Slips, trips & falls
Aims of this session:
To ensure you are aware of your
responsibilities with regard to falls
To ensure that you are complying with the
Slips, trips and falls policy
To refresh your knowledge of risk factors for
falls and osteoporosis
To ensure you are using the correct
documentation
SHFT Falls Prevention Team Aug 2011
Relevance of falls training to OPMH /AMH / LD / SS
Falls data for April 2010 - March 2011
OPMH reported 1249 falls (15 falls resulted in fractures)
AMH reported 149 falls -76 had no injury & 73 had an injury
(23 each in The Meadows and Kingsley)
LD reported 30 falls (15 in Foxmead & 6 in Westview)
SS reported 9 falls (3 in Southfield & 2 in Bluebird- Stewart)
SHFT Falls Prevention Team Aug 2011
Doing a falls & bone health
assessment
- whose role is it?
SHFT Falls Prevention Team Aug 2011
FALLS
Falls are CORE BUSINESS for any health or social care
professional
EVERYONE should ask their patients if they have had
a fall in the past year
EVERYONE should do falls and bone health
assessments
SHFT Falls Prevention Team Aug 2011
Risk factors for falls
In the next 5 minutes write down:
5 intrinsic risk factors
5 extrinsic risk factors
2 behavioural risk factors
Decide which of these are:
modifiable
non-modifiable
More risk factors = higher risk of fall and injury
SHFT Falls Prevention Team Aug 2011
Risk factors for falling:
Modifiable:
Orthostatic hypotension
Footwear, foot health
Gait and balance problems
e.g. muscle weakness, unsteady
gait
Impaired vision e.g. cataracts
Home hazards or hospital
environment
Medications
Delirium
Continence
SHFT Falls Prevention Team Aug 2011
Non-modifiable:
Certain medical conditions
e.g. stroke or Parkinson’s
Disease
Dementia
Impaired vision
e.g. macular degeneration
or glaucoma
Sensory loss
e.g. peripheral neuropathy
NICE Clinical Guidelines 21 -2004
(Specifically for people over 65)
Case/risk identification – health
screen/opportunistic
Multi-factorial falls risk assessment
Evidence based, multi-factorial interventions
i.e. identification, assessment, treatment
SHFT Falls Prevention Team Aug 2011
Taking a falls history
What questions would you ask?
Start with the index fall
– the most recent one
Ask about other falls in last year
Look for patterns relating to time, location , activity,
etc
SHFT Falls Prevention Team Aug 2011
SPLATT!
S – symptoms immediately before or during the
fall
P – previous years falls history
L – location of fall
A – activity at the time of the fall
T – time of fall and length of time on the ground
T – trauma or injury including loss of confidence
SHFT Falls Prevention Team Aug 2011
Red flags in falls history
Sudden falls/frequent falls with little or no warning
Don’t remember hitting the floor
May be lucid immediately afterwards
Sustained facial injuries
If any of the above - suspect syncope / blackout
REFER TO GP/DOCTOR URGENTLY!
SHFT Falls Prevention Team Aug 2011
What falls documentation should you be
using in ICS?
In the Community:
Multi-factorial Falls & Osteoporosis Assessment Part
1 and Part 2
In Community Hospitals:
Falls Inpatient Care plan
New Post Falls checklist
Inpatient Falls Assessment Summary
SHFT Falls Prevention Team Aug 2011
What falls documentation should you be
using in MH / LD?
Two questions re falls risk in RIO assessment
In Older Person’s Mental Health and Learning Disability
units:
If ‘yes’ to falls history, complete ‘Fallers Risk
Assessment’
In Adult Mental Health & Specialised Services
Consider risk of falls and complete ‘Fallers Risk
Assessment’ , as appropriate
SHFT Falls Prevention Team Aug 2011
Assessing for Orthostatic hypotension
Definition of orthostatic / postural hypotension:
A drop of 20mm Hg systolic or 10mm Hg diastolic
blood pressure on standing from lying
A systolic reading of 90mm Hg or below
SHFT Falls Prevention Team Aug 2011
How to undertake a lying and standing
blood pressure
Do not use automated equipment – use a manual
sphygmomanometer
Ensure the cuff size is appropriate for the patient
Ensure the patient is lying down for at least 15 minutes & record
blood pressure in lying
Leaving the cuff in place, stand the patient (with assistance if
necessary)
Immediately, retake the blood pressure
Repeat readings at 1 minute and 3 minutes (if the patient
cannot stand, they can sit for this)
Document the result and how you did it
SHFT Falls Prevention Team Aug 2011
Falls and Bone Health
1 in 2 women and 1 in 5 men over the age of 50 are at risk of
osteoporotic fracture as a result of a fall.
In UK:
1 wrist fracture every 9 mins
1 vertebral fracture every 3 mins
1 hip fracture every 10 mins
70% of those who have a fracture will have ANOTHER fracture
within 3 years
SHFT Falls Prevention Team Aug 2011
Risk factors for Osteoporosis
Early menopause < 45 or untreated hysterectomy
Family history of osteoporosis or hip fracture
Fragility fracture after age 50
Planned or current long term steroid use
Other gastrointestinal conditions: crohn’s, coeliac disease,
hyperthyroidism, liver disease
Immobility
Rheumatoid Arthritis
‘FRAX tool’ for GPs at www.shef.ac.uk/FRAX
SHFT Falls Prevention Team Aug 2011
Lifestyle advice for bone health
Regular weight bearing exercise
Adequate exposure to sunlight (15-20 minutes / day
3x week to face and arms during summer months)
Avoid smoking
Avoidance excessive alcohol intake
Good back care (vertebral fractures)
A balanced diet including adequate Calcium &
Vitamin D
SHFT Falls Prevention Team Aug 2011
Falls prevention - the evidence
In the community – effective multi-factorial
assessment and interventions can reduce falls by 3050%
In hospital- effective multifactorial interventions
can reduce falls rates by an average of 18% (NPSA 2007)
or 20% (Cameron et al 2009) & may take a year or more to
take effect
Evidence shows that “many falls cannot be
prevented and are a feature of underlying medical
problems or frailty” (Oliver, D, Healey, F(2009)
SHFT Falls Prevention Team Aug 2011
Where can you refer community
patients if you are unable to identify
cause of falls?
Refer to GP/doctor for medication review or regarding
orthostatic hypotension
Refer to community rehab or therapy team for advice on
gait, balance or mobility problems
Ask GP to refer to nearest falls clinic if complex / medical /
loss of consciousness suspected
Call Sue Morris, Jill Phipps or Jo Murray for advice if unsure
SHFT Falls Prevention Team Aug 2011
Falls in hospital
– what is your responsibility?
Record all falls by completing an incident form
If patient hit their head or fall was unwitnessed (they may have hit their
head) you must do neurological observations (see Head Injury handout)
If fall was from bed, review whether bedrails are appropriate – use
bedrails risk assessment, consider if a hi-lo bed is appropriate
Review Inpatient Care Plan/ Fallers Risk Assessment after each fall
Complete New Post Fall Checklist (which reflects NPSA Post Fall Protocol)
after each fall and review trends to decide why patient has fallen
SHFT Falls Prevention Team Aug 2011
What do you need to do after this session?
Ask your patients about falls in the last year
Take a Falls History – using SPLATT!
Assess for falls and bone health risk factors
Identify risk factors which could be changed
Discuss with the patient/family
Provide information and advice
When you get back to your base:Identify your falls champion (ICS) or falls link nurse (OPMH)
Look at your falls prevention folder (ICS)
SHFT Falls Prevention Team Aug 2011
Information on
falls & osteoporosis
Profane – Prevention of Falls Network
www.profane.eu.org
Age UK – falls publications
www.ageuk.org.uk
National Osteoporosis Society
www.nos.org.uk
SHFT Falls Prevention Team Aug 2011
For advice, contact:Sue Morris for SHFT West at [email protected]
Tel: 02380 423262 Mob: 07867 801 430 or
Jill Phipps for SHFT S/East at [email protected]
Tel: 01329 224531 Mob: 078807 738914
Jo Murray SHFT North at [email protected]
Tel: 01420 82811 Mob: 07908 526248
Shelly Mason – OPMH – [email protected]
Fiona Hartfree – AMH – [email protected]
Joan Brock – Specialised Services - [email protected]
Carol Cleary – LD – [email protected]
SHFT Falls Prevention Team Aug 2011