Policy No: ## Policy on the Management and Prevention of Slips, Trips and Falls
Rehabilitation & Intermediate care staff
Contents Section 1: Introduction Section 2: Risk assessment for the prevention and management of slips, trips and falls
Potential risks and hazards in the care environment
Assessment of patient/service users in a community/domiciliary
Section 3: Document Consultation, Approval & Ratification Section 4: Training, Distribution & Implementation Section 5: Monitoring Compliance
Standards and Key Performance Indicators
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Glossary of Terms References Useful Contacts Appendices
Slips, trips and falls- Potential risks and solutions
Drugs which increase risk of falls in older people
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Section 1: Introduction Introduction
Slips, trips and falls on level ground consistently account for 1 in 3 major
injuries and 1 in 5 moderate injuries (absent for over 3 days) in work place
areas throughout Great Britain, a total of at least 35000 injuries per annum.
The Health and Safety Executive (HSE) state that the majority of these are
Patient/service user and staff safety is a key priority within NHS Newcastle
and North Tyneside Community Health. Falls can affect individuals of all
ages with older people being especially vulnerable. Falls are a particular
clinical concern because of the frequency at which they can occur and also
because of the physical, psychological and social consequences.
Falls are also a key focus within the National Service Framework for Older
People with Standard 6 aiming to reduce the number of falls which result in
serious injury as well as ensuring effective treatment and rehabilitation for
Falls are a major cause of disability and nationally a leading cause of
mortality. A fall can precipitate the need for long-term care; fear of falling
can provide a significant limitation on daily activities and long-term
psychological difficulties for the older person.
More falls are reported to the National Patient Safety Agency than any
other type of patient safety incident, (NPSA 2007)
Slips, trips and falls can be minimised through planning and positive
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management during re-furbishment and new build. Good housekeeping is
an essential part of the prevention of slips, trips and falls.
Both PCOs are committed to the safety of all staff, patients/service users
and visitors and seeks to provide care in safe environments. Preventing,
wherever possible, patients from falling and managing fall incidents
appropriately, are recognised as being crucial to the safety of patients.
The Health and Safety at Work Act 1974 (HSWA) requires employers to
ensure the health and safety of all employees and anyone who may be
affected by their work. This includes taking steps to control slips and trip
The Management of Health and Safety at Work Regulations 1999 build
on HSWA and include duties on employers to assess risks (including slip
and trip risks) and where necessary take action to safeguard health and
It is the duty of each NHS body to establish and keep in place
arrangements for the purpose of monitoring and improving the quality of
health and social care provided by and for that body. NHS Newcastle and
North Tyneside Community Health (NNTCH) is committed to this policy and
the implementation of risk management strategies to reduce the risk of
This policy applies to those members of staff that are employed by
Newcastle and North Tyneside primary care organisations and for whom
the PCOs have legal responsibility. However, it is recognised that primary
care practitioners are also part of the organisations and as such this policy
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is offered for use by them to adapt to their own practices and organisations
as appropriate. The Quality and Safety Lead is available to offer help and
support to primary care practitioners who wish to use and implement this
To provide an understanding of potential causes of slips trips and falls and
to outline a range of strategies that can be used to reduce the risk to staff,
To provide a framework for the initial and ongoing assessment of the fall
risks of individual patients/service users and the reporting and management
of fall incidents and to ensure that falls (and the risk of falls) by
patients/service users are effectively managed in a proactive way rather
than simply by reacting to individual fall incidents.
Duties and Accountability Roles and responsibilities Trust Board as an employer are responsible for fulfilling all duties assigned
to them in current Health and Safety legislation and are responsible for the
successful implementation of this policy.
Quality and Safety Department: is responsible for ensuring NNTCH
reviews and learns from reported slips, trips and falls by:
• Regular reports sent to service managers/departmental leads. • Monitor trends in slips, trips and falls and report to the appropriate
designated governance groups (See 1.4.2)
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• Reporting of accidents and incidents as appropriate to the Health and
• Monitoring action taken in response to any issues raised.
• Ensure the Department of Health’s guidance and advice referred to in
HTM61 (Hospital Technical Memorandum) is followed with regard to
flooring design, specification, procurement, construction,
commissioning, cleaning and maintenance of flooring.
• Ensure contractors and sub-contractors are aware of this policy and are
effectively monitored in order to reduce slips and trips hazards they may
• Ensure pathways and roads around Trust premises are suitably treated
during adverse weather conditions (e.g. Snow and ice) in order to
• Ensure an effective planned preventative maintenance programme for
the repair of Trust pathways, car parks and floor surfaces in order to
• Ensure that warning signs are prominently displayed when floors are
• All cleaning staff to manage tripping hazards from cables when they are
• Require cleaning staff to report any falls of their staff when working in
• Require cleaning staff to make local staff aware of any potential tripping
hazards they find during their work in PCT premises.
Senior Managers/Heads of Service: It is the responsibility of managers to
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• All staff are trained appropriately • All slip, trip and fall incidents are reported. • Monitor any trends in reported accidents/incidents and take action to
reduce the risk of slips, trips and falls.
All Employees have a personal responsibility for maintaining health and
• Must be vigilant and ensure any slips and trips hazards that they are
aware of are reported to their line manager as a minimum requirement.
• Ensure they appropriately clear up any spillages or ensure action is
taken to do so. E.g. Use warning cone and report to domestic services.
• Ensure they complete the incident reporting form, where an incident
or near miss occurs, as per the Accident and Incident Policy.
• Position equipment to avoid cables crossing pedestrian routes • Ensure necessary risk assessments are undertaken and kept up to date • Wear suitable footwear for the environment and its risks. • Attend falls risk assessment and intervention training appropriate to
their role and / or demonstrate appropriate level of competency /
The Quality and Safety Lead is responsible for ensuring that all incident
reporting forms are reviewed and any slips trips or falls which have resulted
in major or moderate injury are fully investigated and reported
Quarterly reports on the numbers and trends of all accidents and incidents
are submitted to the Governance and Risk Management Committee,
Integrated Governance Committee and to Trust Board.
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There are many definitions of falls within the Healthcare setting. However, it
is important to identify a practical definition that is workable in the clinical
setting, as the current lack of conformity has led to vast differences in
auditing and researching the numbers of falls (Cochrane 2001). The
following definitions, can apply to patients, staff and visitors.
FALL – A fall is an event which results in the person or a body part of the
person coming to rest inadvertently on the ground or other surface lower
than the person, whether or not an injury is sustained.
SLIP – A slip is to slide accidentally causing the person to lose their
balance, this is either corrected or causes a person to fall.
TRIP – To stumble accidently, often over an obstacle, causing a person to
lose their balance, this is either corrected or results in a fall.
This policy should be applied within the context of a number of other
• Health, Safety and Wellbeing Policy • Accident and Incident Reporting Policies • Safer Handling Policy • Use of Restraint: Alternatives and Considerations (Newcastle PCT)
(note the above list is illustrative, not exhaustive and all policies are
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Equality and Diversity
All public bodies have statutory duties under the Race Relations
(Amendment) Act 2000, the Disability Discrimination Act 2005 and the
Equality Act 2006 to set out arrangements to assess and consult on how
their policies and functions impact on race, gender and disability equality, in
effect to undertake equality impact assessments on all policies/guidelines
and practices. Best practice also suggests that Equality Impact
Assessments (EIA); should be extended to include equality and human
rights with regard to age, religion and sexual orientation and as such the
three North of Tyne PCOs have adopted this best practice approach within
its EIA as from the date of the adoption of the Policy for the Development
The three North of Tyne PCOs are committed to providing services that
meet the equality and diversity needs of staff and service users within the
framework of current legislation. Current equality and diversity legislation
includes, disability, gender, age, race, sexual orientation and religion. It is
the responsibility of managers and staff to ensure that they act on this
policy in a manner that meets the needs of people from these groups. It is
always best to check with individual staff/service users what their needs
are, but needs may include providinginformation in an accessible format,
considering mobility and communication issues, being aware of sensitive
This policy has been Equality Impact assessed recommendations from the
assessment have been incorporated into the document and have been
considered by the approving committee. A copy of the EIA summary is on
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Section 2: Risk assessment for the prevention and management of slips, trips and falls Potential risks and hazards in the care environment
Service managers must ensure that within the care environment all slipping
and tripping hazards are minimised and where ever possible rectified.
Appendix 2 describes potential hazards and solutions as defined by the
Assessment of in-patients
On admission to the ward an individual Falls Risk Assessment and
Intervention Plan must be completed. Communication support for people
with sensory or communication impairment and people that do not speak
English should be provided for this assessment. The results of this
assessment and intervention plan must be held in the individual patient’s
record. Every time a patient/service user falls (or is found on the floor and
a fall is suspected) the assessment and intervention plan should be re-
evaluated to ensure that it remains appropriate and this should be noted in
the patient’s/service users care plan. If there is an increase in the
frequency of falls of any individual patient/service user this should trigger a
full re-assessment. Again this re-assessment should be noted in the care
Ward managers must also ensure that potential patient/service user factors
in trips and falls are monitored and controlled.
• Ensuring the patient/service user has appropriate footwear • Ensuring the patient/service user has appropriate walking aid(s)
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• Checking that patients/service users have their own glasses • Reviewing the medication to see if it could be a contributing factor
(Appendix 3 Drugs which may increase the risk of falls in older people)
• Sensory and communication needs • Only issuing bed rails in line with guidance and where they are used
checking that bed rails are appropriate to the individual patient and that
• Assessing the potential fall risks posed by the use of special mattresses • Ensuring that nurse call systems and bed/chair alarms are properly
• Paying special attention when patients/service users are attached to
Action following a fall in an in-patient setting:
• The patient/service user should be reassured by staff • An immediate physical assessment of injury should be carried out • The patient/service user should be assisted back to their bed / chair /
feet as appropriate. Appropriate moving and handling equipment (e.g.
hoist) should be used wherever possible. (See Safer Handling Policy).
Patients should not be manually lifted from the floor.
• An incident report form must be completed describing the
circumstances of the accident and detailing action taken subsequently
• The individual Falls Risk Assessment and Intervention Plan should be
re-evaluated and a full reassessment undertaken whenever appropriate
Assessment of patients/service users in a community/ domiciliary setting
A Falls Risk assessment accompanied by appropriate action to prevent
falls must be carried out as part of the initial assessment process for all
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new referrals. (Examples of documentation are available on the INFONET )
Every time a patient/ service user falls (or is found on the floor and a fall is
suspected) the risk assessment and action plan should be re-evaluated to
ensure that the intervention plan remains appropriate and this should be
noted in the person’s care plan. If there is an increase in the frequency of
falls of any individual patient/ service user this should trigger a full re-
assessment. Again this re-assessment should be noted in the person’s
Action following a patient/service user or carer fall in a community setting:
• The patient/service user should be re-assured by staff • An immediate physical assessment of injury should be carried out. This
should include asking the patient/service user to describe any injury
• Whenever serious injury is suspected an ambulance should be called • Incident reporting form must be completed describing the circumstances
of the accident and detailing action taken subsequently
• The person’s GP should be informed • The patient/service user should be assisted back to their feet / chair /
bed as appropriate. Manual handling equipment should be used (e.g.
Hoist or Mangar Elk), patients should not be manually lifted from the
floor. If necessary assistance and equipment should be sought from
colleagues and/or community base. (See Safer Handling Policy)
• A note of the incident and action taken should be made in the person’s
All slips, trips and falls must be reported using the Trust’s standard Incident
reporting form even if the person is unhurt. An incident form must also be
completed when a person is found on the floor.
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Slips, trips and falls will be reported externally as defined in the Accident
Section 3: Document Consultation, Approval & Ratification Consultation
This document has been produced by theQuality and Safety Lead, on
behalf of NHS Newcastle and North Tyneside Community Health. In
preparing the document for official ratification the stakeholders listed on the
front sheet were consulted upon and their comments added to the
Document Approval & Ratification
The Newcastle and North Tyneside Community Health Board is the
committee with delegated authority for the approval and ratification of this
document. The committee has ensured that a full and proper consultation
has been carried out and has considered the content of the document in
terms of current best practice, guidelines, legislation and mandatory and
statutory requirements before formally approving and ratifying it on behalf
of the Board. In considering the document for approval the committee also
took into account the results and recommendations of the Equality Impact
This policy was formally approved by the Newcastle and North Tyneside
Community Health Board on [enter the date of approval].Document Development
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The Governance and Risk Management Committeeand nominated author
is responsible for the development, review, implementation, performance
management and distribution of this policy in accordance with the
procedures set out in this documentand the ‘Policy for the Development
and Management of Approved Documents’.
Version Control & Review
Version control of this document is the responsibility of the author in
conjunction with the Corporate Affairs team. The author must ensure that
timely reviews are completed and informed to the Corporate Affairs team
who will in turn maintain a register of approved documents and issue index
This policy will be reviewed every 3 years by the Governance and Risk
Management Committee or as and when significant changes make earlier
Section 4: Training, Distribution & Implementation Training
All staff are required to attend Health and Safety training as part of
Corporate and local induction. This includes risk assessment, hazard
awareness and incident reporting. An annual update will also be provided
as part of statutory and mandatory training.
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All clinical staff working in an in-patient setting must receive training during
their local induction period, in how to assess fall risks and use and develop
Service managers must also ensure that staff identified as patient handlers
are trained annually in patient/service user handling and the use of hoists
or other moving and handling aids used on the ward/department or in the
Additional specialist Falls training will be provided to clinical staff on request
and/or in response to concerns identified through review of incident report
Refer to the Learning and Development Policy for specific training
This policy is available for all staff to access via the Infonet/extranet. Staff
without computer network access should contact their Line Managers for
All staff will be notified of a new or revised document via the Chief
This document will be included in the Publication Schemes for Newcastle
and North Tyneside PCTs in compliance with the Freedom of Information
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It will be the responsibility of Quality and Safety Team to ensure
Line managers have a role to play in ensuring staff are aware of this policy
All staff have a responsibility to adhere to this policy.
Key slips, trips and fall issues will be highlighted through quarterly reports
to the Governance and Risk Management Committee, Integrated
Section 5: Monitoring Compliance Standards and Key Performance Indicators
Compliance with these standards is monitored by the Care Quality
Commission on an annual basis. Reporting, monitoring and learning from
accidents and incidents is included in Core standard C1a.
‘Health care organisations protect patients through systems that identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents’.
‘The organisation has approved documentation which describes the process for managing the risks associated with slips, trips and falls involving patients, staff and others.’
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National Standards Framework for Older People DoH 2001: Standard 6
‘The NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older Older people who have fallen receive effective treatment and rehabilitation and, with their carers, receive advice on prevention through a specialised Monitoring Compliance
Monitoring of compliance is by review of all incident report forms received
and through the quarterly reports of trends to Governance and Risk
Management Committee, Integrated Governance Committee and Board.
HSE Website- www.hse.gov.uk/slips/index.htm
Department of Health (2001): National Service Framework for Older People
National Patient Safety Agency (2007), Slips, trips and falls in hospital
Luton and Dunstable Hospital NHS Foundation Trust
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985
Workplace (Health, Safety and Welfare) Regulations 1992
Department of Health (2006) Health Technical Memorandum 61 Flooring
Risk Manager - For advice on risk assessment and solutions – Telephone number:
Spinal Awareness team - For advice and training on moving and handling –
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Appendix 1 Slips, Trips and Falls- potential risks and solutions
The Health and Safety Executive outline 6 main contributory factors for slips, trip
and falls, one or more may play a part in any situation or accident:
• The floor in a workplace must be suitable for the type of work activity that
• Where a floor can't be kept dry, people should be able to walk on the floor
without fear of a slip despite any contamination that may be on it. So it
• The floor must be cleaned correctly to ensure that it does not become
slippery or keeps its slip resistance properties (if a non slip floor)
• The floor must be fitted correctly to ensure that there are no trip hazards
and to ensure that non slip coatings are correctly applied.
• The floor must be maintained in good order to ensure that there are no trip
hazards e.g. holes, uneven surfaces, curled up carpet edges
• Ramps, raised platforms and other changes of level should be avoided, if
50% of all trip accidents are caused by bad housekeeping. So improving
housekeeping would eliminate a large number of accidents
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• Ensure there is a suitable walkway through the workplace • Keep it clear, no trailing wires, no obstructions. • Look at people’s workstations, are the floors tidy, do they have enough
• What about other rooms? Are they tidy, are goods suitably stored, are there
Good housekeeping doesn't cost money; it just takes a little personal effort.
All staff should take responsibility. Contamination and cleaning
Most floors only become slippery once they become contaminated. Prevent
contamination to reduce or eliminate the slip risk. Contamination can be
classed as anything that ends up on a floor, e.g. body fluids, oil, grease,
cardboard, product wrapping, food, rainwater etc. the list is endless. It can be a
by-product of a work process or be due to adverse weather conditions.
First think about whether the problem can be eliminated, e.g
• Ensure bodily fluids are collected correctly • Drip trays for leaks • Do not walk around the hospital with uncovered drinks, put lids on cups and
• Good sized mats at building entrances to dry feet • Fit effective canopies to external entranceways to stop rainwater from
entering a building. Fix leaking machines.
Cleaning affects every work place and is not just a subject for cleaning
managers and staff. Everyone in the workplace should keep their workspace
clear and deal with their own spillages.
People and Human Factors
How people act and behave in their work environments can affect slips and
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• A positive attitude towards health and safety can reduce the risk of slip and
trips accidents e.g. dealing with a spillage, instead of waiting for someone
• Things that prevent you from seeing or thinking about where you are going,
can also increase the risk of an accident e.g. rushing about, carrying large
objects, becoming distracted whilst walking, e.g. using a mobile phone.
• If individuals have a physical problem that stop them from seeing, hearing,
or walking in a regular manner it can increase the likelihood of an accident
e.g. vision, balance, age, disability that effects gait and ability to walk.
There are also many medical factors (e.g. low blood pressure, on-going
infection, slow heart rate, stroke disease) that may cause someone to fall.
Factors in work, or created by the work activity can help stop or increase the
• What tasks are taking place? Can they be improved? e.g. fewer/smaller
boxes to carry so worker can clearly see route ahead.
• Maintenance of equipment • Housekeeping systems • Provision of appropriate personal protective equipment • What footwear is worn can also make a difference e.g. wearing highheels
at work will make you more vulnerable to a slip.
Environmental issues can increase the risk of, or prevent slips and trips, so it is
important to take them into consideration, e.g. lighting (natural or otherwise),
loud or unfamiliar noises, the weather, humidity, condensation etc.
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The following gives an indication of how they can affect slips and trips
Too much light on a shiny floor can cause glare and stop people from seeing
Too little light will also prevent people from seeing hazards on the floor and
Unfamiliar and loud noises may be distracting
If rainwater gets onto a smooth surface inside or outside of a building, it may
create a slip hazard. Good entrance design (e.g. canopies) can help.
Cold weather can cause frost and ice to form, which may create slippery
It is vitally important to ensure that smooth floors are kept clean and dry
Footwear can play a part in preventing slips and trips.
Where we can’t control the footwear it is vitally important that smooth floors are
For work situations it is recommended that staff adhere to a sensible footwear
policy i.e. Flat, with a sensible heel, with a sole and heel that provide some
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Appendix 2 Drugs which increase risk of falls in older people
There are many side effects of drugs, which can increase the risk of falls in older people. The table below lists these and examples of drugs causing them. Other risk factors include polypharmacy and recent drug changes.
Side Effect Examples of drugs
Benzodiazepines e.g. temazepam, lorazepam &
Antipsychotics e.g. chlorpromazine, resperidone, olanzepine
Benzodiazepines e.g. temazepam, lorazepam & nitrazepam
B blockers e.g. atenolol, bisoprolol, metoprolol, propranolol ACE inhibitors e.g. lisinopril, perindopril, ramipril, enalapril, captopril Diuretics e.g. bendrofluazide, frusemide, bumetanide Nitrates e.g. glyceryl trinitrate isosorbide mono & dinitrate Tricyclic antidepressants e.g. amitriptyline, imipramine Antipsychotics e.g. chlorpromazine, risperidone, olanzepine
Typical antipsychotics e.g. haloperidol, trifluoperazine, chlorpromazine Atypical antipsychotics e.g. olanzepine, risperidone (less common) Prochlorperazine
Antihistamines e.g. chlorpheniramine, hydroxyzine, promethazine Typical antipsychotics e.g. haloperidol, chlorpromazine Tricyclic antidepressants e.g. amitriptyline, imipramine Procyclidine & benzhexol
Oral hypoglycaemics e.g. gliclazide, tolbutamide
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Antipsychotics e.g. chlorpromazine, haloperidol, trifluoperazine, risperidone, olanzepine Levodopa including co-careldopa & co-beneldopa Procyclidine & benzhexol Cimetidine, ranitidine Spironolactone
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Original Article Evaluation of Erectile Dysfunction with Color Doppler Sonography Vaqar Bari, M. Nadeem Ahmed, M. Zafar Rafique, Kashif Ashraf, Waseem Ahmad Memon, M. Uzair UsmanRadiology Department, Aga Khan University Hospital, Karachi Abstract Objective: To assess the role of Color Doppler Sonography in the evaluation of erectile dysfunction. Methods: A cross-sectional study was c
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