Falls Prevention Management in Swansea Nhs Trust
Total Page：16
File Type：pdf, Size：1020Kb
FALLS PREVENTION MANAGEMENT IN SWANSEA NHS TRUST CONTENTS 1. Outline of Falls Prevention Management in Swansea NHS Trust 2. Nursing Procedure for Reducing Patient Falls 3. Flow Chart, Reducing Patient Falls - On Admission 4. Flow Chart, If a Patient Falls Post Admission 5. Patient Falls Risk Assessment Tool 6. Morse Falls Risk Assessment 7. Patient Care Management Plan a. Low Risk b. Medium risk c. High Risk 8. Patient Care Management Plan -Falls Care Plan 9. Falls Diary 10. Guidelines For The Use Of Side Rails 11. Risk Assessment Tool For The Use Of Side Rails 12. Audit of Bed Rails Falls Prevention Management in Swansea NHS Trust 1 1. FALLS PREVENTION AND MANAGEMENT - Swansea NHS Trust Swansea NHS Trust was established on 1 April 1999. It provides a comprehensive range of hospital and community health services for the Swansea population of approximately 250,000. The Trust also provides many specialist services for the people across south and mid Wales and some specialist services for the whole of Wales. Services are provided from 9 hospitals with over 1,800 beds and in a range of community premises. Hospitals • Morriston Hospital • Fairwood Hospital • Singleton Hospital • Clydach Hospital • Cefn Coed Hospital • Gellinudd Hospital • Gorseinon Hospital • Garngoch Hospital • Hill House Hospital These include psychiatric day centres and resource centres, health centres, health clinics, hired premises, GP surgeries and patients' homes. The Trust is one of the largest in Wales with an annual income in excess of £240 million. The number of staff employed by the Trust is approximately 7,000 Background The most common cause of death in adults over 75 is falls, as well as being a significant cause of injury and disability (DTI 1999, Smith 2000). Over 14,000 older adults die each year following osteoporotic hip fractures (DoH 2001). The Department of Health has addressed falls prevention in standard six of the National Service Framework for The Older Adult (DoH 2001). This Standard is aimed at reducing the incidence of serious fall-related injuries whilst promoting the effective treatment and rehabilitation of the victims. In June of 2003 Swansea NHS Trust undertook a pilot project to introduce a Falls Prevention and Management resource pack into 9 of its sites. This Initiative was supported by the Foundation of Nursing Studies (www.fons.org). A Falls resource pack was developed by reviewing some of the highly successful innovations to prevent falls throughout the country and in particular work previously undertaken by Barnett (2002). The pack was piloted in the identified areas throughout the Trust. Post Falls Pilot A trend analysis shows the incidence of falls pre and post the pilot period A decrease can be seen in falls during the pilot phase of the project. Falls Prevention Management in Swansea NHS Trust 2 Progress to Date Resource pack Falls Log Book Since the introduction of the Datix Incident Recording System there is no longer a need for a Falls Log Book. Falls data can be requested and returned electronically, as required, by each unit. Visual Cues Visual cues are no longer used due to the fact that many of the patients often leave the bed side, where the visual cue would be displayed, and sit in the ward day room. There was no suitable place by each patient’s chair in the day room to display the patient’s visual cue. Side Rails A local audit of 8 Elderly Care Wards identified side rails that required attention, the need for more cot bumpers and extra height side rails. The Trust is currently looking at a bed management system which will take into consideration all of the issues discussed in the Audit of Detachable Side Rails. Patient Falls Audit A random selection of 10 patients nursing records including care-planning documentation was audited. It highlighted the need for further training in 3 of the 9 pilot areas. Falls Prevention Management in Swansea NHS Trust 3 The Way Forward The falls Prevention and Management Group disbanded in November 2003 due to Management Restructuring throughout the Trust. However the Resource Pack continued to be used within the 9 identified areas. The group reconvened in June 2004 to discuss the development of a Falls Prevention and Management Integrated Care Pathway which would incorporate the existing Resource Pack. The group is multi-agency with representatives from all areas within the Trust and Local Health Board. Process Mapping will be undertaken by the group in October 2004. This will assist in identifying the existing Falls Prevention services within Swansea NHS Trust, whilst enabling the recognition of services that will require development. In August 2004 the existing work was presented to Swansea NHS Trust Innovations in Care Board, where the need for resources was identified to enable the existing work to continue and services to be developed. References: Barnett, K. (2002) Reducing patient falls in an acute general hospital. In Shaw, T. and Sanders, K. (Eds) Foundation of Nursing Studies Dissemination Series. Vol. 1, No, 1. Department of Trade and Industry (1999) Accidental Falls: Fatalities and Injuries. An Examination of the Data Sources And Review of the Literature on Preventative Strategies. Newcastle: University of Newcastle Upon Tyne. Department of Health (2001) National Service Framework for Older People. London: The Stationary Office. Morse, J. (1997) Preventing Patients Falls. Sage Publications. Morse, J. M., Morse, R. and Tylko, S. (1989) Development of a scale to identify the fall prone patient. Canadian Journal on Ageing. Vol. 8. No. 4. pp 366-377. Smith, S. (2000) Catch-all Solution. Nursing Times. Vol. 96. No. 3. pp 22-23. This project received professional support and a grant of £2000 from the Foundation of Nursing Studies. Falls Prevention Management in Swansea NHS Trust 4 2. NURSING PROCEDURE FOR FALL RISK PREVENTION - Swansea NHS Trust Falls are the most common injury sustained by hospitalized patients. They are a major cause of injury and death among the elderly and debilitated patients. Environmental, physical, and psychological factors contribute to patient falls and the ensuing injuries. Falls are preventable occurrences that injure patients, prolong hospitalizations, and significantly increase healthcare costs. The implementation and adherence to an effective fall prevention program negates many of these incidences of injury and additional costs. The goal of the fall prevention program is to identify the patient who is at risk to fall, institute proactive efforts to reduce the occurrence of fall- related incidents, and provide a safe environment. Definition • Any untoward event in which the patient comes to rest unintentionally on the floor. • Professional and clinical judgement is needed to capture the full range of possibilities. Implementation Procedure • All patients, over the age of 50, will be assessed for potential to fall using the Patients Falls Risk Assessment tool. • The tool must be completed within 24 hours following admission. Further assessments will be completed according to the patient/clients level of risk. • Based on the assessment, the nursing staff will assign the appropriate fall risk level and institute a fall prevention management plan. • Additionally, patients will be re-evaluated for fall potential whenever there is a change in status, a transfer to another unit, or as necessary. • If a patient/client falls an incident report must be completed, the details must also be recorded in the patient/client’s fall diary. • If side rails are to be considered, please refer to the Guidelines For The Use Of Side Rails. • It is advisable that the unit undertakes an environmental risk assessment annually. This will assist in identifying any hazards/risks that could be the cause of a fall. Action can then be taken to eliminate or reduce the hazards/risks. Falls Prevention Management in Swansea NHS Trust 5 3. REDUCING PATIENT FALLS – ON ADMISSION - Swansea NHS Trust Patient admitted to hospital Morse falls risk assessment completed within 24 hours Manual handling risk assessment completed within 24 hrs Good basic nursing care provided Morse falls reassessment every Bed on lowest appropriate Low risk of falling week setting Ensure patient has necessary items in easy reach Refer to Assess environment appropriate members of multi- disciplinary team Encourage regular toileting Additional strategies considered: Medium risk of falling Re-orientate confused patients Morse falls reassess- Assess patient with regard to ment every use of side rails 4 days Educate patients in safe practices Additional strategies considered: Arrange care management Position patient in easily meeting to discuss High risk of observable area alternative falling strategies Consider using sensor alarms Consider one-to-one nursing Morse falls reassessment alternate days Patient reassessed using Morse falls assessment tool Falls Prevention Management in Swansea NHS Trust 6 4. IF A PATIENT FALLS POST ADMISSION - Swansea NHS Trust Patient admitted to hospital Near Miss Details for incident report: Patient Falls Time of incident Where incident occurred Circumstances Patient is physically surrounding Medical staff examined to incident determine if an injury If Fall has occurred Fall score prior to fall Strategies in place prior to fall Staffing levels at Incident report completed time of fall Strategies to be put in place to prevent further falls occurring Circumstances surrounding Low risk fall documented in care identified plan. Medium risk identified Patient’s reassessed