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Until the FRAMP is available through eMR 2, it will need to be completed on paper and placed with other paper based notes easily accessible to staff.

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Mrs P, is an 87 year old lady who has been admitted to the ward following a fall at home. She was got up to go to the toilet at 12 am and fell on the floor. She was found the next morning by a carer who had come to shower her at 8am. She states she felt a little light headed prior to her fall. An X-ray has shown she has sustained a # colles in her right wrist. She is right handed and usually holds the w/s in her right hand. She reports she has had 3 falls in the last month but has never hurt herself and has always managed to get up. 2 falls have happened at night whilst going to the toilet and the other one occurred when she got up from the chair after having her dinner. Mrs P is alert and orientated but is afraid of falling again. She a very independent lady as she has been managing on her own for the last 10 years since her husband died and has stated she doesn’t want any fuss.

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Whilst talking to her she is trying to unpack her bag the carer put together for her. She has her wrist in a back slab and has been started on Targin with breakthrough Endone to help reduce her pain. She wears glasses for reading. She wear incontinent pads “just in case” as she can get urge incontinence.

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• A is ticked as the assessment is on admission. • The date the interventions were put in place was the 1st June 2018. • There was no sensor mat available on the 1st june, therefore the 2nd June is written

to indicate the date the mat was put insitu. • Additional comments under Hx of falls demonstrates that a postural BP was taken

and the Reg informed • Mental statues – identifies the reason the mental status is a risk (anxious/ fear of

falling/ impulsivity) • Circling AMTS identifies which screening tool was completed • Every intervention is initialed and dated where applicable. If the strategies are

either not suitable or available, leave the sign/date section empty • We can see she has been referred to an OT for MMSE • We can see the sensor mat was identified as required on the 1st June and was

ordered, but didn’t arrive til the 2nd June. • Reading glasses are identified and comment that an effort has been made to keep

them in reach • Type of incontinence identified- management plan described in comments • Footwear – Noted in comments that pts footwear appropriate and documented

that a conversation around footwear has occurred • Medications – type circled (opioids) and in comments section identified that

monitoring of confusion is being considered due to new medication • Alert methods identified (Journey Board/ Pt Care Board / Above the bed alert sign)

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• All appropriate actions are identified and implemented – Comment waiting for sensor mat

• Comments on pt engagement Flyer given and discussed Flyer has been named. • Signed designation and name documented at bottom of FRAMP

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• Consider 1:1 supervision for patients at high risk of falling who require increased observation and/or display challenging behaviours associated with delirium, dementia, drug and alcohol withdrawal or mental health conditions.

• Please refer to SWSLHD policy on Increased Supervision of the At Risk Patient • If a patient insists that they attend the toilet/bathroom unaccompanied and are

deemed competent to make that decision, an entry should be recorded in their clinical notes advising of this.

• Bladder assessment/screening should be taken into consideration when assessing falls prevention strategies.

• Adult elderly men with prostatic enlargement can also experience these symptoms.

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• Restraints are not to be used as a mechanism to prevent falls. Refer to SWSLHD_GL2016_003 Delirium. Similarly, bed rails should not be used to keep a patient in bed against their wishes. For guidelines on the appropriate use of bed rails, refer to SWSLHD_PD2014_031 Safe and Effective Use of Bedrails – Adult Patients

• If appropriate footwear is not available, consideration should be given to alternatives, such as the provision of non-slip socks or mobilising barefoot.

• Safe footwear characteristics include: Thin soles with tread; Low, wide heels with a rounded edge; Firm heel cup; Laces, buckles or Velcro fastenings; Wide and deep toe box; The correct length. • The CEC flyer, Falls Prevention – Foot Care and Footwear, is available to provide

patients and carers with information about appropriate footwear in hospital. • The decision requires staff to use clinical judgement and take into account individual

patient factors (e.g. wounds, dressings, patient preference), as well as resource availability.

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• Please note The medical officer who reviews the patient must document an assessment and management plan in the medical record and hand over to nursing staff.

• In the event of a patient falling who was previously had a NFR, not for CRC or Observations order, Observations show be carried out as per CEC guidelines until advised by the Medical Officer post review.

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• Accurate information during clinical handover is key to patient safety. • Information that must be included as part of clinical handover varies depending on

the point of handover but includes: Current falls risk status Falls prevention strategies in place Inpatient fall incident details and post fall management Referrals requiring follow up Testing of chair/bed alarms Continence and toileting regimes

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Discharge referrals that may be appropriate include: Specialist medical practitioners such as a Geriatrician or Ophthalmologist Specialist clinics e.g. falls clinic, osteoporosis clinic or aged care clinic Home medicines review Community health services Allied health and other health professionals e.g. physiotherapists, occupational therapists, dietitians, podiatrists, continence advisors Evidence-based multifactorial falls prevention such as Stepping On and Able and Stable Evidence-based exercise such as Tai Chi.

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