FALLS PREVENTION
ALAS HEALTHCARE
Scope
The Policy Statement
The Policy
Assessment and Monitoring
Falls and Injury Prevention Strategies
In the event of a Fall
Related Policies
Related Guidance
Training Statement
Policy Statement
A fall is a sudden, unintentional change in position causing an individual to land at a lower level on an object, the floor or the ground other than the sudden onset of paralysis epileptic seizure or overwhelming external force.
This organisation has identified the importance of staff being aware of the varying causes of falls and supporting service users by giving information, carrying out risk assessments and working with outside professionals to reduce their number of falls.
This policy reflects the NICE guidelines and current best practice.
The Policy
Assessment and Monitoring
At assessment, planning, reviews and in the day to day work with our service users we monitor the following aspects of the individuals care and support needs which may lead to them tripping or falling
The number of falls sustained in the last month and over the past 12 months
Uneven floor or ground surface.
Inappropriate footwear: Footwear that is borrowed, the wrong size (too big too small), too tight/loose, the heels being too high making the wearer unsteady.
Visual impairment: This can be as a result of poor or failing eyesight, insufficient or inadequate lighting or the presence of smoke.
Medical conditions. Individuals suffering from conditions that:
Affect balance, such as Parkinson’s disease, arthritis, multiple sclerosis and stroke.
Cause sudden drops in blood pressure, like postural hypotension.
Cause insomnia or incontinence which means you are frequently getting in and out of bed at night thus increasing the risk of falling.
Cause confusion and other physical disabilities such as Alzheimer’s disease or other forms of dementia.
Non-ambulant people or those with little mobility. Joints and muscles become stiff and this makes standing and walking difficult and painful.
Mental illness: For example, individuals suffering from psychiatric or physical conditions which cause delusions or the presence of the visual cliff effect. Depression has also been identified as being a cause of people falling.
Mobility aids: These can cause people to fall if they are not the correct type or height and if used inappropriately can be a hazard.
Polypharmacy: Older adults are often prescribed many different drugs for different medical conditions. However, sometimes this mix of medication can cause an older person to become confused, depressed, and drowsy or at times giddy leading to an increased risk of falls. Medications such as laxatives, diuretics, anti-depressants or sedatives, can contribute to falls.
Hazards: This can include obstacles left in walkways, rugs, ill-fitting carpets, trailing wires, wet or slippery surfaces, uneven surfaces, unfamiliar environments.
Poor lighting prevents obstacles from being seen and also creates shadows.
Falls and Injury Prevention Strategies
If the care or support needs assessment identifies that the individual is at any risk of falling a falls risk assessment will be carried out immediately before or when the service commences. The appropriate professional will also be contacted e.g. falls risk advisor, occupational therapist if there are changes in the service users health or they begin to fall. A falls risk assessment will then be carried out.
From the assessment and the outside professional advice, any or all of the following may be put in place.
Shock absorbent pads in undergarments (hip protectors). When wearing these protectors if the individual falls the pad absorbs the shock from hitting the ground and in the majority of cases prevents the hip from fracturing. It is important that the manufacturer instructions are followed and that they are the correct size and worn all the time.
Adjustable beds, pressure alarms and personal alarms. The adjustable bed makes it easier for the individual to get in or out of bed independently and therefore reduces the potential of a fall. Pressure alarms and pads immediately alert staff that a person is out of bed or the chair and staff can then quickly support an individual who may be likely to fall.
Exercise and activity for balance, strength and mobility
Exercise improves balance, strength, mobility and general well-being. Falls are reduced most significantly when exercise is individually tailored and supported by staff trained to provide exercise for older people. Some Community Centres or Local Authorities offer exercise programmes for people from the community. Individual and group exercise has wider benefits, including improved general social interaction and well-being. Staff are trained to work with physiotherapists to define one-one exercise plans, exercise sessions or activity classes.
External trainers provide regular armchair exercise.
Service users, who have fallen can attend outpatient ‘balance’ classes or physiotherapists’ ‘falls prevention classes.
Calcium and vitamin D supplements. A good level of calcium and vitamin D must be maintained in the body. This strengthens bones and helps prevent fractures. Osteoporosis occurs when these levels drop and the bones become brittle and more likely to fracture. It is not always necessary to take drugs for this condition but vitamin D and calcium supplements will be prescribed. The calcium and vitamin levels will be monitored by the GP because if the levels of calcium in the body are excessive kidney stones can develop. If there is excessive vitamin D, your kidneys and tissues may be damaged.
Too much calcium can cause constipation.
Too much vitamin D can cause nausea and vomiting, constipation, and weakness.
Calcium and vitamin D may interact with other medicines. A drug interaction happens when a medicine you take changes how another medicine works. One medicine may make another one less effective, or the combination of the medicines may cause a side effect you don’t expect.
Changing the medication regime. The individuals prescribed medication may be a cause of falls. For example, sedatives causing drowsiness, diuretics causing the person to rush to the toilet and codeine-based analgesia causing constipation and confusion in the elderly person. A regular review of medication type, strength and time of administration should be regularly carried out by the pharmacist or GP.
Improved Vision. Sight plays an important part in balance and gait stability so the selection of appropriate glasses for those who wear them is very important. Bi-focal and tri-focal glasses are often used by older individuals to provide for the ability to read and perform everyday functions without the necessity of changing glasses for each change of activity. Glasses used for reading, are not suitable for general use and very often not even for watching television. The changed focal point can make these glasses dangerous in certain situations. Particularly in the elderly different glasses for different tasks are more suitable, even with the added problem of confusion. Individuals must be encouraged to request assistance as needed. Regular eye tests should be encouraged and when required staff should ensure that glasses are clean and fit well.
Footwear. Individuals are encouraged to wear non-slip footwear. Footwear should also be comfortable and well fitting. Sloppy slippers or shoes will add to the danger of falling and must be discouraged.
Foot care. Hard skin or corns cause pain and this causes mobility problems. It is important that where prescribed creams are applied, skin softening creams may be used after bathing and visits to the chiropodist should be regularly encouraged, arranged and appointments kept.
Appropriate seating should be provided. If seats are too low, they cause problems in getting up and can lead to a loss of balance. If too high and the feet do not touch the ground there is also the problem of overbalancing. Adjustable beds also assist individuals in keeping independent by making getting in and out of bed easier.
Walking Aids When first receiving a walking aid staff should check that the individual is clear how to use it properly and they should be monitored until they are confident. An occupational therapist or physiotherapist must always be involved in the choice and use of walking aids. Walking Aids should be regularly checked for damage. Cleaned to prevent cross-infection Rubber ends regularly checked and replaced as necessary to prevent slipping. Regularly reviewed as the individual’s needs change. Walking aids should always be kept within easy reach of the individual.
The Environment. The service user should be encouraged to keep their home free from potentially unsafe conditions. Good housekeeping is essential and staff must be vigilant and put equipment away so as not to create a hazard.
Physical Intervention. For example, bed rails must be fully risk assessed and discussed with the relevant professional before being used or implemented.
Individuals and family members must be involved the individual with capacity must understand what is being suggested to help prevent falls and also that they consent to what is being put in place. The individuals understanding and co-operation are essential for the process to work effectively. They will be required to sign and consent to any reviews of the care or support plan. It is essential especially in the individuals’ own home that family or friends support and work with the individual in maintaining their independence while helping to reduce the risk of falls. Where appropriate the family should be included at the development stage of any personal safety plan.
People who lack capacity will need a plan that is clear to staff in how they support them and prevent falls but does not deprive them of their liberty and follows the Mental Capacity Act 2005 Code of Practice. A DoLS referral or Best Interest or Community Deprivation Order should be obtained if necessary.
Effective staff training is important. Staff need to be aware of who is “at risk. Good communication and recording play an important part in recognising potential risks to the individual and preventing falls. Understanding why people fall and what can be done to prevent it assists the worker to keep the individual safe.
Incontinence management. People often fall when rushing to the toilet for fear of incontinence. The individual’s medication needs to be considered, the dose and the time of day prescribed. The individual needs to know where the toilet/commodes are and the necessary aids should be in place to enable them to use it safely. Doors that are easily opened. The use of incontinence aids reduces the fear of the individual of having an accident.
Postural Hypertension management. Postural hypotension is a medical condition where blood pressure falls rapidly after the body changes position most commonly occurring after standing up after sitting for long periods. It is also known as orthostatic hypertension or postural hypotension. Individuals with postural hypertension experience symptoms of low blood pressure when the condition occurs. Postural Hypertension is quite common among the elderly and doctors regularly see symptoms in peoples as young as their mid-30′s. People that have postural Hypertension often experience symptoms immediately upon a body position change. Common occurrences are getting out of bed or bath, standing up from a seated position, or getting into a car. Management of this condition may greatly reduce the likelihood of a fall. This includes the individual learning to move slowly when standing up and to be aware of the potential risk of falling when doing such moves.
Personal items should be kept in easy reach or accessible to the individual. For example, the phone, spectacles, radio. This will prevent unnecessary movement for someone with poor mobility or balance. However, mobility is important so this goes alongside keeping the area free of hazards so people can walk around safely.
An interdisciplinary team approach is required for an effective outcome to all of the above. This organisation has links with the local NHS and the Local Authority falls services.
In the event of a Fall
Check to see if there are any injuries. If the person says that they are not hurt and that they feel strong enough to stand, encourage them to get up slowly and carefully. It may help them to hold onto furniture, providing that this is stable. It’s a good idea for them to sit and rest for a while until they are properly orientated.
If the staff member believes the person is injured, they should not encourage them to stand up but dial 999 and follow any guidance given by the 999 operators.
If there are 2 members of staff then one of them should immediately contact the office who will contact any family or representative. If only 1 member of staff then they should do this as soon as possible.
All falls should be recorded in the daily notes where a 999 call has been made the office should be informed. The incident/ accident form should be completed where appropriate and a notification sent to the regulatory body if required.
[INSERT OWN PROCEDURES FOR THE ABOVE AS REQUIRED]
Related Policies
Accidents, Incidents and Emergencies Reporting (RIDDOR)
Dignity and Respect
Health and Safety
Medication
Meeting Needs
Moving and Handling
Risk Assessment
NICE Guidelines [CG161], June 2013, updated 23 May 2019, Falls: Assessment and Prevention of Falls in Older People
https://www.nice.org.uk/guidance/cg161
NICE Quality Standard [QS86], March 2015, updated January 2017:
https://www.nice.org.uk/guidance/QS86
NICE Quality Standard (QS16), March 2012, updated May 2017: Hip Fracture in Adults:
https://www.nice.org.uk/guidance/qs16
Public Health England: Strength and Balance Quality Markers:
Training Statement
All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required.
Date Reviewed: October 2022
Person responsible for updating this policy:
Next Review Date: October 2023
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