Slips, trips and falls are the most common causes of workplace injury in the UK, accounting for over a third of all major injuries reported each year. In the care sector, the dangers of such accidents are not only a risk to staff and volunteers but also a significant hazard to vulnerable service users.
Care home managers must ensure that they are controlling the risks as effectively as possible. Here are 9 key measures they can take.
1. Include slips, trips and falls in risk assessments
Care home managers must ensure that their health and safety risk assessments include slips, trips and falls hazards.
They should walk around the home and:
look out for hazards such as poor lighting, wet or uneven floors, trailing cables and frayed carpets
decide who might be harmed and how
review current controls and decide whether they are adequate
formulate a plan to get something done about the hazards wherever risks are significant
record and regularly review assessments.
Risk assessments should cover both outdoor and indoor areas and pay particular attention to thoroughfares such as pathways, pavements, steps, stairways and corridors.
Assessments in a residential care setting should always take into consideration frail or infirm service users with limited mobility or a history of falls.
2. Keep an eye out for typical hazards
Managers should look out for the following common hazards.
floors that are inherently “slippery”
wet floors, eg after a floor has been washed, if water is spilt in the kitchen or in the bathroom after someone has taken a bath or a shower
spillages that are not cleaned up immediately, eg spills of drinks, food, medicines, urine, etc
loose rugs and mats on shiny or slippery floor surfaces
contaminated floor surfaces.
trailing wires, cables and power leads (including temporary plugged-in devices)
worn areas, or raised edges, of carpets, mats and rugs
items and objects left on the floor
protruding or obstructing furniture and low-level open drawers or doors
worn, loose or poorly fitted footwear (particularly slippers) or untied shoelaces
variable floor levels and slopes
worn or unsafe steps
uneven or broken floor or ground surfaces
external paths, drives and steps which may become slippery in icy or wet weather
people with impaired balance or mobility, eg elderly and infirm people.
3. Encourage staff to be alert for slip and trip hazards and to report them
Care home managers should involve staff in the process of identifying slip or trip hazards. All staff should be trained to be aware of the dangers and to report any problems.
Slip and trip hazards do not need to wait until a formal risk assessment to be identified. They should be reported whenever they are spotted and managers should take appropriate action.
4. Reduce risks by making simple changes around the home
There are many things that a care home can do to eliminate slip and trip hazards and reduce the risks of falls.
To reduce the risks of people slipping care home managers should:
fit “non-slip” floor surfaces wherever necessary, such as in kitchens, toilets, sluices and bathrooms
fit handrails in bathrooms and toilets as required
put in place procedures for cleaning up spillages quickly and efficiently — including water left on the floor after baths
limit access to areas where floors are wet after cleaning
generally avoid the use of loose rugs and mats
put procedures in place for ensuring that the footwear of residents and staff do not add to slip and trip risks
de-ice external footpaths when necessary and remove slippery leaves and mud
fit good quality doormats at entrances and exits to prevent rain being tracked into the home.
To reduce the risks of trips managers should:
ensure that all activities involving portable electrical equipment are planned to minimise trailing wires, ie staff should always use the nearest socket available
provide an adequate number of sockets in areas where electrical equipment is situated and ensure that cables are routed so that they do not present a trip hazard
repair or replace worn or frayed carpets
implement housekeeping procedures to prevent objects being left on the floor, especially in busy communal areas
remove or modify protruding or obstructing items of low-level furniture or equipment
ensure that edges or variations in floor height, such as step and stair edges, are clearly marked.
Managers should take additional actions such as:
fitting secure and obvious hand rails and grab rails in bathrooms and toilets
ensuring that lighting levels are adequate to enable people to see obstructions and potentially slippery or uneven areas
putting in place a planned preventive maintenance programme linked to regular risk assessment inspections.
Maintenance systems should be designed to ensure that a flat, even walking surface is provided throughout the home, wherever possible. Steps and stairways must be properly looked after and lights should be replaced, repaired or cleaned whenever poor lighting levels are identified as a hazard. Footpaths and patio areas outside the home should be maintained in good condition with potholes and cracks filled in.
5. Prevent floor contamination
People rarely slip on a clean dry floor. Most floors are not inherently slippery and only become slippery once they become contaminated. Contamination is classed as anything that ends up on a floor and increases the risks of a slip. Examples include water, oil, grease, detergent and dust, etc. Reducing or eliminating the potential for contamination will greatly reduce the risk of slip accidents occurring. This is especially important in areas such as kitchens where effective cleaning should keep floors clear of grease and oil residue.
6. Double check that steps are safe
Steps require special attention as they are often an accident blackspot. Steps should be of equal height and width and a suitable handrail should be fitted. They should have high-visibility, non-slip, square edges. Adequate lighting should be provided and applicable building regulations followed.
7. Address cleaning hazards
Floor cleaning is a significant cause of slip and trip accidents, both to cleaning staff and others. For example, floors left damp by a mop are likely to be slippery until they dry out. Trailing wires from a vacuum or buffing machine can present a trip hazard.
Care home managers should ensure that:
cleaning methods are suitable for the type of surface being treated
main thoroughfares are not routinely “wet mopped” at times when they are likely to be busy with people passing through – where appropriate safer methods should be used, such as dry mopping
all spillages are cleaned up as soon as possible by “spot” cleaning.
Cleaning staff should be trained in the correct use of any safety equipment, eg placing “Wet Floor” warning signs whenever floors are wet or excluding other staff or service users from areas where floor cleaning is being conducted.
8. Include falls prevention in service user needs assessments and care plans as appropriate
In a care home setting, slips, trips and falls not only affect staff but also service users, particularly those who are elderly or infirm or have impaired vision or mobility. For vulnerable residents even a relatively minor fall can cause serious fractures and trauma, especially for those with conditions such as osteoporosis.
All care homes should have in place a falls prevention strategy. Residents should be assessed for risk in this area and appropriate support mechanisms put into place.
To help to reduce the risk of falls care home managers should put in place a range of measures.
providing falls prevention advice and support for those with identified risk (including those with osteoporosis) including awareness of the risk factors and ways to prevent falls
appropriate systems for summoning help in case of a fall, for example, emergency call systems and alarms in bathrooms and bedrooms
beds and chairs to be appropriate to individual needs and in good repair
using non-slip mats in baths or showers where indicated in a needs assessment
physiotherapist and occupational therapist support where required to implement treatment and prevention strategies
staffing levels to be sufficient to allow supervision of service users at risk at all times
staff, service users and carers to be aware of medication side effects related to falls (some drugs can disturb balance and mobility)
provision of an adequate, nutritious diet (poor diet is related to light-headedness, poor concentration, osteoporosis and poor balance)
secure window locks and opening limiters fitted where indicated in needs assessments to prevent falls from height through open windows.
For elderly service users who have had a fall in the past, or who are actively recovering from a fall, care workers have an important rehabilitative role in helping them to exercise safely and get on their feet again.
9. Access national campaigns and resources to raise staff awareness
Care home staff should be trained to be aware of the risks of slips, trips and falls. To support training it may be useful to include material from national campaigns such as those run by the Health & Safety Executive.
The HSE Shattered Lives campaign is a good example.
The website is available at www.hse.gov.uk
The site includes a link to a slips and trips e-learning package (STEP). The package provides an introduction to slips and trips, how they are caused, why preventing them is important and how to tackle them.
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