Contents
1 Aim
The aim of this procedure is to ensure that the prevention and management of falls is implemented for patients with a learning disability under the care of the trust.
2 Scope
This procedure is for RDaSH patients presenting with a learning disability or a learning disability and autism (LDA) within the community or day services (adults and children). In particular, it focuses on the needs of those patients who are in the higher falls risk groups or who already have a history of falls.
3 Link to overarching policy, and or procedure
4 Procedure or implementation
People with learning disabilities have a similar risk of falls throughout their lives as older people. Around one-third of falls by people with learning disabilities result in injury and the rate of fractures is higher than in the rest of the population. This may be due to increased risk of osteoporosis. Falls and injuries are avoidable causes of frailty and reduced wellbeing, in addition to significant costs caused to health and social care.
Falls risks are usually multi-factorial, factors may be intrinsic to the person (such as sensory impairments), some linked to behaviour and lifestyle, and some environmental.
A growing body of evidence relating to people with learning disabilities suggests that policy and guidance should take account of some specific considerations including:
- providing accessible information for people with learning disabilities and information for family members and paid support colleagues
- ensuring that risk assessments cover risks known to be associated with having a learning disability (for example, epilepsy, impaired vision, multiple medications)
- making reasonable adjustments to enable full assessment of bone density
- tailoring interventions to the individual, their lifestyle and the support available to them
- providing adapted interventions (such as strength and balance exercise programmes)
GOV.uk, (2019).
The learning disability service’s recognise their responsibility to ensure that all reasonable precautions are taken to minimise the risks of slips, trips and falls for colleagues, patients, visitors and contractors.
- Adults who are assessed as being at high risk of falling are managed within the respective LDA service but may need to be referred onto the specialist falls service if their needs cannot be met, for further advice or assessment.
- Reviews of falls related incidents are carried out by the service to identify and plan for risk factors and underlying conditions that may need escalation to other professionals such as the general practitioner (GP). Care planning will be adjusted to mitigate falls as much as is reasonable.
All patients with either a history of falls or risk factors known to contribute to falls will receive a multifactorial falls risk assessment (MFRA) (or similar falls risk assessment) and the falls template care plan is completed to reduce the risks of further falls.
4.1 Day services (adults)
To reduce and control risks of slips, trips and falls by:
- putting in place policies and procedures for reducing the risk of slips, trips and falls in the environments
- ensuring that all patients are assessed for any history of falls and those with a history of falls have a risk assessment conducted and the results added to the patients care plan
- regularly scrutinising accident reports to identify if slip, trip and fall hazards are being effectively controlled
- ensuring that all colleagues are trained in the recognition and reporting of potential slip, trip and fall hazards
- to reduce the risk of slip hazards: Non-slip floor surfaces will be used wherever possible, especially in higher risk areas such as kitchens, toilets, sluices, and bathrooms
- access to areas where floors are wet after cleaning or where spillages have occurred will be restricted to authorised colleagues only by use of appropriate warning or barriers to prevent access
- safe systems will be in place for cleaning up spillages, including water left on the floor quickly and efficiently
- procedures will be in place for de-icing external footpaths
- good quality doormats will be used around entrances and exits to the outside with doorways protected from the weather and the ingress of rain
4.1.1 To reduce the risk of trip hazards
- Activities involving electrical equipment will be planned to minimise trailing wires, for example, colleagues should always use the nearest socket available.
- Good housekeeping procedures will be implemented to prevent items and objects being left on the floor, especially in busy communal areas.
- Dependent or frail patients will be supervised as appropriate, for example, to ensure shoelaces are securely tied and that slip-on shoes are not loose fitting and likely to fall off edges or variations in floor height, such as step and stair edges, will be clearly marked wherever possible.
4.1.2 To reduce the risk of fall hazards
- Secure and obvious handrails will be fitted where appropriate.
- Step edges will be clearly marked.
- A planned preventive maintenance programme will be in place, linked to regular risk assessment inspections, to ensure that all floor and other entry and exit routes have flat, even surfaces.
- Lighting should be adequate to enable people to see obstructions and potentially slippery or uneven areas, etc so that colleagues can work safely and patients can move about safely.
- Lights will be replaced, repaired, and cleaned whenever light levels become too low and new lights should be installed wherever poor lighting levels are identified as a hazard.
4.2 Falls Prevention Community LD and Autism Services (adults and children)
The community learning disability services are committed to an active approach of falls prevention. To help reduce the risk of falls amongst patients we will put in place the following measures:
- patients identified as having a high falls risk will receive a MFRA (or similar) on referral into service
- the provision of regular falls prevention advice from health professionals as part of their holistic care with patients and carers
- advice on mobility aids, beds and chairs appropriate to individual needs and to check they are in good repair
- physiotherapist and occupational therapist support where required to assess and implement treatment and prevention strategies appropriate to the individual to reduce the risk of falling. Onward referral will be required for children to access occupational therapy and physiotherapy services outside of the Trust for any physical health needs
- advice on appropriate levels of supervision for mobility and within 24-hour routine to minimise risk of falls and referral to social care if required
- onward referral for any environmental adaptations, assistive technology or medical review as required
- support from dietetic service is sought for patients with dietary or nutritional needs
- bone health and risk of fractures are a key consideration for patients with a learning disability. Appropriate moving and handling and posture management will reduce the risk of fractures and falls. Patients who are known to be osteoporotic are managed accordingly in liaison with GP, pharmacists with respect to medication management
Falls prevention advice for these services can be obtained from the falls leads, physiotherapists or occupational therapists in each area.
Colleagues, patients and carers will be made aware of drug side effects related to falls as some medications can disturb balance and mobility. Please see the medication management and falls procedure appendix E list of medications and their impacts on falls for further details.
Incident reporting, IR1’s are reviewed as required by the service.
Slips, trips and falls training is completed annually by clinical colleagues as part of MAST. Any specialised handling situations which arise clinically would be managed on an individual basis and training provided accordingly.
5 References
Document control
- Version: 1.
- Unique reference number: 1053.
- Approved by: Clinical policy review and approval group.
- Date approved: 1 August 2023.
- Name of originator or author: Clinical team leader.
- Name of responsible individual: Executive director of nursing and AHP’s.
- Date issued: 11 August 2023.
- Review date: 31 August 2026.
- Target audience: Clinical staff.
- Description of change: Procedure to a manual.
Page last reviewed: March 27, 2024
Next review due: March 27, 2025