{"id":394,"date":"2024-01-30T12:22:53","date_gmt":"2024-01-30T12:22:53","guid":{"rendered":"https:\/\/staff.nhslothian.scot\/falls\/falls-toolkit-bundle\/"},"modified":"2024-02-26T22:32:35","modified_gmt":"2024-02-26T22:32:35","slug":"falls-toolkit-bundle","status":"publish","type":"page","link":"https:\/\/staff.nhslothian.scot\/falls\/falls-toolkit-bundle\/","title":{"rendered":"Falls Toolkit Bundle"},"content":{"rendered":"\n<p>The Falls toolkit bundle aims to support a reduction of inpatient falls and falls with harm.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What is a bundle?<\/h2>\n\n\n\n<p>A bundle is a structured way of improving the processes of care and patient outcomes: a small, straightforward set of evidence-based practices that, when performed collectively and reliably, have been proven to improve patient outcomes. (<em>SPSP Pioneering Patient Safety)<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">For All Patients:<\/h2>\n\n\n\n<p>All adult inpatients must have a falls risk assessment within 24 hours of admission and the following actions must be completed in that time period:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Complete and document the screen for more vulnerable patients (5Qs \u2013 see below)<\/li>\n\n\n\n<li>On admission, immediately document assessment of mobility.<\/li>\n\n\n\n<li>Provision of walking aid as required and that it is within easy reach.<\/li>\n\n\n\n<li>A working Call bell is in reach.<\/li>\n\n\n\n<li>The patient is wearing or has appropriate footwear.<\/li>\n\n\n\n<li>If glasses and hearing aids are required and are in use.<\/li>\n<\/ul>\n\n\n\n<p>5 Questions&nbsp;(5Qs)<\/p>\n\n\n\n<p><strong>If the patient answers &#8220;yes&#8221; to any of the five questions, the patient is identified as &#8220;more vulnerable&#8221; to falls.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\" start=\"1\">\n<li>Has the patient fallen in the last 6 months &#8211; including during this admission?<\/li>\n\n\n\n<li>Does the patient have a 4AT greater than 0&nbsp;or&nbsp;acute confusion&nbsp;(delirium)?<\/li>\n\n\n\n<li>Does the patient attempt to walk alone although unsteady or unsafe?<\/li>\n\n\n\n<li>Does the patient or their relative\/s have fear or anxiety re falling?<\/li>\n\n\n\n<li>Based on your clinical judgement, is this patient at high risk of falling<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Safety Bundle for more vulnerable patients<\/u><\/strong>&nbsp;(and all in care of elderly wards)<\/p>\n\n\n\n<ul class=\"wp-block-list\" start=\"1\">\n<li>Communicate mobility status for walking and transfers (safety brief)<\/li>\n\n\n\n<li>Chair and bed consistently at best height for individual, to enable safe transfers<\/li>\n\n\n\n<li>Identify patients with cognitive impairment and\/or with poor mobility and known not to ask for assistance, and provide close observation whilst using the commode, toilet, in bath or shower<\/li>\n\n\n\n<li>For patients known to take risks with mobility, clearly document intensity of observation required (positioning of bed; cohorting; 1:1, care and comfort rounds<\/li>\n\n\n\n<li>Assess for bedrails using a decision making tool \/ algorithm and use if indicated<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Multidisciplinary Assessment and Intervention Bundle (for Vulnerable patients and all in care of elderly wards)<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\" start=\"1\">\n<li>A documented cognitive assessment and delirium screen, with findings recorded and action plan initiated<\/li>\n\n\n\n<li>Bladder and bowel dysfunction with diagnosis, treatment \/ management plan recorded<\/li>\n\n\n\n<li>A documented assessment of postural hypotension and arrythmias, with management plan recorded<\/li>\n\n\n\n<li>A documented medication review for medications that can increase the risk of falls, with management plan recorded (1-4 of this bundle parralels the Comprehensive Geriatric Assessment) see * below.<\/li>\n\n\n\n<li>Multidisciplinary review of further falls risk factors with management plan recorded<\/li>\n<\/ul>\n\n\n\n<p>*In addition to bundle components 1-4 this includes a falls history, (including causes and consequences such as injury and fear of falling), health problems that may increase their risk of falling, postural instability, mobility problems and\/or balance problems, syncope syndrome, visual impairment and assessment of fracture\/osteoporosis risk.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Post fall bundle<\/h2>\n\n\n\n<ul class=\"wp-block-list\" start=\"1\">\n<li>Assess for signs and symptoms of fracture or potential spinal injury before the patient is moved<\/li>\n\n\n\n<li>Safe manual handling methods for patients with signs and symptoms of fracture or potential for spinal injury<\/li>\n\n\n\n<li>Frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (e.g. un-witnessed falls) based on guidance<\/li>\n\n\n\n<li>Adhere to agreed timescales for medical examination following a fall or high vulnerability to injury, or who have been immobilised<\/li>\n\n\n\n<li>Conduct a post fall review \/ rapid root cause analysis (to learn how further falls can be prevented for the patient and annotate during report of incident for wider learning).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>The Falls toolkit bundle aims to support a reduction of inpatient falls and falls with harm. What is a bundle? A bundle is a structured way of improving the processes<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":28,"comment_status":"closed","ping_status":"closed","template":"page-templates\/widewidth.php","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[],"class_list":["post-394","page","type-page","status-publish","hentry"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"davidmcbain","author_link":"https:\/\/staff.nhslothian.scot\/falls\/author\/davidmcbain\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"The Falls toolkit bundle aims to support a reduction of inpatient falls and falls with harm. What is a bundle? A bundle is a structured way of improving the processes","_links":{"self":[{"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/pages\/394","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/comments?post=394"}],"version-history":[{"count":2,"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/pages\/394\/revisions"}],"predecessor-version":[{"id":818,"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/pages\/394\/revisions\/818"}],"wp:attachment":[{"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/media?parent=394"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/staff.nhslothian.scot\/falls\/wp-json\/wp\/v2\/categories?post=394"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}