1. How to Find Your Way Around… SEPT - MANDATORY TRAINING 1. You can play the PowerPoint, and find the Test here EXAMPLE COURSE

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4. SLIPS, TRIPS AND FALLS SEPT - MANDATORY TRAINING

5. 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. 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.

6. 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.

7. 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).

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. SEPT - MANDATORY TRAINING

15. Now You need to take the Test. SEPT - MANDATORY TRAINING Please click the ‘Test’ icon in the left column, and then click for Questions. EXAMPLE COURSE Remember to click the ‘Home’ icon when you finish the Test to save your results