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Unwitnessed incidents in care homes
- 1. RESPONDING TO INCIDENTS - RECOGNISING WHEN AN INCIDENT IS A SAFEGUARDING CONCERN - WHAT TO INCLUDE IN REPORTS - GOOD PRACTICE GUIDANCE
- 2. WHAT IS SAFEGUARDING? - What does safeguarding mean? - What would trigger you to make a safeguarding referral?
- 3. SIX PRINCIPLES OF ADULT SAFEGUARDING Empowerment – Encouraged to make own decision and informed consent. What does the person want thee outcome to be? Prevention – Be proactive better to action before harm occurs Proportionally – The least intrusive response Protection – Support an representation for those who greatest need Partnership – Offering local solutions , working with community's Accountability – Being transparent
- 4. UNWITNESSED INCIDENT AND UNEXPLAINED INJURIES • Scenario, • Fred lives in care home. He has a diagnosis of dementia and spends a lot of his day walking with purpose. Due to the dementia, he has a poor short-term memory. He has regular medication, zopiclone , carbamazepine and furosemide. Fred had been watching television in the lounge with two other residents and then took myself off to be around 22:30. Whilst night staff did their first observation check at 23:00 he was found on the floor in his bedroom. • What might have happened?
- 5. COMPLETING INCIDENTS FORMS Can the person tell us what happened, do they have capacity to do so. Background What risk factors have been considered? (Medical history, environmental, risk from others, mobility equipment) Was the care plan being followed, if not why not.
- 6. MAKING A SAFEGUARDING REFERRAL Making a decision to refer – who decides Which incidents do you report and which once do you not report? What further info should be provided
- 7. NEGLECT 1:1 went to toilet, individual found on floor. Sleeping medication administered before person was in bed and fall walking to bed. Equipment not used properly as a consequence a laceration to leg. A person pushes sensor floor mat out of the way, no alternative risk management. No seizure sensor in place for a person with epilepsy who has no waking night staff. Grade 1 pressure sore. Call bell not in reach. No staff in lounge resident found on floor, uses mobility aid. A person at high risk of falls has no Risk Assessment in place and falls, no injury.
- 8. GOOD PRACTICE GUIDANCE • Assessment and recorded • Nutrition and hydration • Independence • Workforce • Referrals to specialist professionals • Safe systems • Appropriate equipment • Environment / footwear
Editor's Notes
- Safeguarding adults is about the safety and well being of all residents but providing additional measures for them to be protected from harm or abuse. What is your perception- learning opportunity, supportive measure, opportunity for development, collaborating to improve the welling of individuals. Working collaboratively, sharing ideas managing risk together. Ensuring risk management is effective What triggers the duty to make SG enquiries? Care and support need, risk of or experiencing abuse, due to needs they are unable to protect themselves.
- Purpose of the enquiry is to But, what if it wasn’t a fall? It’s important to remember that when dealing with these incidents, the key piece of information is that the incident was unwitnessed. So we actually don’t know how the person ended up on the floor, or how the bruise occurred etc.
- Background – The person needs and diagnosis's -other professionals involvement and outcomes Medical history – hydration, epilepsy, medication, timing of meds compliant etc Environmental – shoes, lighting, Risk from others What if the person who was found on the floor was actually pushed? Pushed by a staff member? Pushed by another resident? Did the last staff member that supported them not provide them with the mobility equipment they needed, and so ended up falling? Was there something hazardous in the immediate environment that had been neglected to be removed by care workers? Mobility equipment – frame not being left within reach, Tends to forgot walking equipment Due to the fact that these unwitnessed incidents are often referred to as ‘unwitnessed falls’, this assumption will have been made as the person has been found on the floor. This language leads us to naturally think about falls risk management e.g. scrutinise the action that was taken to manage the fall etc. If it was felt this was appropriate, we are unlikely to take any further action. But, what if it wasn’t a fall? It’s important to remember that when dealing with these incidents, the key piece of information is that the incident was unwitnessed. So we actually don’t know how the person ended up on the floor, or how the bruise occurred etc. Based on the context, we are likely to make assumptions about what has occurred, and then looking to prove this with the information we request – optimism bias, group think and confirmation bias. What if the person who was found on the floor was actually pushed?
- You should report any incidents which were not witnessed or are unexplained, where the individual lack capacity to report what happened or where there are concerns that incident may have been caused by abuse or neglect EG. Found on the floor, found unresponsive, taken to hospital due to unknown reason, unexplained bruise or cut, Reporting process – who signs off incident reports / who's the decision maker? Could this lead to a time delay? Trends and Themes? – repetitive falling.
- Consider this – a resident with capacity knocks on your door and tells you a resident has pushed them to the floor – would you report this ? If you found someone on the floor but unable to express how they got there – would you report this? Who's is more vulnerable and at risk the person who can communicate or the other person ? When looking at each statement which ones do you consider to be reportable.
- To consider a fall is the result of neglect, it is necessary to establish that everything practicable was done to reduce the risk of the person falling. Whilst not an exhaustive list, the following should be take n into account: Assessment and recorded -adequately detailed falls risk assessment, including a falls screening tool, been undertaken? Has there been a reassessment of the adult’s risk factors after each fall, and control measures updated? Nutrition and hydration -Is there evidence of good nutritional care, for example is the client well-nourished and hydrated? do they have a fluid chart? Independence -adult’s support plan reflect the support needed Workforce- enough staff to support the needs of the client group? Are staff trained to ensure they are competent in moving and handling Referrals to Specialist professionals -evidence that referrals have been made to appropriate health care professionals once a risk has been identified, such as GP, CMHN, eye specialist, Falls Clinic and Falls Management Team? Recommendations followed Safe systems -clear guidance for staff to follow once an adult has fallen, including: Immediate action including examination, signs to look for, whether to move the client if injury is suspected. Who to contact (such as GP, emergency services and so on) and when. Follow-up action – reporting, recording, supervision and monitoring and reviewing of an adult. Appropriate equipment - Have appropriate equipment and aids to help prevent falls been provided once a risk has been identified? Is equipment in good repair? Is there appropriate equipment and training to assist staff to safely lift an adult from the floor following a fall? Environment / footwear -lead to falls such as uneven, and worn flooring / ground, changes in level, types floor covering, lack of appropriate safety measures around stairs, poorly lit areas, trailing wires? Is the adult wearing poorly fitting or inappropriate footwear