Last reviewed 30 October 2018
According to the Health and Safety Executive (HSE), accidents in the healthcare sector involving slips and trips resulting in falls are responsible for nearly half of all reported injuries. Such injuries can be serious. Some can even be fatal. Managers in general practice settings must ensure that they are controlling the risks of slips and trips as effectively as possible. In such settings, the risks not only affect staff but can also be a significant hazard for patients and visitors. Martin Hodgson, a writer in health and safety, lists the 10 most effective actions managers can take.
1. Complete a risk assessment
As a starting point, practice managers should ensure that a suitable and sufficient risk assessment is completed which identifies any slip and trip hazards, and determines who might be at risk. The assessment should be supported by the implementation of suitable prevention and control measures which seek to eliminate the hazards completely, wherever possible, or reduce them to a minimum if not.
Risk assessments should cover all areas of a practice premises. They should include outdoor and indoor areas, and pay particular attention to thoroughfares such as pathways, pavements, steps, stairways, corridors or doorways.
Assessments should be recorded and regularly reviewed to ensure that precautions remain adequate to deal with the risks, especially if any significant changes to the premises take place. They should always take into consideration staff, patients or visitors with particular mobility or visual needs.
2. Make sure the most common hazards are covered
The most common slip and trip hazards in a primary care setting will probably include:
slippery or wet floors, eg after a floor has been washed, if water is spilt in the toilets or in a treatment room, rain water around entrances, etc
spillages that are not cleaned up immediately, eg spills of drinks, blood, medicines, urine, etc
worn areas of floor, or raised edges of carpets or floor tiles
loose rugs or mats
clutter and items left on the floor
trailing wires, cables and power leads (including temporary plugged-in devices)
low-level open drawers, or protruding or obstructing furniture
variable floor levels, slopes and steps, especially if they are not obvious
external paths, drives and steps which may become slippery in icy or wet weather or with falls of leaves.
The use of a suitable checklist can often aid identification. Find the template on Slips, Trips and Falls Risk Assessment Checklist here.
3. Attend to any maintenance and improvements
A well-maintained premises is safer than a poorly maintained one. To reduce the risks of trip hazards, managers should ensure that a planned preventive maintenance programme is in place. This should be linked to regular risk assessment inspections and an effective system of defect reporting.
The programme should ensure that:
all floor surfaces have flat and even surfaces
edges or variations in floor height, such as step and stair edges, are clearly marked
worn or frayed carpets and raised carpet edges are identified and repaired or replaced
lighting levels are adequate to enable people to see obstructions and potentially uneven areas
lights are replaced, repaired or cleaned whenever light levels become too low
protruding or obstructing items of furniture or equipment, especially at low level, are removed.
Both internal and external steps require special attention. Steps should have high-visibility, non-slip, square nosings on their edges. They should be of equal height and width, and, where necessary, a suitable handrail should be fitted.
Entry and exit points to buildings should be of an appropriate design. Good quality doormats should be used with doorways protected from the weather and the ingress of rain.
Outside footpaths should be maintained in good condition with potholes and cracks filled, and raised edges flattened. In winter, there should be procedures in place for de-icing. A suitable stock of grit or rock salt should be obtained in the autumn ready for colder weather.
Staff should be encouraged to report defects and hazards immediately when they notice them. Repairs or remedial work should be prioritised according to the risk presented.
4. Wherever practicable install non-slip floors in higher risk areas
Higher risk areas might include toilets, kitchens and treatment rooms where spillages are more likely to occur. In these areas, it may be advisable to fit non-slip floor surfaces wherever possible. These are generally “rougher” than normal floors and allow better grip.
The selection and fitting of suitable floor surfaces can be complex and will vary from building to building. Advice should be obtained from an expert flooring contractor with experience in healthcare facilities.
5. Keep floors free of contamination and spillages
People rarely slip on a clean dry floor. Most floors are not inherently slippery and only become so once they become contaminated with substances such as water, oil, grease, detergent, body fluids, dust, etc.
Reducing or eliminating the potential for contamination will greatly reduce the risk of slip accidents occurring.
All spillages can cause a slip, no matter how small. It is essential that they are cleaned up as soon as possible. Body fluid spills also constitute an infection control risk and should be covered by suitable policies and procedures.
6. Keep the practice tidy
Good housekeeping procedures should be implemented to prevent objects being left on the floor where they can cause trips. Low-level drawers should be kept closed and toys, provided to amuse children in waiting rooms, packed away when not in use.
Electrical leads can be a particular trip problem, especially for staff in office areas where having a lot of electrical equipment is now the norm. Such areas should be well designed with an adequate number of fixed electrical sockets to ensure that trailing leads and cables can be tidied away wherever possible.
7. Provide support for people with limited mobility
Patients and staff with mobility needs should be given appropriate support. The practice should comply with the guidelines and best practices on disabled access.
8. Make sure risks associated with cleaning are controlled
Cleaning is an essential activity in a general practice. Not only is cleaning vital in keeping a practice looking presentable, it is also a key element in controlling infection. However, cleaning can also be a cause of slip and trip accidents if it is not conducted safely.
In relation to cleaning activities within the practice, managers should ensure that:
all staff are aware of the potential for slips on wet, polished or soapy surfaces
cleaning methods and equipment used are suitable for the type of surface being cleaned
main thoroughfares are not “wet mopped” at times when they are in use or likely to be busy with people passing through — it is safest for such activities, where necessary, to be reserved for times when the building is closed
set procedures are in place and all cleaning staff are trained in the correct use of any safety equipment, eg placing “Wet Floor” warning signs, or excluding staff from areas where floor cleaning is being conducted.
Cleaning activities involving portable electrical equipment, such as vacuums, should be planned to minimise the danger of trailing wires, ie cleaning staff should always use the nearest socket available.
9. Report accidents and incidents
Staff should be encouraged to report any slip or trip accidents whether they result in injury or not. This includes “near misses” which would have caused an accident but for chance.
Managers should take all incident reports seriously and investigate the causes, taking appropriate remedial action to prevent any recurrence. Reports should be regularly reviewed to identify trends or training needs.
10. Put appropriate policies and procedures in place, and train and inform staff
All primary care settings should have a policy on slips and trips which is agreed with workforce representatives. Find a template model policy on slips, trips and falls here.
Any work to identify and control hazards should be planned with staff who should be trained and made aware of the dangers. New staff should be introduced to the key points of relevant policies and procedures during induction. Key safety information should also be provided to any temporary staff.
Training can make use of resources provided by the HSE. This includes materials which form part of the HSE Shattered Lives campaign which seeks to reduce the number of accidents by raising awareness and improving the management of risks.