Standard 4: Environment and Accessibility

Why it matters. A patient who is unsteady and walks along a corridor can fall where there is nothing to hold. Continuous handrails on both sides let them hold on for the whole route.

Sample. Walk 3 patient routes (ward corridor, stair or ramp, and route to the toilet) with the survey form on the day of assessment.

1. Handrails are fitted continuously on both sides of each corridor, stair and ramp.

Method. Walk each route and check both sides.

Evidence to show. Environmental falls-risk survey (ACS-FRM-001).

Pass when. Every route has continuous handrails on both sides.

2. The handrails are fixed and sturdy.

Method. Pull each handrail at three points on the walk.

Evidence to show. Survey record.

Pass when. No handrail moves under load.

3. Each quarterly survey is recorded.

Method. Check the survey dates for the last 12 months.

Evidence to show. Survey records.

Pass when. All four quarters are recorded, with findings closed.

Immediate fail (any one means the criterion is not met)

• A route used by patients has no handrail on one side, with no marking or action.

Why it matters. Toilet transfers are one of the most common moments of falls in care. Grab bars in the right place and fixed firmly give the patient something to hold.

Sample. Check 5 toilets and washrooms, including at least one accessible cubicle, on the day of assessment.

1. Grab bars are placed for toilet transfer.

Method. Check each toilet for horizontal and vertical bars.

Evidence to show. Toilet and washroom check (ACS-FRM-002).

Pass when. Every toilet checked has grab bars placed for transfer.

2. Grab bars are fixed and do not turn in their fittings.

Method. Apply force to each bar on the walk.

Evidence to show. Toilet and washroom check.

Pass when. No bar turns under load.

3. Defects are reported and fixed.

Method. Check the defect record for the last 12 months.

Evidence to show. Defect record.

Pass when. Every defect is fixed within the set time.

Immediate fail (any one means the criterion is not met)

• A grab bar turns in its fitting and is still used by patients.

Why it matters. A patient who uses a wheelchair cannot use a toilet that is too small to turn in or has no bars to transfer with. At least one accessible toilet is needed for those patients to use the facility at all.

Sample. Check 5 toilets and washrooms, including at least one accessible cubicle, on the day of assessment.

1. At least one toilet is accessible for a wheelchair user.

Method. Measure the floor space and check the transfer bars.

Evidence to show. Accessibility check (ENV-FRM-001 and ACS-FRM-002).

Pass when. At least one accessible toilet is present, with the space and bars the guidance sets.

2. The accessible toilet is signed and reachable.

Method. Walk from the main route to the toilet.

Evidence to show. Walk record.

Pass when. The route is clear and signed.

3. The design meets recognised guidance.

Method. Compare the measurements with the guidance.

Evidence to show. Design check record.

Pass when. Measurements meet the guidance used.

Immediate fail (any one means the criterion is not met)

• No toilet in the facility can be used by a wheelchair user.

Why it matters. A patient who falls behind a toilet door that opens inward may not be found in time. A door that opens outward, or that can be released from outside, lets staff reach the patient in an emergency.

Sample. Check 5 toilets and washrooms, including at least one accessible cubicle, on the day of assessment.

1. Toilet and washroom doors open outward, or release from outside.

Method. Open and release each door from outside on the walk.

Evidence to show. Toilet and washroom check (ACS-FRM-002).

Pass when. Every door opens outward or releases from outside.

2. The release works in an emergency.

Method. Test the release from outside with a staff member.

Evidence to show. Test record.

Pass when. Each release works when tested.

3. Staff know how to release a door.

Method. Ask 3 staff to show the release.

Evidence to show. Staff check record.

Pass when. At least 2 of 3 staff show it correctly.

Immediate fail (any one means the criterion is not met)

• A patient who has fallen behind a toilet door cannot be reached from outside.

Why it matters. Patients get up at night and move in poor light. A dark corridor or toilet is where a fall is most likely. Adequate light, and night lighting, make the route safe at all hours.

Sample. Walk 3 patient routes (ward corridor, stair or ramp, and route to the toilet) with the survey form on the day of assessment.

1. Corridors, stairs, toilets, washrooms and rooms are lit at a safe level.

Method. Measure the light level at each point on the walk.

Evidence to show. Lighting check on the survey.

Pass when. Every area on the route meets the set level.

2. Night lighting or motion lighting is on the routes patients walk at night.

Method. Check the night route after dark.

Evidence to show. Night check record.

Pass when. Night lighting is working on every night route.

3. Lights that fail are reported and fixed.

Method. Check the fault record.

Evidence to show. Fault record.

Pass when. Every fault is fixed within the set time.

Immediate fail (any one means the criterion is not met)

• A patient route at night has no working light.

Why it matters. A high bed is a common cause of falls when a patient climbs out. A low bed, with brakes on and the call bell in reach, keeps the patient safer in bed and on the way out.

Sample. Check 10 beds across the wards on the day of assessment, with the bed check records for the last 30 days.

1. Beds are set low when occupied, with brakes locked.

Method. Check each bed on the walk.

Evidence to show. Bed check (ACS-FRM-003).

Pass when. At least 90% of occupied beds are low with brakes locked.

2. The call system and personal items are within reach.

Method. Test the call system and check the reach from the bed.

Evidence to show. Bed check.

Pass when. Every bed checked has the call system in reach.

3. Beds are checked each shift.

Method. Check the records for the last 30 days.

Evidence to show. Bed check records.

Pass when. At least 90% of shifts have a recorded check.

Immediate fail (any one means the criterion is not met)

• A patient is in a high bed with the brakes off.

Why it matters. A patient who needs a walking frame or a wheelchair but finds none, or finds one that is broken, is put at risk. Having the right aids, in the right sizes, and checking them on a schedule keeps them ready.

Sample. Check 10 walking aids and wheelchairs from the register, and the mobility equipment check records for the last 3 months.

1. Mobility equipment is available in the sizes needed.

Method. Compare the stock sizes with the needs of current patients.

Evidence to show. Mobility equipment register (ACS-REG-001).

Pass when. Every size needed is in stock.

2. Equipment is in working order.

Method. Check each item on the walk.

Evidence to show. Mobility equipment register.

Pass when. Every item in use works.

3. Equipment is checked on the defined schedule.

Method. Check the check dates against the schedule.

Evidence to show. Mobility equipment register.

Pass when. At least 90% of items are checked on time, and faulty items are out of use.

Immediate fail (any one means the criterion is not met)

• A faulty walking aid or wheelchair is in use with a patient.

Why it matters. A cable, a box or a mat on the floor is among the commonest causes of falls in a ward. Clear routes, with any hazard that cannot be removed marked, keep patients moving safely.

Sample. Walk 3 patient routes (ward corridor, stair or ramp, and route to the toilet) with the survey form on the day of assessment.

1. Patient routes are kept clear of trip hazards.

Method. Walk each route and record any hazard.

Evidence to show. Environmental falls-risk survey (ACS-FRM-001).

Pass when. No hazard is found on a route, or every hazard is marked.

2. Each hazard that cannot be removed is marked and managed.

Method. Check each marked hazard for the mark and the plan.

Evidence to show. Hazard record.

Pass when. Every marked hazard has a plan and an owner.

3. Staff are trained in falls prevention.

Method. Check the training record for the ward staff.

Evidence to show. Falls prevention training record (WRK-REG-005).

Pass when. At least 90% of ward staff are trained in the last 12 months.

Immediate fail (any one means the criterion is not met)

• A trip hazard is left on a patient route with no mark and no action.