COMMUNITY FALLS MANAGEMENT POLICY
POLICY NUMBER:
COMMUNITY FALLS MANAGEMENT POLICY
Document History
Version Date:
April 2011
Version Number:
1
Status:
Next Revision
Due:
Developed by:
Approved
Policy Sponsor:
Pathways & Clinical Outcome Manager
EQIA completed:
Dec 2010
Approved by:
Quality committee
Date approved:
11th April 2011
April 2013
Falls Implementation Group
Revision History
Version
Revision
date
Summary of Changes
To support inclusive access of this policy (guideline etc), it has been left-aligned and is
available in alternative formats. To obtain a copy of the policy in large print, audio, Braille
(or other format) please contact by Tel: 01773 525099 or email
communications@dchs.nhs.uk
Version Number
Page 1 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
TABLE OF CONTENTS
1. FULL DETAIL OF POLICY (INCLUDING RESULTS OF IMPACT AND RISK
ASSESSMENTS) .........................................................................................................................3
1.1
Community Patients ........................................................................................................3
1.1.a
1.1.b
1.1.c
1.1.d
1.1.e
1.2
Screening ................................................................................................................3
Risk Assessment .....................................................................................................3
Treatment Plan ........................................................................................................3
Fall ..........................................................................................................................4
Onward Referral to Specialist Falls Services (Community or Day Service) ............4
Training and development for falls prevention and management ...............................5
2.
References and Associated Documentation .....................................................................5
3.
Appendices ..........................................................................................................................6
Appendix 1 – COMMUNITY FALLS MANAGEMENT FLOW CHART ........................................7
4. AIM .......................................................................................................................................10
5.
5.1
6.
Background ........................................................................................................................10
Table - Objectives .........................................................................................................11
Area for Implementation ...................................................................................................11
7. Organisational Accountability/Responsibilities i.e. CEO, Directors, Managers,
Staff ............................................................................................................................................11
8.
Intended Users ...................................................................................................................12
9.
Definition ............................................................................................................................12
10.
Indications for Use .........................................................................................................12
11.
Contra-indications .........................................................................................................12
12.
Equality Impact Statement ............................................................................................13
13.
Monitoring and Performance Management of the policy ...........................................13
14.
Support and Additional Contacts .................................................................................14
Equality & Diversity Impact Assessment :
Version Number
Page 2 of 15
Level I Screening ...........................................15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
INPATIENT FALLS MANAGEMENT POLICY
1.
FULL DETAIL OF POLICY
This policy is to assist staff to reduce the risk, incidence and severity of falls by patients
receiving care from Derbyshire Community Health Services, (DCHS), staff in their own
homes or community settings.
The policy should be read in conjunction with the policy for The Management and
Prevention of Slips, Trips and Falls and the Community Bed Rail policy.
1.1
COMMUNITY PATIENTS
All staff working in the community and see patients in their own homes or in outpatient
settings must follow these steps.
1.1.a Screening
All people over 65 years who have contact with clinical DCHS staff will be routinely
screened to identify their falls risk. They will be asked if they have fallen in the past 12
months. This is the population cohort where evidence suggests maximum positive impact
can be achieved. If they indicate they have experienced such a fall, additional information
regarding the frequency, context and characteristics should be documented.
1.1.b Risk Assessment
If screening question prompts a positive response and the additional information obtained
indicates that it is appropriate to do so, a falls risk assessment must be completed see
appendix 2 - Risk Assessment for the Prevention and Management of Falls in the
Community by the member of staff who has asked the screening question.
If assessment is ‘yes’ to four or more factors refer to specialist falls services, either in
community or day services for specialist falls interventions.
If assessment is less than 4 ‘yes’, the staff member who has completed the assessment
should act upon any risk factors that were answered ‘yes’, that are appropriate to their
scope of practice, in order to reduce the patient’s risk of further falls. Falls Prevention
advice and information should be given to the patient e.g. Age UK Staying steady leaflet
accessed via: http://www.ageuk.org.uk/ Onward referral to specialist falls services should
be made for identified risk factors that fall outside the assessing member of staff’s scope of
practice.
A copy of the risk assessment and action plan will be held in the patient’s records. There
should be evidence of any onward referral for medication review, specialist falls service,
physiotherapy assessment, occupational therapy assessment or specialist nurse
assessment.
1.1.c Treatment Plan
Version Number
Page 3 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
A treatment/care plan should be generated identifying the risks and interventions agreed
with the patient and be evaluated as clinically indicated see Appendix 3, Falls Risk
Assessment for Older People – Community Tool – Action Plan.
1.1.d Fall
If a patient falls or a fall related near miss occurs:

Check the patient for signs of significant injury. If a severe injury is evident or
suspected on initial assessment - dial 999 for transfer to Accident and Emergency.

If the patient is assessed as having a fall without a severe injury return them to
bed/chair using appropriate moving and handling technique and refer to GP. Perform
baseline observation and document in patient notes and inform next of kin/ main carer.

All incidents must be reported including patient details, time, location and
circumstances of the falls.

Reassess risk and document any actions required. If indicated initiate referral for
medication review, falls service, community therapy services or specialist nurse
assessment and document all interventions in the patient’s records.
All incidents which have level 3 or 4 harm will be evaluated using root cause analysis by
the Patient Safety Team.
1.1.e Onward Referral to Specialist Falls Services (Community or Day
Service)
All patients referred will receive: i.
Evidence Based Multi-factorial Falls Assessment
This uses the agreed standardised documentation within DCHS which is based upon the
Connecting for Health Do Once and Share pathway for falls (2004). This includes the
Community Falls Generic Assessment (document number 1143) for community therapy
services and Staying Steady for day services (document number 0259).
ii.
Individualised Treatment Plan
An individualised multi-factorial treatment plan will be generated and all interventions will
be documented in the patient records.
iii.
Onward Referral
An onward referral using locally agreed pathways, e.g. general practitioner, out-patient
clinics for patients with an unexplained fall or request for further investigation if indicated,
or for evidence based falls prevention exercise training.
iv.
Review
Specialist falls prevention services will review case loads at agreed time intervals to
monitor effectiveness of service and impact interventions.
Version Number
Page 4 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
1.2
TRAINING AND DEVELOPMENT FOR FALLS PREVENTION AND
MANAGEMENT
Within DCHS there will be 3 levels of training for falls prevention and management:
Level 1 - ALL DCHS staff regardless of location, should have basic awareness training in
relation to falls prevention and their roles and responsibilities therein. This will include an
understanding of the potential causes of falls including intrinsic and extrinsic factors.
All DCHS staff assessing patients, again regardless of location, will be made aware of and
trained in the use of the relevant falls prevention and management tools and associated
processes. They will also undertake further fall prevention and management training on
areas relevant to their profession.
All Level 1 staff will access the Falls Training DVD and line managers must keep a record
of the staff who have undertaken this training and forward the details to the Learning Team
to ensure the electronic staff record (ESR) is updated. Falls Awareness and Prevention will
be included in essential training, all new staff induction and preceptorship competency
frameworks.
Level 2 - All services / teams /departments should have an identified ‘Falls Champion’ who
will be expected to lead and ensure the process is in line with the policy and to lead the
local scrutiny of monthly falls reports. Identified champions and other key clinical leaders
will receive training on the falls policy, risk assessments decision algorithms.
Level 3 - All staff providing a specialist falls service or performing specialist falls
assessments will require evidence based training and skills updating. This training will
require individuals to access ‘learning beyond registration’ funding to apply for accredited
courses delivered by external providers.
2.
REFERENCES AND ASSOCIATED DOCUMENTATION
Department of Health (2009) Falls and Fractures: Effective interventions in health and
social care.
DCHS Management and Prevention of Slips, Trips and Falls Policy
DCHS Record Keeping Policy
DCHS Incident reporting Policy
DCHS Joint Derby and Derbyshire Health & Social Care Policy for the Safe Use of Bed
Rails in the Community.
DCHS Policy for the Safe and Effective Use of Bed Rails within the Community Hospital
Do Once Share Pathway web site accessed November 2010:
http://www.connectingforhealth.nhs.uk/resources/systserv/do-onceand/?searchterm=do%20once%20and%20share
Fonda D et al. (2006) Reducing serious fall related injuries in hospital. Medical Journal of
Australia 184: 379-382
Version Number
Page 5 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
Haines TP et al (2004) Effectiveness of targeted falls prevention programmes in a sub
acute setting. A randomised controlled trial. British Medical Journal 328: 676-679
Healey F et al. (2004) Using targeted risk factor reduction to prevent falls in older hospital
inpatients A randomised controlled trial Age and Ageing 33: 390-395
Help the aged (2008) Falling Short Help the Aged London
NHS Institute for Innovation and Improvement (2009) High Impact actions for Nursing and
Midwifery
http://www.institute.nhs.uk/images/stories/Building_Capability/HIA/NHSI%20High%20Impa
ct%20Actions.pdf
National Institute for Health and Clinical Excellence (2004) Falls-The assessment and
prevention of falls in older people. Available at:
www.nice.org.uk/guidance/CG21/guidance/pdf/English
Department of Health (2001) National Service Framework for Older People
Medicines and Healthcare products Regulatory Agency Device Alert 2007/001. Reporting
Medical Device Adverse Incidents and Disseminating Medical Device Alerts. Available at:
www.mhra.gov.uk
The Patient Safety First Campaign have recently issued a ‘How to’ Guide for reducing
harm from falls. http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/Interventionsupport/FALLSHow-to%20Guide%20v4.pdf
Prevention Package for Older People
http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Olderpeople/Preventionpack
age/index.htm
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/document
s/digitalasset/dh_103152.pdf
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/document
s/digitalasset/dh_103151.pdf
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/document
s/digitalasset/dh_103147.pdf
Royal College of Physicians (2008) National Falls and Bone Health in Older People
accessible via (Accessed 9th November 09).
3.
APPENDICES
Appendix 1 – Community Falls Management Flowchart
Appendix 2 – Risk Assessment for the Prevention and Management of Falls in the
Community
Appendix 3 – Falls Risk Assessment for Older People – Community Tool – Action Plan
Version Number
Page 6 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
APPENDIX 1 – COMMUNITY FALLS MANAGEMENT FLOW CHART
All DCHS clinical staff who work in the community or in
out-patient settings should routinely ask all people aged
over 65 years: 1. Have they have fallen in the past year?


‘Yes’ - Complete Falls Risk Assessment for Older
People Tool. (hyperlink to)
Complete action plan detailing treatment plan /
onward referrals.
Scored 4 or
more
risk factors

Version Number
Referral to
Specialist Falls
service,
Community based
or
day services
Scored less
than 4 risk
factors


Page 7 of 15
Provide intervention
to reduce risk of falls
associated with
identified risks.
Provide advice
leaflet regarding falls
prevention i.e. Age
UK Staying Steady
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
APPENDIX 2
RISK ASSESSMENT FOR THE PREVENTION AND
MANAGEMENT OF FALLS (COMMUNITY)
SURNAME
NHS No
___/___/____
FORENAME
ADDRESS
MALE / FEMALE
D.O.B
HOSPITAL
WARD
GP/Consultant
FALLS RISK ASSESSMENT FOR OLDER PEOPLE / COMMUNITY TOOL
SCREENING TOOL
Risk Factor
Yes No
1.
History of Falls
Has history of 1 or more falls in past year
2.
Number of Medications
Takes more than 4 medications per day
3.
Central Nervous System Suppressants
(e.g. sleeping tablets, anti-depressants) Uses 1 or more for more than 2
weeks
4.
Alcohol Intake
More than 1 unit of alcohol per day
5.
Postural Hypotension
Dizziness on standing or sitting up
6.
Nutrition
Recent loss of weight, poor fluid intake
7.
Vision
Difficultly reading a book or newspaper, cannot recognise an object
across room, recently started wearing bifocals
8.
Hearing
Has difficulty in hearing conversational speech
9.
Footwear / Foot Care
Difficulty with foot care affecting mobility, inappropriate footwear
10.
Balance
Needs to hold onto furniture, requires walking aid
11.
Transfers
Lack of control when moving between surfaces, e.g. bed to chair
12.
Walking
Unsteady on feet, shuffles or takes uneven steps, housebound
13.
Environmental Hazards
Cluttered, slip or trip hazards
14.
Reduced Confidence
Fear of further falls, change in lifestyle due to falls
15.
Coping Strategies
Unable to get up from floor. Unable to summon help
16.
Memory/Comprehension (understanding)
Short-term memory or comprehension difficulties which may affect
ability to follow advice given
if ‘YES’ for any factor, refer to intervention/referral guide, complete action plan and
issue falls leaflet. If ‘YES’ for four or more factors, refer Specialist Falls Service.
Version Number
Page 8 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
APPENDIX 3
FALLS RISK ASSESSMENT FOR OLDER PEOPLE –
COMMUNITY TOOL – ACTION PLAN
SURNAME
NHS No
___/___/____
FORENAME
ADDRESS
MALE / FEMALE
D.O.B
HOSPITAL
WARD
GP/Consultant
FALLS RISK ASSESSMENT FOR OLDER PEOPLE / COMMUNITY TOOL
ACTION PLAN
(including onward referrals if appropriate)
Risk
Identified
Action
Date/Time
Print Name
and Sign
Please refer to guidance notes available on the intranet under Community Hospitals
documentation.
© Copyright 2009 Quality & Integrated Governance Team, Derbyshire Community Health
Services
Version Number
Page 9 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
4. AIM
The aim of this Policy is to manage the risk of, reduce the incidence of, and thereby
reduce the harm from older people experiencing falls whilst under the care of DCHS staff
in their own homes or other community settings. The Policy provides a framework with
quality standards to:
 identify people who have fallen and or who are at risk of falling again
 identify those people who have sustained a fragility fracture and provide
rehabilitation to restore function and prevent further fractures
 assess the level of risk for those individuals that have had a fall
 generate, implement and evaluate appropriate treatment plans
 provide a specialist falls service that delivers evidence based multi-factorial
assessments and targeted interventions
 identify the need and scope for and of a specialist falls intervention.
There is an expectation that clinicians will use the framework within everyday practice
within DCHS.
It recognises that falls are a multi-dimensional problem which requires a partnership
approach across the localities and between health, social care and voluntary
organisations. DCHS will deliver a service/pathway which will be based upon evidencebased practice as stated in key national guidelines (NICE). Our services will use, as part
of the framework, validated tools to support the assessment and treatment process.
5.
BACKGROUND
Falls represent a significant public health challenge, with incidence increasing at about 2%
per annum. Increased rates of falling, and the severity of the consequences, are
associated with growing older and the rising rate of falls is expected to continue as the
population ages.
Hip fractures remain the most serious consequence of a fall and the commonest cause of
accident-related death in older people – 20% of people with hip fracture die within four
months and 30% within a year (DH 2009). Approximately half of those people who were
previously independent become partly dependent following a hip fracture, while one-third
become totally dependent.
Falls are not a consequence of old age; rather they are nearly always due to one or more
underlying risk factors. Recognising and modifying these risk factors is crucial in
preventing falls and injuries. .
Historically, the National Service Framework (2001) gave organisations key guidance in
the identification and treatment for patients who have fallen.
NICE guideline CG21 “Falls: the assessment and prevention of falls in older people” was
issued in 2004 to provide guidance on key areas of risk, assessment, interventions,
participation and education for the health care community.
The Department of Health (DH) issued the Prevention Package for Older People which
builds on the National Service Framework and NICE guidance. The Falls and Fractures,
effective interventions in health and social care package outlines four key objectives
shown in Table 1.0 (July 2009).
Version Number
Page 10 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
5.1
TABLE - OBJECTIVES
See below
Table 1.0
Objectives - Effective Interventions in Health and Social Care for Falls and Fractures
1.
Improve patient outcomes and improve efficiency of care after hip fractures through
compliance with core standards.
2.
Respond to a first fracture and prevent the second – through fracture liaison
services in acute and primary care settings.
3.
Early intervention to restore independence – through falls care pathways, linking
acute and urgent care services to secondary prevention of further falls and injuries
Prevent frailty, promote bone health and reduce accidents – through encouraging
physical activity and healthy lifestyle, and reducing unnecessary environmental
hazards.
In order for DCHS to meet the above objective and NICE guideline, the Falls framework
and quality standards will be implemented.
4.
6.
AREA FOR IMPLEMENTATION
All patient homes or community settings where the patient receives community nursing or
therapy service from DCHS.
7.
ORGANISATIONAL ACCOUNTABILITY/RESPONSIBILITIES I.E.
CEO, DIRECTORS, MANAGERS, STAFF
This section to set out who holds organisational accountability and responsibility for the
policy.
 The Chief Executive holds overall accountability and is responsible for assuring that
there are effective systems in place to implement the guidance.
 The Director of Service Delivery is the lead operational officer for Derbyshire
Community Health Services and is accountable to the Managing Director.
 The Director of Nursing and Quality is accountable for the quality and delivery of care.
 Operational Managers have responsibility for managing staff groups, risk management,
clinical incidents, and competency practice issues once identified. Records of
attendance on training will be kept by the Trust. Patient records will be audited to
monitor compliance with policy. Staff competency will be evaluated during PDR
process.
 Professionally Registered Staff. All staff are accountable for their professional practice
and hold individual responsibility to maintain their knowledge and skills in relation to falls
management. It is their responsibility to identify training needs and plan to meet
learning objectives identified in their PDR.
Version Number
Page 11 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
The policy sponsor is David Muir, Pathways & Clinical Outcome Manager.
-
The Policy is developed in line with the DCHS Policy Development Framework;
The Policy is disseminated to its target audience;
Appropriate training is given in the use of the Policy;
The Policy’s implementation is monitored and reviewed on a regular basis.
8.
INTENDED USERS
All staff working for DCHS in the Community or in Outpatient situations.
9.
DEFINITION
Fall:
An event which results in a person coming to rest at a lower
level.
Explained Fall:
We know and understand the reasons that have contributed
to falls.
Intrinsic:
Medical, psychological and physiological reasons for falls,
e.g.
●Cognition & behaviours
●Mobility and transfer skills
●Incontinence
●Medical conditions
●Medication review
●Vision/hearing
●Footwear & clothing
Extrinsic:
Environmental reasons for falls.
Unexplained Fall:
We do not understand the reasons that have contributed to
falls history. To presume these are more likely to have
medical factors influencing i.e. history of falls
Multi-professional:
Multidisciplinary approach to falls prevention involving
medical, nursing and therapy assessments.
10.
INDICATIONS FOR USE
All patients under the care of DCHS in the Community or Outpatients settings identified as
at risk.
11.
CONTRA-INDICATIONS
None.
Version Number
Page 12 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
12.
EQUALITY IMPACT STATEMENT
We welcome feedback on this policy and the way it operates. We are interested to know
of any possible or actual adverse impact that this policy may have on any groups in
respect of gender or marital status, race, disability, sexual orientation, religion or belief,
age, deprivation or other characteristics.
This Policy has been screened to determine equality relevance for the following equality
groups: Race, Gender, Disability, Age, Sexual Orientation, Religion/Belief, Transgender/
Transsexual. The Policy is considered to have little or no equality relevance.
The person(s) responsible for equality impact assessment for this policy is Edwina Layton.
Tel: 01246 515151
13. MONITORING AND PERFORMANCE MANAGEMENT OF THE
POLICY
To measure compliance to the Policy an annual audit will be developed and completed.
This audit will be both of process and record keeping, but also of the quality and impact of
risk assessments and action plans
The findings of the audits and action plans will be reported and monitored by the Falls
Implementation Group, (FIG). Exceptions will be reported by FIG to the Safety Committee
and
to the Service Delivery Directorate’s Governance Group.
The Falls Implementation Group will define, develop and implement an implementation
strategy across the county.
Monitoring of the Guideline will take place via Falls Implementation Group.
 Audit of number of clinical incidents arising from falls in the community and out-patient
setting.
 Audit number of hip factures
 Audit number of admissions due to falls
 Analysis of data demonstrating uptake of falls training.
 Complaints with regard to receiving falls service.
Review of Guidelines initially after two years or earlier if new national guidance is released.
Version Number
Page 13 of 15
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
14.
SUPPORT AND ADDITIONAL CONTACTS
Name
David MUIR
Sarah
SPILSBURY
Joanna SILLS
Title
Falls Implementation Group
Chair
Senior Physiotherapist/
Falls Lead
Integrated Community
Manager
Adelle
CLEMENTS
Patient Safety Manager
Peter SLOAN
Older Peoples Mental
Health Liaison and Practice
Development nurse
Occupational
Therapist/Occupational
Therapy Team Leader –
Learning Disabilities
General Manager
Nancy
ABBOTTS
Edwina LAYTON
Karen CHAPPLE
Version Number
Senior Physiotherapist /
Falls Lead
Page 14 of 15
Base
Babington
Hospital
Long Eaton
Health Centre
St Oswald’s
Hospital
Walton
Hospital
Newholme
Contact Number
Mobile: 07766500363
Telephone:
0115 8554067
Telephone:
01335 340806
Telephone:
01246 515814,
Mobile:
07824 624452
Telephone:
01629 817945
Ash Green
Telephone:
01629 532317
Walton
Hospital
Walton
Hospital
Mobile: 07881850226
Telephone:
01246 515910 / Email
Policy date
COMMUNITY FALLS MANAGEMENT POLICY
EQUALITY & DIVERSITY IMPACT ASSESSMENT :
SCREENING
Race
Which of the following diversity
profiles could suffer detriment as a
result of this policy / procedure
/process?
Religion/Belief
What is the purpose of the policy under assessment?
What is the background to the policy? (e.g. in response to
a statutory requirement, development of good practice,
organisational review etc..)
Who is intended to benefit from the proposed policy?
Is there any potential for impact on non-beneficiaries?
Is there up to date data on the groups/individuals on
whom there may be impact?
Have there been changes to the equalities profile of the
above groups/individuals since the collection of the data?
Does the policy influence in a positive way relations
between different groups of people?
LEVEL I
Gender
Disability
Age
Sexual
Orientation
Transgender/
ALL GROUPS
Transsexual
The purpose of the policy is to screen, risk assess and treat patients who are
at risk of falls living in the community or hospital.
The back ground of the policy is to develop benchmark good practice
against national guidelines.
All patients who is at risk of or fears falling.
The policy is for patients that are identified as at risk of falls or who fall whilst
under the care of DCHS there is no impact on non-beneficiaries.
This policy will impact upon patients being treated by DCHS and the
implementation of a screening, risk assessment and treatment process to
support the identification of those at risk of falls. Data on patients who have
fallen whilst under the care of DCHS can be obtained from Datix.
No
It aims to be inclusive for those who are at risk of falls. It forms part of the
falls pathway from identifying to specialist assessment / treatment.
It gives the opportunity for screening, risk assessment and specialist
Does it promote equality of opportunity?
assessment for patients within DCHS relating to falls.
Does the function either eliminate or contribute to the
Although policy is biased towards older people, the policy recognises there
elimination of unlawful; discrimination across all equalities are other patient groups in the community who may be at risk of falls due to
themes?
acute or long term conditions.
The policy also links closely with the bed rails and in-patient policies.
Are there any concerns expressed about the policy having No
the potential for adverse impact on any group/s of people?
Assessment Outcomes High
Level 2 assessment required by Dec 2011
Level 1 assessment – signing off date: Dec 2010
Assessment carried out by: Edwina Layton, General Manager Walton
Version Number
Page 15 of 15
Policy date