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Environmental risks procedure

Contents

  1. Aim
  2. Scope
  3. Link to overarching policy and, or procedure
  4. Procedure or implementation
  5. Appendices

1 Aim

Environmental hazards contribute to slips, trips and falls both within the healthcare setting, at home or in the community. This procedure details some of the common environmental risks which contribute to patient falls and the responsibility of healthcare workers in identifying and reducing such environmental risks as part of their holistic care with patients.

2 Scope

This is a trust wide procedure which is applicable to all patients under our care. It focuses in particularly on the needs of those patients who are in the higher falls risk groups or who already have a history of falls (over 65’s and, or patients with pre-existing health conditions which means they are at a higher risk of falling).

3 Link to overarching policy, and or procedure

4 Procedure or implementation

The physical environment is considered to have an important role in falls. Review and actions taken to make the environment safer can have a significant impact on falls risks.

Environmental factors that may impact on falls risk include:

  • trip hazards-medical devices, cables, clutter
  • flooring-density, sheen, surface and pattern can either be slippery or cause an illusion, or glare of steps or obstacles to patients with impaired vision
  • spillages
  • cleaning timing and methods, ensure cleaning is done at quieter times and that when mopping there are still dry routes
  • call bells or sensors or patient alarms-availability, visibility and location, consider any ligature risks, document clinical decision making
  • doors-including how they close
  • distance between hand holds-rails, chairs, beds and toilets
  • colleagues locations for observing patients
  • furniture in a suitable position, for example, not going to move when standing and sitting, having against a wall or with grip under feet
  • furniture, for example, chairs and beds are of the suitable height
  • clutter, Lighting, especially at night
  • consider the environment is someone is visually impaired-a high colour contrast for, for example, light switch, doors, alarms may be invaluable

4.1 Inpatient environmental factors

The Royal College of Physicians FallSafe (RCP, 2012) project (which reduced falls by up to 25% in some inpatient areas) shows that a pro-active approach to environmental risk is needed on inpatient wards. In particular, their research showed that having a framework in which environmental assessment is combined with mapping the patient journey and a review of recent incidents contributes to falls incident reduction. The framework (which is used alongside the FallSafe care bundles approach) is briefly outlined below.

For full details including tools to assist in implementation please see RCP london FallSafe (opens in new window).

4.2 FallSafe framework

  1. Improve the environment and access to essential equipment.
  2. Review falls incidents and understand what is being reported.
  3. Mapping the patient journey (completed in the trust following moderate harm incidents as part of the falls review process).

Understand what it is like to be a patient for example by choosing a patient on their ward and start a mapping from the patient’s bed using the prompts below taking into account the patient’s level of mobility and abilities. Prompts include:

  • mobility factors, patient’s level of mobility
  • patient’s personal area, is the area free of clutter?
  • flooring, suitably non-slip? Spills or unevenness?
  • lighting, well lit? Consider route at day and night
  • signage, is it clear where the nearest toilet is?
  • toilet facility, is the door heavy? Room for a walking frame, what is the position of the rails, toilet paper and the wastepaper bin
  • shower facility, non slip, rails or equipment, for example, shower chair, flow of water
  • colleagues, are they visible?

In addition to the approach advocated in FallSafe there other methods of carrying out wider environmental review; all are intended to lead to actions to minimise falls risk and increase safety but should not inadvertently lead to unnecessary loss of independence or mobility.

4.3 Safety at home

NICE Quality Standard 86 January 2017 (opens in new window) states:

  • “older people who are admitted to hospital after having a fall are offered a home hazard assessment and safety interventions. Healthcare professionals (in particular occupational therapists) ensure that they perform home hazard assessments for older people who are admitted to hospital after having a fall and offer safety interventions and modifications as appropriate. This should happen in the person’s home and within a timescale that is agreed with the person or their carer”

Patients with the highest risk factors for falling will be offered a home visit either on the day of discharge to enable a smooth transition into the home, or prior to discharge if complexity is high. Patients for whom follow up rehabilitation interventions are required to further reduce the likelihood of falls will be referred onto the relevant community service on discharge. This may include the specialist falls service.

5 References

Document control

  • Version: 1.
  • Unique reference number: 1047.
  • 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: April 23, 2024
Next review due: April 23, 2025

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