighting, monitor floors for wet areas - clean or report as soon as possible. d. Ensure adequate hydration during the day, not excessive in late afternoon. e. Provide with commode chair or urinal as appropriate. Date and sign Consider: f. If required, referral to district nurse or the continence service. 10

11 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) 5/ 7 Risk factor (Tick if applicable, then link with recommended actions) 9. Sensory impairment: Does the resident have poor vision? (Remember: following a stroke someone may have restricted vision on one side, some people with dementia experience visual problems?) Does the resident have poor hearing? 10. Night patterns: *to be completed by night staff Does the resident often get out of bed overnight? If yes: Is the resident able to get in and out of bed safely on their own? Recommended actions (Select appropriate interventions and record in care plan) a. If vision has not been tested in past 12 months, refer to optometrist. b. Ensure room is free of clutter and obstacles. c. Ensure bedroom lighting is adequate, consider need for night lights. d. Ensure glasses are in good condition, clean (each morning), worn consistently (prompting, note in care plan), kept within reach when not worn, and appropriate (eg reading vs. distance) e. If hearing has not been assessed in last 12 months, discuss options, including referral to audiologist with GP. f. Ensure hearing aid is worn, clean and batteries are working. g. Use common gestures/cues/instructions. h. Minimise excess noise. a. Provide night lighting appropriate to vision. b. Optimise environmental safety remove clutter and hazards. c. Check bed height is suitable for the resident. d. Ensure spectacles and buzzer are within easy reach. e. Discuss with family if nightwear is not appropriate consider especially slippers (should be good fit, with back and heel support) and length of nightgowns. Consider: f. Treaded bed socks. g. Alert pad if resident is likely to fall while moving around the room. h. Hi-low bed. Keep in a position to suit the resident s needs overnight. i. Provide with commode or urine bottle for night toileting. j. If agitated at night: Ensure calm environment and follow advice in the behavioural plan for settling the resident. Observe every 15 to 30 minutes overnight. Engage in regular activity during the day to aid sleep at night and/or reduce agitation during the day. k. Refer to GP for review of evening or night medication. Date and sign 11

12 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) Risk factor (Tick if applicable, then link with recommended actions) 11. Feet and footwear: Does the resident have corns, ingrown toe nails, bunions, fungal infections, pain or loss of the sensation in their feet? Does the resident wear ill-fitting shoes, highheel shoes, or shoes without grip? 12. New or respite resident: Is the resident oriented to their new environment? Does the resident have suitable clothing and footwear? Other: Are there other factors that you consider relevant in considering this resident s falls risk, eg alcohol intake, pain, low mood/ depression? Recommended actions (Select appropriate interventions and record in care plan) a. Refer to podiatrist (or GP if fungal infections). Start foot care regime. b. Liaise with family to provide shoes with thin hard sole, enclosed heel, fastening mechanism. c. Do not walk with socks only. If shoes are too tight or loose fitting, walk with bare feet. d. Consider rubber tread socks if shoes are often removed. a. Orientation to facility/unit including their room, the bathroom, communal areas and outdoor areas. b. Optimise environmental safety - remove clutter and hazards. c. Inform and discuss with family/visitors as appropriate. d. Refer to pre admission information to identify specific issues. e. Liaise with family and principal carer to provide suitable clothing and footwear. Refer to information sent in from carer with regard to safety and falls risks. Identify suitable action/s. Date and sign 6/ 7 12

13 Tools for Managers 2. Care homes multifactorial falls risk assessment and management tool (includes an osteoporosis risk screen) Consider the relevance of the following risk factors: 7/ 7 Perceptual/Cognitive Physical Environment Activities Insight/ judgement Cognitive status Memory Orientation Psychiatric condition Anxiety Depression Motivation Medication effects Communication Nocturnal patterns Balance Strength Vision Hearing Continence Nutritional status Time spent outside Medical condition Medication effects Sensation Range of movement Foot health Constipation Footwear Aids Equipment Clothing Lighting Floor surface Location of bedroom Seating Bedroom furniture Signage Contrasting colours Mobility Transfers ADL Opportunity for exercise High risk activity Inactivity Fitness Action plan: Risk factors identified Intervention listed in: Intervention strategies and referrals Care plan Hand over sheet Date: Review date: Signature and designation: Adapted from a tool developed by Westerlands Care Home, Stirling Also known as Tool 5: Multifactorial falls risk assessment and management tool Version no: 1 January 2015 Unique identification no: NR527d 13

14 Tools for Managers 3. Care homes falls prevention monitoring form (walking aids/footwear/wheelchairs/commodes/chairs) 1/ 2 Falls prevention monitoring form (walking aids/footwear/wheelchairs/commodes/chairs) Week commencing: Issue Y/N Comments Any action required To whom reported Initials Date Have all walking aids been checked for wear and tear? Have all resident s shoes been checked for safety/mobility? Have all wheelchairs been checked for safety? Have all chairs been checked for wear, tear and safety? Have all commodes been checked for wear, tear and safety? 14

15 Tools for Managers 3. Care homes falls prevention monitoring form (walking aids/footwear/wheelchairs/commodes/chairs) 2/ 2 Action taken Date Name/initials Adapted from tool developed by Lynn Flannigan, NHS Lanarkshire Version no: 1 January 2015 Also known as Tool 16: Falls prevention monitoring form (walking aids/footwear/wheelchairs/commodes/chairs) Unique identification no: NR527e 15

16 Tools for Managers 4. Care homes generic falls environmental risk assessment Generic Falls Environmental Risk Assessment 1/ 4 Bathroom and shower rooms Are floor coverings of bath/shower rooms a different colour from wall coverings? Are floor coverings provided with a non-slip surface? Are floor coverings free of defects? Is a system in place to ensure spillages are cleaned up without delay to prevent slippage risks? Are handrails positioned properly and securely next to toilet, shower and bath? Are raised toilet seats available which are well fitting and secure? Are non-slip mats used in bath/shower? Are receptacles for soap/shampoo easy to reach and do not require user to bend over? Do all shower chairs have adjustable legs, armrests and rubber stoppers on legs? Do commode chairs have wheels, castors, brakes that work smoothly and effectively? Do all shower chairs and commode chairs have seat belts or safety bars? Are areas immediately around bath and sink marked in contrasting colours? Is there room for a seat in/near shower? Are call buttons accessible from a sitting position in the shower? Is suitable transfer equipment (side loading trolley, hoist, etc) provided for users? Is bathroom/shower room free of stored materials that could present a tripping risk? Is bathroom/shower room door able to be opened/closed easily by user? Is bathroom/shower room free of a change in floor level? Is bathroom/shower room provided with adequate lighting? Area of consideration Yes No N/A Passageways Yes No N/A Are passageway floor coverings a different colour from wall coverings? Are floor coverings in passageways free of defects? Remedial action required to address significant finding 16

17 Tools for Managers 4. Care homes generic falls environmental risk assessment Passageways Yes No N/A Is a system in place to ensure any spillages are cleaned up without delay? Are passageways provided with adequate lighting? Are passageways free of a change of floor level? Are adequate handrails provided along length of the passageway? Are passageways wide enough to allow people to pass each other? Are passageways maintained free of stored materials? Are doors across passageways maintained in the open position by hold open devices connected to the fire alarm? Are all cables positioned so that they do not present a tripping hazard to users? Common dining area Are floor coverings of dining area a different colour from wall coverings? Are floor coverings in dining area free of defects? Is a system in place to ensure any spillages are cleaned up without delay? Is the dining area provided with adequate lighting? Is floor covering in dining area free of change of floor level? Is dining area maintained free of stored materials? Are all cables positioned so that they do not present a tripping hazard to users? Common lounges Are floor coverings of the lounges a different colour from wall coverings? Are floor coverings in lounges free of defects? Is a system in place to ensure any spillages are cleaned up without delay? Are the lounges provided with adequate lighting? Are floor coverings in lounges free of change of floor level? Is lounge area maintained free of stored materials? Is furniture in lounge area arranged so that tripping hazards are minimised? Are all cables positioned so that they do not present a tripping hazard to users? 2/ 4 17

18 Tools for Managers 4. Care homes generic falls environmental risk assessment 3/ 4 Stairs and internal ramps Yes No N/A Is the height of the steps the same throughout the whole length of the stair or stairwell? Are the nosings (edge of step) square edged, highly visible and provided with a non-slip finish? Are steps of stairs free of defects and provided with a non-slip finish? Are suitable handrails provided on stairs? Are stairs provided with adequate lighting? If an internal ramp is provided has it been clearly identified? Is the floor covering on the ramp free of defects? Is the slope of the ramp suitable? Is ramp provided with adequate lighting? Is ramp provided with suitable handrails? Lifts Is the lift floor covering a different colour from the wall coverings? Is floor covering in lift free of defects and provided with a non-slip finish? Are suitable handrails provided in lift? Are call buttons arranged so that they can be easily reached by users? Does the lift stop level with floor landing? Is the lift provided with adequate lighting? External Are external footpaths/areas used by residents (eg car park) even and free of defects? Is a system in place to ensure external routes are maintained free of slipping/tripping hazards eg falling leaves, moss, uneven paving, pot holes Is a winter maintenance procedure in place that monitors footpaths/roadways to ensure they remain free of contaminants eg ice? Are footpaths/roadways free of a change of level that present a tripping hazard? If a ramp is provided is the slope of the ramp suitable? If a ramp is provided is the surface free of defects? If a ramp is provided are suitable handrails provided? Are external footpaths, roadways and ramp provided with suitable lighting? Are door mats to remove possible contaminants from feet suitable? 18

19 Tools for Managers 4. Care homes generic falls environmental risk assessment 4/ 4 References Queensland Health general environmental checklist All Wales Falls Framework - falls prevention document (draft) Minimising the risk of falls & falls related injuries Victoria Quality Council Generic Environmental Checklist The Generic Environmental Checklist pertains to the entire environment within the care home and its grounds where residents might spend some of their time. Instructions for Use: Overall responsibility to ensure the completion of the environmental checklist lies with the home manager. This is necessary as remedial action may involve major and/or costly modifications to the area or changes in the operational activities within the area. The checklist should be carried out at least annually. Tool developed by Carolyn Wilson, NHS Tayside Also known as Tool 9: Generic Falls Environmental Risk Assessment Version no: 1 January 2015 Unique identification no: NR527f 19

20 Tools for Managers 5. Care homes monthly falls overview form Care home monthly falls overview form Care home: Month/year: Resident s name Date/ time Room no./ location Why did resident fall? Type of injury sustained/hospital admission required Service contacted at time of fall, eg GP, NHS 24, SAS, A&E Action recommended to prevent further fall Action completed yes/no Initials Tool developed by Carolyn Wilson, NHS Tayside Version no: 1 January 2015 Also known as Tool 11b: Care home monthly falls overview form Unique identification no: NR527g 20

21 Tools for Managers 6. Care homes post fall/incident report form Post fall/incident report form 1/ 4 Resident s name: Date of birth: Room number: Date of fall/ incident: Time of fall: Fall location Outdoors Bedroom En-suite Bathroom Corridor Sitting room Dining room Exact location Surface type Carpet Linoleum Other (specify) Surface condition Wet Damaged Slippery Other Bed position High Low Tilted N/A Call bell in reach Yes No N/A Light On Off N/A Mobility Ambulant Non-ambulant Independent Assistance of 1 Assistance of 2 Aids None Stick Walking Frame Crutches Wheelchair 21

22 Tools for Managers 6. Care homes post fall/incident report form Was aid used at the time of fall? 2/ 4 Used correctly Used incorrectly Not used Unknown Condition of aid Type of fall Slip Trip Collapse Legs gave way Loss of balance Unknown Falls direction Drop Forwards Backwards Sideways Unknown Any warning prior to fall Dizziness Faintness Confusion Fit Loss of consciousness Palpitations Aggression Breathlessness Altered mental state Toileting None of above/other (specify) Resident attempting to go to toilet Incontinence Frequency Urgency Footwear Shoes Slippers Socks Bare feet Condition Glasses None Reading Distance Bi-focals Vari-focals Type worn at the time of fall None Reading Distance Bi-focals Vari-focals Condition of glasses History of falls No Yes Number of falls in past 12 months Medication/substance use - potentially a contributory factor? Yes No N/A Unknown Time taken Medication/substance identified 22

23 Tools for Managers 6. Care homes post fall/incident report form Description of event 3/ 4 Was the resident aware the fall was going to happen? Yes No Unknown Residents description of fall including activity immediately prior to falls Brief description of fall. What was seen or heard. Witnesses description (note any incontinence or abnormal movements). Witness name/status: Clinical observation/vital signs following fall Vital signs checked following fall Yes No N/A (BP, pulse, respiration) Any noticeable changes in residents health Yes No (note any pallor or cyanosis) AMT required Yes No N/A AMT Score: First aid administered Yes No N/A Hospital attendance required Yes No N/A Injuries sustained: Fracture: Yes No Head injury Yes No Laceration/bruising Yes Other (specify): Immediate action taken Doctor notified Yes No Time notified: Seen by doctor Yes No Time seen: Doctors name: No 23

24 Tools for Managers 6. Care homes post fall/incident report form Outcome (note if RIDDOR reportable) 4/ 4 Action taken to prevent re-occurence (please specify) Falls risk assessment/care plan updated? Yes No N/A Environmental risk updated? Yes No N/A Assessed by Date Tool developed by Carolyn Wilson, NHS Tayside and Jerry Forteath, Angus Council Social Work and Health Version no: 1 January 2015 Also known as Tool 10b: Post fall/incident report form Unique identification no: NR527h 24

25 Annex A Care homes post fall pathway Pathway for managing a resident who has fallen or who has been found on the floor A resident has fallen or has been found on the floor STAGE 1 Assess resident s responsiveness and for any injury (including cuts, bruising, deformities or pain) No obvious injury sustained Obvious injury sustained Check for any pain, swelling or abnormality. Check understanding and comprehension. If in any doubt follow procedure for obvious injury. Once established as far as reasonably practicable that there has been no obvious injury sustained, correct moving and handling practice should be followed to assist the resident from the floor. Independent person: Verbally talk through rising from the floor. For Stage 1 see section A6 for more detail Dependent person: Appropriate hoist/floor lifting cushion must be used to lift from floor Notify next of kin as agreed Commence falls investigation Do not move the person (unless in immediate danger of further injury). Call for assistance/alert senior staff. Keep person warm and note any changes. Assess level of injury, provide reassurance and take appropriate action (eg call ambulance/gp/nhs 24). If competent take vital signs eg BP. Attend to superficial wounds. Injury to head suspected ongoing observation for neurological changes. Safe to move person Not safe to move person Call ambulance/ GP/NHS 24 STAGE 2 Complete accident/post falls report form to determine causes/ circumstances of fall Compile an action plan from the above finding to reduce the risk of a similar fall occuring again Refer on to appropriate services if required Review falls risk assessment/care plan and update as required Complete individual falls record and/or care home falls record Complete incident reports as required by organisation Communicate to all relevant staff that individual has fallen and has an increased chance of falling again Discuss with individual and their family the circumstances of falls, the consequences and action plan to reduce further risk, including any referral on for further assessment/intervention Ensure ongoing monitoring of individual as some injuries may not be apparent at the time of fall. Observe individuals who are taking anticoagulants or antiplatelets carefully because they have an increased risk of bleeding and intracranial haemorrhage. Adapted from tool developed by Carolyn Wilson, NHS Tayside Also known as Tool 8: Pathway for managing a resident who has fallen or who has been found on the floor 25

26 Annex B Care homes had a fall poster With acknowledgement to Berkshire Health Promotion 26

27 Annex C Medicines associated with falls Medicines associated with falls Taking certain medicines can make you more likely to fall. However, while they may contribute to falls in some people, they don t cause falls in everyone. Medicines act in different ways, e.g. Medicines acting on the brain can cause drowsiness, loss of balance and slow reaction times Medicines that lower blood pressure or slow the heart can cause faintness, dizzy spells or legs to give way e.g. blood pressure may suddenly fall when standing up or stretching. People on FOUR or more medicines (polypharmacy) are at greater risk of falling. Regular medication reviews play an important part in preventing medicines-related falls. Common examples of medicines acting on the brain: Sleeping tablets and anxiety treatments e.g. temazepam, diazepam, zolpidem, zopiclone, Some antidepressants may cause drowsiness* e.g. amitriptyline, mirtazapine, citalopram, fluoxetine Some antidepressants may cause dizziness e.g. venlafaxine, duloxetine Strong painkillers e.g. codeine, tramadol, fentanyl Antipsychotics* (medicines for mental health problems and agitation) e.g. olanzapine, quetiapine, risperidone, haloperidol Medicines for Parkinson s disease* e.g. co-beneldopa and co-careldopa Some antihistamines e.g. chlorphenamine and cinnarizine Medicines for epilepsy e.g. phenytoin and carbamazepine Medicines for nausea, vomiting, travel sickness e.g. cyclizine *these medicines can also lower blood pressure March Common examples of medicines that lower blood pressure or slow the heart: Medicines to treat high blood pressure and heart disease e.g. digoxin, doxazosin, lisinopril, losartan, amlodipine, diltiazem, atenolol, glyceryl trinitrate, fluid tablets (examples below) Other commonly-used medicines known to increase the risk of falls: Medicines for dementia may cause fainting or dizziness e.g. donepezil, galantamine, rivastigmine and memantine Medicines for diabetes may cause dizziness e.g. insulin, pioglitazone, gliclazide Medicines for bladder overactivity may cause blurred vision e.g. oxybutynin, tolterodine Some eye drops or eye ointments may cause blurred vision e.g. latanoprost, pilocarpine Fluid tablets may cause rushing to the toilet e.g. bendroflumethiazide, indapamide, furosemide Laxatives may cause rushing to the toilet e.g. senna, macrogols Refer to British National Formulary (BNF) latest edition for further examples of medicines listed above Iff I a rresi identt seems tto be att an incrreased i rri isk off ffal lling due tto tthei irr medicines,, tthe carre--home nurrse orr managerr should discuss tthi is witth tthe rresidentt s pharrmacistt orr GP.. 27

28 Copyright 2015 Care Inspectorate All rights reserved Printed January 2015 Planned review January 2016 Sutton and Merton Community Services 120 The Broadway London, SW19 1RH The Care Inspectorate and NHS allow all or part of the text of this document to be reproduced, free of charge, in any format or medium provided it is not for commercial gain. The text may not be changed and must be acknowledged as Care Inspectorate and NHS copyright with the document s date and title specificed. This booklet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. This resource pack has been adapted from the Managing falls and fractures Resource Pack as developed by, and with kind permission of, the Care Inspectorate. The full resource can be downloaded at: Details of the references used in writing this booklet are available on request from: The Royal Marsden Help Centre Freephone: patientcentre@rmh.nhs.uk No conflicts of interest were declared in the production of this booklet. The information in this booklet is correct at the time of going to print. 28 NR527 Version 1, January 2015