Falls and Fractures
The 'Managing Falls and Fractures in Care Homes for Older People good practice resource' is a revised and improved edition of the resource pack launched in 2011.
This resource pack will help staff in care homes to assess how well falls prevention and management and the prevention of fractures is being addressed in their service.
It aims to provide the answers to many of the questions care home managers have, and can also act as an educational tool for new or existing care home staff. It provides practical help, guidance and tools and signposts to resources available online.
There are a number of changes and additions in the 2016 edition.
The self assessment is still your starting point when using the resource pack; you will notice it has a few additional ‘good practice statements’ in line with the updated practice. It will help you identify what improvements, if any, you need to make in your care home to prevent falls.
Section 5 - 'Learning from falls' emphasises the importance and value of learning from the information you gather about falls. Section 2 'Guidance for improving the quality of care’ is a new section which has been added to support you to identify, plan, test and implement lasting improvements in your care home. Section 4 ‘Keeping well’ is another new section, focusing on 10 common risk areas and includes guidance, points to consider, tools and links to useful websites.
Care home stories have been added throughout the resource pack to give examples of new ways of working. To emphasise the importance of working with the wider health and social care team Section 6, ‘Working together’ has been added, which suggests ways to develop and improve links.
And finally, some tools in the toolkit have been updated and new tools added including a falls data spreadsheet to gather and analyse information about falls in your care home (this is accessible on the internet along with instructions for its use) and a DVD education pack that goes with the falls awareness DVD that came out with the original pack.
Please make use of the revised resource in a way that fits with the needs of the staff and residents in your care home. We hope you find it useful, comprehensive and easy to use. Most importantly we hope it supports you to improve the care and lives of older people at risk of falling.
The resource can be downloaded here or by clicking on the image above.
Resource Tools
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Tool 1a The Model for Improvement
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Tool 1b The Model for Improvement and PDSA cycle planning and progress proforma
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Tool 2a Improvement log
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Tool 2b Action plan
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Tool 4a Multifactorial Falls Risk Screen (MFRS) and falls care plan
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Tool 4b Care home resident falls and fracture risk/intervention tool
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Tool 6 Falls management checklist
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Tool 10 Protocol for measuring lying/standing blood pressure (BP) (checking for Orthostatic Hypotension)
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Tool 13 Bedrail risk assessment
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Tool 14 Seating matters
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Tool 15 Post fall pathway for managing a resident who has fallen or has been found on the floor
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Tool 16 Telecare matters: A quick guide to technology enabled care and support
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Tool 17a Guidelines for completing a post falls/incident report form
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Tool 17b Post fall/incident report form
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Tool 18b Care home monthly falls diary
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Tool 19 Fall data spreadsheet
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Tool 20a Procedure for the use of measles chart/falls plotting
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Tool 20b Measles chart example
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Tool 21b Falls safety cross
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Tool 22 Training database
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Tool 23 Managing falls and fractures in care homes for older people: DVD education pack (This links with the falls awareness DVD which is available below)
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Tool 24 Service directory
Watch the falls awareness educational video here.
We first published the resource in 2011 and carried out and evaluation in 2012. You can read the full evaluation report here.
For more information please contact Fiona Currie, Improvement Adviser at fiona.currie@careinspectorate.gov.scot.
Strength and Balance DVD to prevent falls and keep well
A DVD has been produced by Active Fife in partnership with Paths for All and is accompanied by their 'Walk Your Way to Better Strength and Balance' leaflet. Anyone outside of Fife who wishes to get copies of the DVD or leaflet can get them directly from Paths For All or through their local health walking group.
The videos contained within the DVD are also available through Paths for All on YouTube.
Useful information
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Make Every Moment Count
We have worked with a team of experts to develop the ‘Make Every Moment Count’ resource, an information leaflet which contains easy to read and simple guidance for everyone supporting older people in a care home or at home.
The resource highlights how making the most of every moment can make a real difference to a person’s quality of life in simple but very meaningful ways.
The five key messages are:
- Get to know me
- It's not just what you do... it's how you make me feel
- Know what I can do and support me to do it
- Help me feel comfortable, safe and secure in my surroundings
- Remember little things all add up
By providing key messages on how to better understand an individual’s needs, values and lifestyle, the guide will help people working in care services to deliver an enhanced experience for Scotland’s older people.
Hear more about the resource in our video.
To order copies of this information leaflet, poster or DVD, please call our enquiries team on 0345 600 9527 or email enquiries@careinspectorate.com.
Some signposts to useful information
www.knowledge.scot.nhs.uk/dementia
http://www.nmhdu.org.uk/silo/files/lets-respect-toolkit-for-care-homes-.pdf
http://www.bhfactive.org.uk/home/index.html
http://www.active-ageing-events.org.uk/home/index.html
Actively Engaged
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Care...about physical activity
The Care Inspectorate’s Care about Physical Activity (CAPA) programme ran from April 2017 to May 2020.
CAPA used an improvement approach to help care providers build physical activity and more movement into the daily lives of those they support. Sometimes within hospitals and care settings and even in our own homes, older people can get out of the habit of moving. This has negative consequences. Prolonged sitting leads to poor health such as frailty, falls and bone health. It also results in a poorer quality of life, depression and loneliness.
Moving more often during the day is of crucial importance to older people’s health and wellbeing. Increasing strength and balance in particular also helps older people to remain independent for longer, have a better quality of life and contributes to reduced falls.
A report, including detail, stories and information from the programme, can be accessed here.
Managers and staff who work with older people from:
*Care at Home *Day Care *Care Homes
*Sheltered Housing *Very sheltered housing *Respite care
across 19 Health & Social Care Partnership areas were involved with the CAPA programme (see map below)
Care professionals of all levels, local inspectors, designated partnership leads, integration leads, community and leisure groups and others came together at a variety of learning events (see red tags on the map). Those present were supported to understand how movement contributes to positive health and wellbeing.
Participants were supported to translate this understanding into developing their own movement ideas in their own settings with the people they knew well. Principles of Community Connection, Organisational Culture and Physical Activity Participation were examined from the viewpoint of each service.
For example, how could residents in a care home connect with others in their community in an area of interest.
Some services used an established battery of physical and psychological tests/ questionnaires to track improvement and to contribute this data to the overall evaluation of the programme.
The CAPA programme complemented the work of adult service inspectors who support services to provide high quality care and support that is right for each person as part of their scrutiny and improvement role.
Independent research commissioned by the Care Inspectorate investigated psychological and physiological impacts of moving more often. The first phase evaluation found that older people involved in the programme have significantly improved their hand grip strength, their low leg strength, gradually increased their flexibility which improved mobility and levels of independence and significantly reduced their likelihood of falls as a result of moving more. People also experienced greater life satisfaction and felt less anxious.
Case studies
Click on the selection of short films below showing what happened when care professionals found ways to promote more movement for those they support. These films can be used in team meetings or viewed by staff who are interested in finding new ideas to improve health and wellbeing.
Margaret's story (Care at Home)
Jacqui, a home carer, talks about how promoting movement is not as time consuming as they originally thought and how they are helping people receiving care at home to incorporate moving more into their daily lives
Jean's story (Day Care)
See how day care centre staff supported Jean to get out of her wheelchair. Jean started to walk, became more active, enjoyed increased energy levels and took up hobbies and passions.
Beth's story (Care Home)
Show this short film to spark discussion at team meetings. Listen to how Beth's quality of life improved when care home staff started something small.
Daphne's story (Care Home)
Care Home staff help Daphne incorporate more movement into her day which improves her health and wellbeing. Daphne’s son talks about the differences he has seen.
Care...about physical activity resources
We developed many resources together with care professionals and people experiencing care. Here is a selection that you might find useful:
'Make Every Move Count' pocket guide which helps staff understand that movement is about the small, simple things we can add into daily life that make a big difference to people experiencing care.
'Moving More Often' pocket guide. People living in their own homes have found these useful to identify what is important to them, give support to move more often every day, promote independence and the possibility of continuing to live at home.
Information for relatives This short factsheet encourages relatives and friends to support their older relative to move more often for positive health and wellbeing. Some services have found it useful to include this information in care plans, introductory packs or newsletters
My moving more improvement record People experiencing care use this to track their improvement over time. People have found this personal record motivating to use themselves, and a useful way to involve family and friends.
'Care...about physical activity' booklet outlines the original CAPA resource developed for care homes
More information and good practice stories can be found by searching further in the HUB
- Go to your area of interest (e.g. Adults & Older People), then e.g. Care Homes for adults.
Under Topics choose ‘Type - creative and physical activity ‘, or ‘Resources - case studies’ to pull up resources including films that you might find useful.
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Variations around the skills mix in care homes
Care homes for older people
The Care Inspectorate is aware of the challenges faced by some care providers on the recruitment and retention of nurses in the care sector. Some care providers have approached us about reconfiguring their staffing model, to develop the role of their senior care workers so that they can deploy their nurses more effectively and in some cases reduce reliance on agency nursing in order to promote more stable staff teams.
The Care Inspectorate recognises and strongly supports the role that nurses play in many care homes, particularly in providing clinical leadership and planning care for residents. We are also keen to support innovation in care that reflects changing needs and demands, where this improves outcomes for service users.
Where care homes for older people are proposing to vary the skills mix in a care home, and this would require a change to staffing schedules, we will consider proposals through our registration variations process. We expect such proposals to improve the quality of care for residents. We will ask care homes to provide us with specific information to support the variation request.
If agreed, we may place specific time-limited conditions on the registration of the service. We will expect any such initiative to be evaluated by the care home provider, before consideration is given to confirming these arrangements as permanent. Where a variation is agreed, the next inspection of the care home is likely to look at all quality themes, even if the home has been performing at a high level for some time.
Prior to submitting your variation, the registration team will be able to advise on what actions you should be taking to support your application. This should include engagement with local commissioners, as well as with residents and relatives and the development of a plan to evaluate the impact and effectiveness of your initiative. Please note, cost saving will not be an acceptable reason for application.
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Promoting continence for people living with dementia and long term conditions
This resource highlights the fundamental and essential care and support required to give people the opportunity to remain continent and maximise their quality of life.
Its production involved people living with dementia and their families and carers as well as staff from across the health and social care sector.The resource can be used by people living with dementia and their families as part of self-management as well as by staff working across health and social care.
The resource, which was piloted across NHS assessment units, care homes, day centres and care at home services, can be used by people to manage their own continence as well as by carers, both formal and informal, in a wide variety of settings.
It contains an easy read guide, poster and DVD to support its five key messages which are:
- Know me and what’s important in my life and do what’s best for me.
- Know me and how I communicate.
- What I need to stay continent and how you can help.
- Create an environment that supports me to be independent and promotes continence.
- Look for every opportunity to promote my continence – be creative.
The project was led by the Care Inspectorate and delivered in partnership with Scottish Care, Scottish Government, NHS Continence Advisers, the Scottish Dementia Working Group, ACA and the National Dementia Carers Action Network (NDCAN).
For copies of the resource call 0345 600 9527.
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