Falls

Falls are the second-leading cause of unintentional injury death, following road accidents. With ambulances responding to around 700,000 calls for people who have fallen annually, preventing falls and providing the right support following a fall is paramount to supporting older populations to live longer better.

Following on from the Frailty topic, it is expected that anyone scoring between 4 – 6 on the Frailty Rockwood scale is one fall away from being a 7. This means anyone with moderate frailty is considered one fall from being severely frail and therefore needing much higher levels of support to have a good quality of life.

Relevant Legislation

Mental Capacity Act

Health and Social Care Act

Resources

HCPA StopFalls Resources

NICE Guidance: Falls in Older People

NHS Falls Prevention Advice

Pre and Post Knowledge Assessment

HCPA have developed word documents which can be used as a guide for pre and post knowledge assessments of the different levels outlines in this framework. The questions in this document can be copied into other formats such as Microsoft Forms or Excel and are a guide to the type of information you need your staff to know.

Falls Awareness Pre & Post Assessment (40kB docx)

Falls Intermediate Pre & Post Assessment (41kB docx)

Falls Advanced Pre & Post Assessment (41kB docx)

Learning Objectives

Identify (General)

Identifying people at higher risk of falls is an important step in prevention, as it enables staff to put in proactive measures to prevent falls. This could be encouraging strengthening exercises, removing trip hazards, improving lighting, encouraging different footwear, or any number of evidence-based interventions. Understanding why the person is at higher risk of falls can be used to plan these interventions, for example, if someone is a higher falls risk due to infection, then treating the infection and monitoring the individual will be more beneficial than removing rugs from the home environment.

Awareness

For staff providing day-to-day care of people living with frailty.

  • Staff understand what determines a fall
  • Staff understand the local and national prevalence and their role within fall prevention
  • Staff know the falls Risks- Causes of falls (e.g. mechanical, balance, loss of consciousness)
  • Staff are able to identify internal and external fall risk factors and understand how they affect likelihood of falls
  • Staff can identify correct footwear and understand the importance of wearing them 
  • Staff can identify and assess risks within the home environment
  • Staff understand the importance of adequate lighting and how this can reduce the risk of falls
  • Staff understand how dehydration and poor nutrition contribute to someone’s risk of falls
  • Staff can identify warning signs of malnutrition and dehydration and manage this to mitigate risks
  • Staff understand the stigma around falls and how this can be damaging
  • Staff understand the importance gaining consent to carry out assessments and intervene in a fall (including best interest)

Intermediate

For staff acting as decision makers regarding people living with frailty’s ongoing care.

  • Staff are able to identify and manage overarching key risk factors 
  • Staff understand the importance of reviewing medication & understanding precipitating factors
  • Staff can identify visual problems and poor eye health and understand how this can relate to falls
  • Staff understand the risks associated with pressure ulcers and the affect these have on falls

Advanced

For staff responsible for equipment of people living with frailty.

  • Staff know how to review equipment and walking aids

Assessment

Staff should be able to assess someone’s falls risk and the risk factors most relevant to the individual. There are many ways to assess someone’s falls risk, including clinical methods such as Multi Factorial Assessment. Assessments are needed for planning the care of people at higher risks of falls and to plan how best to reduce the risk or harm of a potential fall

Awareness

For staff providing day-to-day care of someone living with frailty.

  • Staff have enough understanding of falls risk to opportunistically identify risk in non-related interactions
  • Staff can identify red flags and when urgent care referral is necessary
  • Staff understand when and how to complete FRAT assessment 
  • Staff understand when and how TimeUp and Go and Postural hypotension assessments are completed

Intermediate

For staff acting as decision makers regarding people living with frailty’s ongoing care.

  • Staff understand how to identify level of falls risk and how to incorporate this into a care plan including pathway details
  • Staff caring for clients identified as low risk of falls understand the step-by-step 1a guide and know where to find this when relevant
  • Staff caring for clients identified as medium risk of falls understand the step-by-step 1b guide and know where to find this when relevant

Advanced

For staff involved in Multi-Disciplinary Team Reviews and clinical decision making.

  • Clinical staff are competent in assessing and managing bone health risk
  • Staff caring for clients identified as high risk understand how to carry out a Multi-Factorial Assessment (MFA)

Action and Management (Prevention)

Next steps once you have identified and assessed a person’s falls risk would be to mitigate the risks where possible. It is important to remember that this needs to be done with the individual, not for them. For example, clutter can increase the likelihood of a fall as there are more trip hazards for the person to avoid, but it is important to work with the individual to plan their environment in a way that feels like their home but is safer to navigate. Working with the individual will usually garner better results as they understand the purpose of the changes.

Awareness

For staff providing day-to-day care of people living with frailty.

  • Staff are able to identify hazards within the home and know how and when to address these
  • Staff are aware of local resources and programmes and understand how they can enhance a person’s life and enable them to reduce their falls risk
  • Staff know the benefits of assistive technology and can make recommendations based on the person’s frailty level

Intermediate

  • Staff understand how to oversee and sign post to Strength and balance exercise
  • Staff know the benefits of assistive technology and can make recommendations based on the person’s frailty level
  • Staff know how to adapt a home environment to promote independence, thermal comfort, safety etc.

Advanced

  • Staff are able to provide advice on preventing falls for someone who is at high risk of falls

Management of a Person who has Fallen (During and Post)

Unfortunately, we cannot prevent every fall and it is important that staff understand their role in supporting a person that has fallen. Better management of a person that has fallen leads to better health outcomes and lower likelihood of repeated falls. 

Awareness

For staff who provide day-to-day care of people living with frailty.

  • Staff can recall red flags that require urgent care post-fall including understanding of additional risks if on anti-coagulants and can carry out basic life support if trained to do so
  • Staff can demonstrate an SBAR handover for 999 based on case study
  • Staff can demonstrate ability to give verbal instructions as required to help someone get themselves off the floor 
  • Staff can demonstrate ability to give moving and assisting as required to help someone get themselves off the floor
  • Staff can assess for amber flags and know when to call 111
  • Staff understand that someone who has fallen should be checked over a 24-hour period and understands what concerns to look for and what next steps to take (including referral where necessary)
  • Staff understand company policy around documenting a fall and how to complete a body map
  • Staff know when and how to raise a safeguarding concern
  • Staff know how to update a falls risk assessment or care plan if necessary after a fall
  • Staff can complete a DATIX/incident report following a fall
  • Staff understand the post-falls protocol

Education Resources and Case Studies

HCPA have developed PowerPoint presentations in line with learning objectives cited in this document. If organisations choose to use these packages for training, they are responsible for editing content to be in line with organisation policies and local strategies.

HCPA Falls Packages – Awareness. Click here (Coming soon)

HCPA Falls Packages – Intermediate. Click here (Coming soon)

HCPA Falls Packages – Advanced. Click here (Coming soon)

Supporting Case Studies – Coming Soon

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