Falls Prevention in Care Homes: A Practical Guide for Care Staff
Falls are an important safety concern in residential and nursing care. For an older person, a fall can result in injury, pain, reduced confidence and a loss of independence. Even when a fall does not cause a serious physical injury, the fear of falling again can affect someone’s willingness to move around and participate in everyday activities. Preventing falls, however, does not mean preventing people from moving. High-quality falls prevention is about understanding each person’s individual circumstances, recognising factors that may increase their likelihood of falling and taking proportionate steps to support them to remain as safe, active and independent as possible. Care workers have an important role in this process. Because staff often spend considerable time with residents, they may be among the first to notice changes in mobility, behaviour, confidence, health or the environment that could contribute to a fall. This guide explores practical ways care staff can contribute to falls prevention while maintaining dignity, choice and person-centred care. Why Are Falls Important in Care Homes? Many people living in residential and nursing care have complex health and support needs. Some residents may be living with: Medicines, environmental factors and changes in a person’s health may also contribute to falls. The important point is that falls rarely have one simple cause. Effective falls prevention therefore requires staff and relevant healthcare professionals to consider the whole person, rather than concentrating on a single risk factor. Falls Prevention Should Be Person-Centred Every resident is different. One person may require significant mobility support, while another may walk independently but become less steady when tired. Someone else may have excellent mobility but experience dizziness after standing. Falls prevention should therefore be based on individual needs rather than applying the same restrictions to everyone. This closely reflects the principles discussed in our guide to person-centred care. Staff should consider: The aim should be to support the person’s life, not simply manage a risk. Do Not Assume That Preventing Movement Prevents Falls Following a fall, there can be a natural temptation to become extremely cautious. Staff or relatives may feel that someone should remain seated or ask for assistance every time they want to move. Sometimes additional support will be appropriate. However, unnecessary restriction can have unintended consequences. Reduced activity can contribute to loss of: Residents should therefore be supported to remain appropriately active according to their individual abilities, care plan and professional recommendations. Falls prevention and independence should work together. Recognise Changes in Mobility Care workers often know residents’ normal abilities extremely well. This means they may notice subtle changes before anyone else. For example: “Mrs Williams normally walks confidently to the dining room, but today she is holding onto the furniture.” That observation matters. Changes might include: Staff should report significant changes according to organisational procedures so that the person’s needs can be reviewed appropriately. Keep the Environment Safe Environmental hazards can contribute to slips, trips and falls. Staff should remain alert to potential problems such as: A hazard should not simply be ignored because dealing with it technically belongs to another department. Our guide to duty of care in health and social care explains why recognising and responding appropriately to foreseeable risks forms an important part of professional care practice. Consider Lighting and Visibility Good visibility can make a significant difference to someone’s ability to move around confidently. Care environments should consider lighting in: Night-time arrangements can be particularly important when residents need to use the toilet. Staff should also be aware that an individual’s eyesight may change over time. If a resident appears to have difficulty seeing objects, judging distances or navigating familiar areas, this should be communicated appropriately. Footwear and Foot Condition Matter Poorly fitting or unsuitable footwear can affect stability. Care staff should be observant where footwear appears: Residents’ personal preferences remain important, but concerns should be communicated and addressed appropriately. Foot discomfort or changes in foot condition may also affect how someone walks and should not simply be ignored. Mobility Equipment Must Be Used Correctly Some residents use mobility aids such as: Equipment should be suitable for the individual and used according to the relevant assessment, care plan, training and instructions. Care staff should not improvise with equipment or alter someone’s mobility arrangements simply because another approach appears quicker. If equipment seems damaged, unsuitable or no longer appropriate, staff should report the concern. Our guide to Moving and Handling in Care Homes provides further information about safe staff practice when supporting people’s movement. Nutrition and Hydration Can Be Relevant Falls prevention is not limited to walking and environmental hazards. A person’s wider health and wellbeing can influence their stability. NICE includes diet, fluid intake and weight loss among the factors that may need consideration within a comprehensive falls assessment. Care workers should therefore remain alert to changes such as: Staff should record and report concerns according to the person’s care plan and organisational procedures. Our guides to nutrition and hydration in care homes and preventing dehydration in care homes provide further practical information. Medicines Can Contribute to Falls Risk Some medicines can contribute to factors associated with falling. For example, a medicine might be associated with effects such as dizziness, drowsiness or changes in blood pressure. This does not mean care workers should decide to stop or change someone’s medicine. Medication decisions should be made by appropriately qualified professionals. However, care workers can play an important observational role. If a resident becomes noticeably more drowsy, dizzy or unsteady — particularly following a medication change — staff should record and report the concern appropriately. Medication review forms part of comprehensive falls management in residential care. Our Medication Awareness in Care Homes guide provides further information about the role care staff can play in supporting safer medication practices. Dementia and Falls Prevention People living with dementia may experience additional factors that affect their safety. These can include changes in: However, dementia should never automatically be used as a reason to remove someone’s independence. Staff should understand the individual
Reducing Medication Errors in Care Homes: Practical Steps for Safer Care
Medication plays an important role in supporting the health, comfort and wellbeing of many people living in care homes. With some residents taking several different medicines at different times of the day, safe medicines management requires careful organisation, clear communication and appropriately trained and competent staff. Medication errors can happen for many reasons. A dose may be missed, information may be recorded incorrectly, communication may break down during a handover, or staff may be interrupted while carrying out medication-related duties. Reducing medication errors is therefore not simply about telling individual staff members to be more careful. Care providers need effective systems, clear procedures, appropriate training and a positive culture where concerns and mistakes can be reported, reviewed and used as opportunities for learning. This guide explores practical ways care homes can strengthen medication safety and help protect the people they support. What Is a Medication Error? A medication error is a preventable incident involving medicines that may result in inappropriate medicine use or potential harm. Within a care environment, an error could involve: Not every medication error results in harm, but every error or near miss should be taken seriously because it may reveal an opportunity to make systems safer. Developing strong medication awareness across the workforce can help staff understand these risks and recognise their own responsibilities. Why Can Medication Errors Happen in Care Homes? Medication management can involve several people and organisations, including care staff, managers, GPs, pharmacies, nurses and other healthcare professionals. Safe systems therefore depend on effective communication and accurate information. Factors that can contribute to errors may include: Rather than automatically assuming an error occurred because one person was careless, providers should consider the circumstances surrounding an incident and whether changes could make the overall system safer. 1. Ensure Staff Understand Their Responsibilities Not every care worker will have the same responsibilities for medication. Care providers should clearly establish which employees are authorised and competent to perform particular medication-related tasks. Staff should understand: Medication awareness is valuable across the wider workforce, even when individual employees do not administer medicines. Knowing the limits of one’s role is itself an important part of safe practice. 2. Provide Appropriate Training and Assess Competence Training should reflect an employee’s role and responsibilities. Where staff are responsible for administering or supporting people with medicines, providers should ensure they have received appropriate training and have been assessed as competent before undertaking those duties independently. Training should not be viewed as a one-off event. Knowledge can fade, procedures change and employees may encounter situations they have not previously experienced. Regular refresher training can therefore form part of a wider programme of supervision, competency assessment and continuing professional development. Managers should also distinguish between completing a training course and demonstrating practical competence. A certificate provides evidence of learning, but providers must still satisfy themselves that staff can apply relevant knowledge safely within their role. 3. Reduce Interruptions and Distractions Medication-related tasks require concentration. Unnecessary interruptions during a medication round can increase cognitive workload and make it more difficult for staff to maintain a consistent process. Care providers should consider how medication rounds are organised and whether avoidable distractions can be reduced. This might include: The objective should never be to rush medication administration simply to meet a timetable. A calm, organised environment supports safer practice. 4. Maintain Accurate Medication Records Accurate record keeping is fundamental to medicines management. Medication Administration Records (MARs), whether paper-based or electronic, provide important information about prescribed medicines and their administration. Records should be completed according to organisational procedures and should provide an accurate account of what has occurred. Poor documentation can create uncertainty for the next person supporting the resident and may increase the possibility of a missed or duplicated dose. Staff should therefore understand the importance of: Good records support continuity, accountability and safer decision-making. 5. Strengthen Staff Handovers A change of shift is a particularly important point for communication. Medication-related information can be lost if handovers are rushed, incomplete or dependent on memory. Relevant information might include: Written records remain essential, but effective verbal communication can provide valuable context. A structured handover process can help ensure important information reaches the right people. 6. Respond Appropriately When a Resident Refuses Medication People receiving care should be treated with dignity and respect, and medication should not simply be forced upon someone because it has been prescribed. If a resident refuses medication, staff should follow the care home’s medicines policy and relevant care plan, record the refusal correctly and seek appropriate advice where necessary. Issues concerning a person’s ability to make a particular decision may also involve the principles of the Mental Capacity Act. Our guide to Mental Capacity Act and DoLS awareness explains why understanding capacity, choice and individual rights is so important within adult social care. Staff should never automatically assume that a diagnosis, disability or age means someone lacks capacity. 7. Recognise and Report Possible Adverse Effects Care workers often spend considerable time with residents and may notice changes that others do not immediately see. Changes could include: Care staff should not attempt to diagnose the cause themselves unless this falls within their professional role. Instead, concerns should be reported promptly through the appropriate channels so that a suitable healthcare professional can assess the situation. Observations should also be recorded according to organisational procedures. 8. Store Medicines Safely Safe medication management extends beyond administration. Medicines should be stored according to relevant requirements, manufacturers’ instructions and organisational policies. Depending on the medicine, this may involve specific requirements relating to: Storage arrangements should help prevent unauthorised access while ensuring medicines remain suitable for use. Regular checks can help identify expired medicines, storage problems or discrepancies before they create unnecessary risk. 9. Encourage Accurate and Open Reporting Staff should know exactly what to do if they make or discover a medication error. Trying to hide an error can increase the risk of harm because appropriate action may be delayed. A positive safety culture encourages staff to report incidents