Community Falls Risk Assessment & Plan- 0245-ASS-DCHSVersion No 1Version Date 24/1/17Review Date 24/1/19

Surname: …………………………………………………..

Forename(s): ……………………………………………………

Date of Birth: _ _ _ _ _ _ _ _ NHS No _ _ _ _ _ _ _ _ _ _

Team/Service/Locality

COMMUNITY FALLS RISK ASSESSMENT AND PLANRisk Factor Yes No

1 History of FallsRecord how many falls in the last 12 months? ………………..Do ANY of the following apply to the patient during the past 12 months?

Suffered a fragility fracture (a fragility fracture is defined as a fracture following a fall from standing height or less)

Attended A&E or admitted to hospital as a result of a fall Seen by emergency paramedic but not taken to hospital following a fall

Suggested Actions: If patient consents a referral should be made to local Single Point of Access/Integrated Care Team where the referral can be triaged.2 Post Fall Coping Strategy

Does the patient have a method of summoning help should a fall occur at home e.g. mobile to hand or pendant alarm?

Is the patient able to get up from the floor independently?Suggested Actions:

- Give advice on pendant alarms from local authority/Age UK and/or mobile phone- Discuss coping strategies to get up from floor e.g. use of furniture to safely stand or advice to summon

help, make self, comfortable and warm.3 Medication

Is the patient prescribed at risk medications related to falls e.g. anti-depressants, sedatives, opioid pain relief, diuretics?

Does the patient report any side effects due to medication taken? E.g. light-headedness, drowsiness

Is the patient concordant with medications prescribed e.g. pain relief?Suggested Actions

- Check that the patient has had a medication review in the last 6 months. Refer for medication review if indicated in relation to falls and fracture risk.

- Check lying/standing blood pressure measurement- Consider the impact of non-concordance on falls risk. Review with prescriber and advise accordingly.

4 Footwear/Footcare Check the condition of the patient’s foot and nails Does the patient have any concerns maintaining their foot health? Are there any observable or reported signs of pain and possible causes? Is the person wearing appropriate footwear?

Suggested Actions- Advise on routine foot care. Refer to podiatry for specific foot health/foot pain concerns- Ensure suitable footwear available and worn.

5 Continence / Hydration Does the patient have any difficulties regarding urinary urgency? Consider

day and night Is a Urinary Tract Infection suspected? Does the patient drink less than 5 cups of fluid a day?

Suggested Actions- Consider referral to continence service for assessment if not known. Consider additional

equipment/location of toilet- Check of clinical signs & symptoms of infection. If suspected, MSU sample required to confirm. If

patient unwell, consider treatment whilst waiting for sample result.- If appropriate, encourage 6-8 cups of fluid per day & review reasons for poor fluid intake

6 Vision/Hearing Impairment

Does the patient have any difficulties with blurring or misjudging distances?

Is the patient wearing clean & correct glasses? Has the patient had their eyesight/health checked in the last 2 years? Is the patient wearing their hearing aid and is working correctly? Does the patient have difficulty with excess ear wax and/or a feeling of

imbalance?Suggested Actions

- Advise caution in new situations, poor lighting, and uneven surfaces.- Advise free eye tests available every two years for 60-69 and yearly for 70 and over.- Ensure appropriate eyewear worn and suitable- If hearing aid not working or hearing assessment advised, refer to audiology (via GP or care co-

ordinator if new problem)- Discuss management of excess ear wax e.g. drops if symptoms persist, refer to GP/nurse

7 Movement / Reduced Confidence Observe balance in standing and when moving for signs of unsteadiness,

muscle weakness and/or reduced confidence Is the patient fearful of further falls/injury? Are they reluctant to continue with activities in the home/go out in the

community due to fear of falling? Does the patient have any difficulties mobilising or with daily function

related to pain? If a walking aid is used, is it safe and appropriate? (height, ferrules,

technique)Suggested Actions

- Consider referral to local Single Point of Access/ Integrated Care team, suitability for strength and balance programme. Advise about safe movement.

- Walking aid – offer replacement or new provision as indicated and advice regarding safe technique and use.

8 Environment Does the patient have difficulties with any of the following: -- Access in/out of the property e.g. door thresholds/steps- Using the stairs in their home- Completing daily activities e.g. bathing Are there possible trip hazards around their home?

Suggested Actions- Consider referral to local SPA/Integrated Care Team for equipment provision/therapy input.- Advise safe movement and minimise potential hazards

Signature/Print Name

Date/Time completed

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FALLS PREVENTION & MANAGEMENT PLAN

PLANConsent: Does the person demonstrate an understanding of the problem / need? Yes □ No □Does the person demonstrate an understanding (capacity) & agreement (consent) of the goals and plan? Yes □ No □If no to either of the above, document reason(s) and action(s) taken (Including Mental Capacity Assessment):

Date/time Identified Falls Risks Initial

Date/time

GoalNo

Longer Term Interventions Agreed With Patient Initial Achieved Date

Date/time

Goal No Short Term Interventions agreed with patient Initial Date Goal

AchievedInitial

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