Contents
1 Aim
Supportive falls intervention (previously referred to as observations for falls) is a prescriptive intervention, which is based on the multi-disciplinary team’s (MDT) risk assessment and management plan which identifies intervention, support and assistance required and key risk times and triggers.
Supportive falls intervention may be put into place due to a physical cause or because the patient suffers from behavioural and psychological symptoms of dementia (BPSD) to such a degree that they are unable to anticipate or understand environmental hazards or dangers and may have spatial awareness difficulties which increase their risks of falls.
It is important that the level of intervention is matched to the degree of risk identified as well as the patient’s individual needs and risks. It must be reviewed regularly and appropriately to ensure it continues to be used in the most appropriate manner for the wellbeing of the patient.
As a duty of care, colleagues should, regardless of a patient’s mental health state, cognitive impairment, or legal status, be aware of their whereabouts at all times with regard to their safety, security and in some circumstances for the protection of others. However, some patients may require a higher level of supportive falls intervention due to their risk of falls.
2 Scope
This is a trust wide procedure which is applicable to all inpatients 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 patients with pre-existing health conditions which means they are at a higher risk of falling).
3 Link to overarching policy
4 Procedure
4.1 Principles and application of supportive falls intervention
Throughout the implementation of this intervention, care will be delivered in accordance with guidance and principles within the most appropriate legal framework for example, Mental Health Act 1983 or Mental Capacity Act 2005.
When assessing the need for supportive falls intervention, the following factors need to be considered:
- where there is at significant likelihood of the patient falling
- where the patient has poor mobility resulting in them being unsafe to walk alone and requiring physical assistance to mobilise or transfer
- when the patient has poor spatial awareness and an inability to safely move around and negotiate furniture
- where the patient is at risk of falling out of bed but where other interventions for example, bed rails or bed alarm are not suitable or not sufficient in isolation
- where their medication increases the risk of falls.
- where the patient’s mental health or cognitive impairment results in the patient being unsafe to mobilise independently
- where the patient’s mental health or cognitive impairment results in unsafe actions by the patient, for example, lifting and moving furniture
- where existing interventions are not suitable, for example, bed sensors when the bed is against the wall or in a low position
4.2 Falls risk assessment
See falls risk assessment procedure in the falls manual for detail.
4.3 Falls intervention support plan (FISP)
The decision to provide supportive falls intervention is linked to the patient’s risk assessment and interventions will be captured in a FISP care plan.
As a minimum the care plan will also detail:
- the identified needs for increased support
- frequency by which this will be provided
- the level and type
- duration of intervention
- person or colleagues who will review assistance and intervention
- process and time frame for review
- the patient’s ability to consent to the intervention
4.4 Review
The plan will include who can review, when and how frequently for example:
- a ward based nursing and therapy review at each handover or if any significant change in presentation occurs
- a daily review by the medical team
- at review by their responsible medical officer (RMO)
- at a full multidisciplinary review following a fall
4.5 Implementation
All clinical colleagues working in in-patient areas the trust are responsible for implementing supportive falls intervention in a way which:
- is part of a therapeutic intervention and not custodial by nature
- it is regularly reviewed
- continues to maintain functioning and mobility
- that the patient is aware of its use
Supported intervention will be carried out by colleagues working with the patient and will be captured on the standard rota.
At the point where the assessment has indicated the need for support the nurse in charge of the ward will activate the FISP plan and devise a rota of colleagues to carry out patient observations and routine monitoring. This rota will enable colleagues to plan their other duties around it and also identify who is responsible for the patient and at what time.
A verbal handover will be given at each change of colleague. When the risk has reduced the FISP plan can be stepped down or deactivated
4.6 Privacy and dignity
Every attempt will be taken to respond to the specific and diverse needs of each patient with consideration given to the need for same sex colleagues to assist whilst personal care is being undertaken. Whilst there is a requirement to respect patient’s wishes, the safe management of any identified risks will always take priority.
4.7 Safe staffing levels
The responsibility for maintaining safe staffing levels lies with the nurse in charge of the ward. See safer staffing manual.
5 Intentional rounding
- This has been developed as an evidence-based structured process in the United States (US). This model uses a documentation log, an hourly reporting dashboard, competency checklist and scheduled meetings between shift leaders and nursing colleagues to review rounding behaviours. In the United Kingdom (UK) intentional rounding methods have been introduced as part of larger quality improvement initiatives, such as the NHS ‘Harm Free’ care campaign (harm free).
- Intentional rounding, sometimes known as hourly rounding, helps frontline teams to organise ward workload and ensure all patients receive attention on a regular basis. In the UK this approach has been found to significantly reduce pressure injuries and falls and improve pain management. Intentional rounding enables colleagues to see patients at specific intervals to address the needs of each individual in an organised way.
- A verbal explanation should be given on admission and the patients’ understanding of the process ascertained.
- Registered nurses must complete the document at set times as indicated to provide an overview of the process and ensure that patients’ care needs are met at all times.
Oxevision. Consider the use of Oxevision as an additional intervention in the management of falls.
Use of Oxehealth (non-contact technology) on older people’s mental health (OPMH) inpatient units SOP
5.1 Planning of care delivery
Ward teams should ensure that the care delivery is planned at the beginning of shifts to facilitate the required support or intervention for individual patients (cover for colleagues breaks, escorting patients for investigations etc). This should be done using a team approach and failure to achieve hourly patient contact should be escalated to the shift coordinator.
Document control
- Version: 1.1.
- Unique reference number: 1054.
- Date ratified: 1 August 2023.
- Ratified by: Clinical policies review and approval group.
- Name of originator: Clinical team leader.
- Name of responsible individual: Executive director of nursing and allied health professionals.
- Date issued: 23 August 2023 (minor amendment).
- 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