PREVENTING AND MANAGING FALLS

New guidance from the Care Inspectorate

Falls and fractures are a major hazard for older people. Our ability to balance, to be agile and have good bone strength can decline as we get older. These can combine and contribute to a greater risk of falls and injuries.

In care homes, many other factors can contribute to prevent or increase the risk of falling: some floor surfaces can provide poor grip, as can incorrect footwear. Also, the layout and design of the building can assist in falls prevention. Good health, particularly maintaining leg and ankle muscle strength, together with a well-balanced diet, contribute to avoid the risk of falls.

Falls are said to be the leading cause of accidental death for people over the age of 75. Many are due to risk factors which can be dealt with to prevent falls and reduce their incidence.

New Scottish guidance on falls and fractures

The Care Inspectorate has, jointly with the NHS, reviewed and updated guidance to care homes on this issue. It aims to help care home services adhere to the Scottish best practice framework ‘The Prevention and Management of Falls in the Community. A Framework for Action for Scotland 2014-16’.

The guidance booklet is available online, and states its purpose as helping to:

• Recognise quality care you are already giving.
• Identify and prioritise areas for improvement.
• Test out and put into practice (implement) new ways of working that both staff and residents will benefit from.
• Maintain the improvements you have implemented.

The guidance can also be used in staff induction and used generally in training to increase awareness, and reduce the incidence of falls and consequent injuries. It also gives clear guidance on what to do, and not to do, when there is an actual fall. All of the guidance is useful, and I thought it would be helpful to consider three areas to look at.

Self-assessment

Care Homes are advised to set up and maintain an ongoing written assessment of how well they are helping to prevent falls. This itself can contribute to awareness for staff, service users and families, of the dangers. It is best practice to involve service users, and families in this assessment, and to link to or include it in the general self-assessment which the service is required to maintain by the Care Inspectorate.

It is important that this assessment is updated regularly, and that it has an action plan, with timescales to implementing identified improvements.

Prevention of Falls and Fractures

This advises on issues such as foot care, footwear, individual risk assessment for falls (including pre-admission questionnaire). Environmental factors are important here also, including handrails and other occupational therapy aids, flooring, furniture, visual design and well-lit areas.

Regular activities, including walking and leg exercises are invaluable also, from my past experience. The guidance gives advice on training and other resources for carrying out group and individual activities.

An important but sometimes overlooked factor is medication. The guidance recommends the risk assessment for the individual is reviewed each time there is a change of medication. Clearly, risk factors can include the side effects of the medication itself or the condition for which it is it is prescribed. Regular medication should be independently and regularly reviewed by the prescriber, which will help to reduce unintended side-effects.

Managing falls and partnership working

When a person has been found to have fallen, the next steps are vital in assisting recovery. The guidance gives the steps to take before attempting to move the person or indeed whether to move the person at all. A first aid trained person on each shift is invaluable here, in knowing how to help the person without causing further harm. Medical help, including ambulance service if needed, should be called for.

When the situation has been properly managed, the incident should be recorded in the general accident records, as well as in the person’s case notes. As soon as possible, the risk assessment for the person should be updated and any measures needing to be taken are recorded.

The guidance notes the importance of working together with other health and social care services generally, in pursuit of the best practice and policy on falls management and prevention.

Towards best practice

This new guidance promises to provide services with sufficient resources and be used by them, to minimise the problem of falls: this will help maintain and improve people's quality of life as they are cared for.

NEW POLICY - No Access

SCC68 - Unable to Gain Access Policy and Procedure

Purpose

l To ensure that all care is delivered safely and in accordance with contractual requirements.

l To safeguard all vulnerable service users, whilst balancing risk, independence and choice.

Scope

l All staff.

Policy

l Staff are required to alert Social Care Alba if they are unable to gain access to a service user’s property.

Procedure – Stage 1 – All Care Staff

l If you are unable to gain access to a service user’s home, you must immediately call 0131 285 1606 and inform the on-call manager.

l Do not leave the property until you have been told to do so by the on-call manager.

l Where possible attempt to identify if the service user is at home or at risk by:

1.      Accessing the property if a key is available

2.      Looking through the windows to see if the service user can be seen

3.      Knocking on the door and/or window to gain the attention of the service user.

4.      Calling out the service users name through the letter box and listening for a reply

5.      Ask neighbours if they have seen the service user.

l Please update the on-call manager on the actions taken and any feedback from neighbours.

Procedure – Stage 2 - The On-Call Manager

l Unless there is a written agreement to the contrary you shall make extensive enquiries as to the whereabouts of the service user, by:

1.       Contacting the service user’s next of kin or emergency contact

2.      Checking the local hospital for a recent admission.

3.      Phoning Social Care Direct 0131 200 2324 or Emergency Social Work on 0800 7316969

l You must keep in contact with the care staff updating them on action taken.  A record must be kept on the care management system of every individual contacted, the outcome and time.

l If the service user cannot be positively located elsewhere within 30 minutes of the staff reporting the No Access, you must contact the Local Police on 999 in an emergency or 101 at all other times to advise of the No Access and to request a Welfare Check. The Police may decide to force entry if necessary.

l Finally you must ensure that:

1.      Care Staff both current and within the next 24 hours are updated, amending shifts as required

2.      An update is given by phone to Social Care Direct or Emergency Social Work

3.      An update is given to the Directors and relevant SCA staff by email

ENDS

Service User Engagement

Social Care Alba believes strongly in service user engagement.  This is why we are proud to sign up to the
National Involvement Networks Charter.  We will be rolling out a series of engagement opportunities over the coming months to support the charter, so please keep an eye on our community. To find out more bout the charter click HERE

What is the National Involvement Network?

The National Involvement Network is a project in Scotland to boost the involvement of people who user services in the development of those services. Fittingly, the network is composed of approximately eighty people who use services. 

 The network had established a Charter for Involvement in 2009, and has relaunched an updated version. The aim is to get services to sign up to the charter, which will demonstrate how well they involve people, or where they need to improve.

The Network intends to produce further tools for services to promote and assess their involvement strategy, and also to become a nationally recognised consultation body in strategy consultations. Another goal is to monitor and evaluate standards for involving people in the services which they use.

What the Charter says

The Network is supported by the Scottish Government and the charity ARC (Scotland), A branch of the UK group the Association for Real Change.

The Charter has twelve areas which services sign up for. These can be summarised as:

1. The person being at the heart of their own planning
2. Living as independently as possible
3. Being involved in the community
4. Being able to speak up about what works in the service, and about what could be better
5. Be involved in the choice of people who support them
6. People who use services giving information and training to staff at all levels
7. Being involved in policy formation and making policies easy to understand
8. To be involved in service decisions
9. To be involved in events run by the organisation
10. Be involved in ‘Speaking-up’ groups
11. Take part in national and local campaigns
12. To be able to make complaints

Achievements so far

The Charter has already been signed by over thirty organisations, and hopes for up to a further twenty after its relaunch. Social Care Alba are proud to sign up to the charter and hope our contribution helps all service users engage in the issues that matter to them.

If music be the food of love…

Poor nutrition is commonly experienced by people with dementia. So it was with interest this week to see a new initiative from the Imperial College Healthcare NHS Trust for the provision of specialist support to dementia patients to ensure that they are eating and drinking enough. The programme, Dementia Nutrition Support in Hospital Pathway (known as NoSH), has 3 levels and aims to provide a tailored response to individual needs.

Pathways for nutrition support in patients with dementia

In NoSH, all patients admitted with dementia are placed on the first level of the programme– core support. This includes having their weights monitored, foods and fluid recorded and access to special snack boxes.

For patients that require more support ‘enhanced’ and ‘intensive’ levels of the programme provide:

• one to one support for dementia patients who struggle to eat and drink
• daily reviews
• development of eating and drinking goals for the patients in conjunction with the family and nursing team
• provision of 5 smaller meals, which can be easier for some people with dementia to manage than the traditional 3.

Music and food intake – is there an association?

But the provision in the programme that caught my eye was the use of music during meals. Can playing music really stimulate nutritional intakes?

Looking at scientific research, several studies have demonstrated the calming effect of music on service users with agitation and anxiety related to dementia. However fewer studies have directly measured the effect of music on meal intake in long term care settings.

In a study of 27 nursing homes, it was reported that residents with dementia increased the percentage of the meal consumed by around 10% when relaxing music was played in the dining room with the evening meal over a 4 day period. However the study was limited by short duration and estimation, rather than a weighed measure, of food intake.

In another study involving 12 nursing home residents with Alzheimer’s disease, researchers played familiar music during the midday meal every other week for 8 weeks, and meal intake was compared for music vs no music weeks. The authors reported an increase of 20% in calorie intake when the music was played. In this study, musical preferences were determined by obtaining input from family members. Interestingly it was suggested that it was the familiarity of the music, rather than the relaxation quality, that contributed to the significance of the results.

And in a charming report from the Slough Public Health team on the Sing for Life programme in 6 care homes, they noted that therapeutic singing increased the weight of those participating in structured singing sessions.

This evidence is clearly limited but music or singing may be worth trying as part of a range of interventions to increase nutrition intake for people with dementia in care home settings. What is also worth considering is whether any parts of the NoSH Programme are not currently in place in your care homes and whether they perhaps should be.

Reproduced with thank to Ayela Spiro, British Nutrition Foundation 

International Women's Day

International Women's Day (March 8) is a global day celebrating the social, economic, cultural and political achievements of women. The day also marks a call to action for accelerating gender parity.

Social Care Alba is proud to celebrate the achievements of women both within and out with the company.  Our company has a balance of genders representing us in every role.

Partnership Working

Social Care Alba has, over the past few years built up a number of partnerships on projects which will benefit both our staff and those for whom we provide support.

Whether it is helping make Edinburgh Dementia friendly or developing new and innovative ways of providing support, we know partnerships work.

If you would like to get involved in one of our existing projects, or you have an idea that you think Social Care Alba can help with, please get in touch.  The only criteria we have for working in partnership is that it has a direct benefit to either:

• Our staff
• Service Users
• Family Members
• Allied health professionals, or
• Care Providers across the UK

BUDDY to join the Team

Yes, Social Care Alba will be the first Care Company to welcome Buddy to Scotland late in 2016.

Buddy is the worlds first Social Robot.  He is not a replacement for staff, but can work in addition to the team when you need the security of knowing help is there if you need it.

Our staff will have their thinking caps on working out ways Buddy can help improve the quality of life of our service users.  If you have any ideas, then I would love to hear from you.  Click HERE to find out more.