FALLS PREVENTION COMPETENCIES - ASSESSOR GUIDANCE (Qualified Nurses)

Competency Category / Competency Assessment
Personal Responsibility / Adheres to legislation, policies, guidelines and procedures and knows where to locate them.
Escalates changes in patient condition, either improvement or deterioration.
Assists in promoting a safe working environment.
Notifies the MDT if the patient has suffered a fall or has a history of falls.
Communication / Maintains confidentiality at all times.
Ensure the RN uses appropriate language, supports the patient throughout any task procedure and offers reassurance. (Cognitive ability to be taken into consideration for vulnerable adults).
Ask the RN what considerations are required in relation to equality, culture & diversity and privacy & dignity (e.g. interpreters, prayer times, respecting a patient’s dignity or respecting people’s religious beliefs, using curtains and communication aids).
Ensure the RN answers questions accurately.
Give the RN a scenario regarding unsafe fall prevention practice and ascertain that the RN is aware they must escalate to the nurse in charge/line manager. For example witnesses a patient mobilising independently/with a family member/MDT without appropriate foot wear/walking aid.
Can provide an example of the importance of communication and the consequences of miscommunication e.g. obtaining information regarding a patient’s falls history
The RN can discuss the consequences of poor communication in relation to falls
(P) Ensure the CSW can demonstrate the ability to communicate with a range of infants to young people and acknowledges the cognitive ability and communication skills of all individuals. Explanations support & reassurance from a parent/family member may have to be sought.
Infection Prevention / The RN can discuss universal precautions and understands when to use them in relation to falls prevention equipment. e.g. source isolation, MRSA, Clostridium Difficile.
Ask the RN to describe the steps taken to minimise the risk of infection of falls prevention equipment from a source isolation room.
The RN is aware when to refer to IPC when there is a conflict between source isolation and falls risk.
Assessment / The RN can discuss the use of the Nursing Specialist Assessment in identifying a patient’s falls risk and can justify when to implement a falls prevention care plan.
Review a Nursing Specialist Assessment which the RN has completed to ensure all domains are completed correctly and the falls prevention care plan has been actioned correctly.
Risk Factors / The RN can identify the following risk factors: Falls history, Inappropriate or ill-fitting foot wear, Lack of or inappropriate walking aid, Cluttered environment, Trailing leads etc, Confusion, Change of environment, Brakes not on equipment, Medication, Bed not at an appropriate height or location within the ward environment, Nurse call bell not to hand, Spills on the floor, Postural hypotension, Patient wearing glasses.
Interventions / The RN should be able to discuss the following falls prevention strategies: Prompt assessment of falls risk, Bed on the lowest setting, Low Care Bed, Physiotherapist assessment for mobility/ walking aids, OT assessment for equipment (perching stools etc.), Use the correct mobility aid for the patient (equipment not to be shared unless directed by a Physiotherapist), Correct fitting & appropriate foot wear, Nursed in the most appropriate area of the ward, Bed area free from clutter and trailing wires, Nurse call bell to hand and patients know how to use it, Intentional rounding, Inform staff if there is a history of falls, Bed and chair alarm cushions (if appropriate to your individual area), Ensure all brakes on bed/equipment are applied, Ensure all spillages are cleaned up immediately and appropriate signage is displayed, Intentional rounding, Patient wearing glasses. The patient and or carers have been given the falls prevention leaflet.
Documentation / Ask the RN to explain or demonstrate the completion of the daily falls evaluation.
Documents appropriately and legibly on more than one occasion.
Equipment / The RN should be able to list the following falls prevention equipment: Low care bed on the lowest setting, Mobility/ walking aids, OT assessed equipment (perching stools etc.), Nurse call bell to hand and patients know how to use it, Bed and chair alarm cushions (If appropriate to your individual area),Brakes on bed/equipment.
Post Fall / The RN should be aware of the need to inform the patient’s relatives, providing information of any injuries sustained and steps taken to reduce re-occurrence.
The RN should be aware that an IR1 is to be completed straight away, a post fall proforma completed and the incident documented in the nursing notes.
The RN can explain that the following should take place: Lying/standing BP, Capillary Blood Glucose & Urinalysis (if appropriate). The patient should also have a medication review, an ECG (if appropriate) and bloods taken.

F:\Falls\Competencies\RN Falls Prevention Assessors Guide.doc