Environmental risks procedure

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 or patients with pre-existing health conditions which means they are at a higher risk of falling).

3 Link to overarching policy

Patient falls manual (prevention and management)

4 Procedure

The physical environment is considered to have an important role in falls prevention. Review and actions taken to make the environment safer can have a significant impact on reducing 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 can cause slips
cleaning timing and methods: ensure floor cleaning is done at quieter times and that when mopping there are still dry routes available. use of the yellow hazard triangles act as an alert if placed over wet floor areas
call bells, sensors or patient alarms: availability, visibility and location (consider any ligature risks which these medical devices may create and document rationale for use or not)
doors: including how they open and close, they can create less space for manoeuvring or cause patients to overbalance
distance between hand holds: rails, chairs, beds and toilets.
colleagues locations for observing patients: it isn’t always possible to have a clear line of sight for all “at risk” patients. patients at highest risk of falls should be located closest to the line of sight for colleagues to monitor whenever possible
furniture located in a suitable position, that is it will not move if a patient uses it to assist them stand or to balance. locating furniture against a wall or with grip under it’s feet is safest
furniture, that is chairs and beds are of the suitable height to aid standing and balancing
clutter will contribute to trip hazards
lighting, consider use of nightlights when lighting is low at night
consider the environment if someone is visually impaired: a high colour contrast for example, light switch, doors, alarms may be invaluable to aid orientation

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. Falls leads complete a ward based environmental risk assessment bi-annually to review the environment and any areas in need of attention to reduce falls risks.

4.2 FallSafe framework

The Royal College of Physicians (RCP) research cited above 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 Royal College of Physicians FallSafe resources.

Aims to:

improve the environment and access to essential equipment
review fall incidents and understand what is being reported
map the patient journey (completed in the trust as part of the falls review process)

For example, choosing a patient on the ward and mapping the journey 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

The approach advocated in FallSafe is intended to lead to actions to
minimise falls risk and increase safety, but should not inadvertently lead to unnecessary loss of independence or mobility which will then increase deconditioning and their falls risk.

The patient safety incident response framework (PSIRF) tools referenced earlier will also help identify any areas for improvement and learning following falls related incidents.

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”

Our trust wide position regarding this quality standard is that 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: 1.1.
Unique reference number: 1047.
Approved by: Clinical policy review and approval group.
Date approved: 1 August 2023.
Name of originator or author: Strategic falls lead.
Name of responsible individual: Director for psychological professionals and therapies.
Date issued: 8 May 2025.
Review date: 31 August 2026.
Target audience: Clinical colleagues.
Description of change: Procedure to a manual.

Page last reviewed: May 08, 2025
Next review due: May 08, 2026

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