3. Reducing the risk of falls on stairs
Please note if you are a provider registered with the Care Quality Commission (CQC), and with premises located in England, they are the relevant regulatory body for patient safety matters. You can find guidance on the Care Quality Commission website.
HSE is aware of numerous incidents where patients or residents have fallen on stairs, which have resulted in serious injury or death. There are a number of factors that are particularly relevant to patients and residents and should be considered in the individual's care plan.
Stairs should be in safe condition and be of suitable design and dimensions for their use, as set out in Building Regulations Approved Document K (on GOV.UK). You should consider whether they:
- are well lit
- have handrails at an appropriate height that contrast with the surroundings
- have good slip resistance properties, particularly at the leading edge
- have clearly marked edges
- are free from trip hazards or obstacles
If patients or residents lack mobility and require extra support, then the stairs should have suitable handrails on both sides. Ideally, stairs should not be steep, winding, curved, nor have open risers. Where individuals are identified as having sight impairment, and are still allowed to use the stairs, the leading edge of the step should be marked to improve contrast between the step and edge. These features make the stairs safer for all users, including staff. Wherever possible, wearing of sensible footwear should be promoted.
Where an individual's mobility, balance or other conditions puts them at risk of falls, an assessment should be completed, which can consider whether access to the stairs is appropriate and under what circumstances. Where they are mobile, but are at risk of falls, the views of the individual, care professionals and family representatives should be considered as part of any assessment when deciding whether access to the stairs is appropriate.
Some stairs (for example steep cellar stairs) may not be suitable for use by residents with mobility or balance issues and may present a significant risk. Where wheelchairs or mobility scooters are used near access points at the tops of stairs, suitable controls should be put in place to reduce the risk of falls.
Where access needs to be restricted for a few individuals, assessment should identify what controls need to be in place. This may include:
- keypads on doors
- emergency release systems (for example in the event of fire)
- alarms alerting staff to the use of stairs (where staff are always able to respond)
- monitoring of stairs (in case of a fall)
Discuss this with a fire safety officer if it impacts on fire evacuation. You may also need to seek advice on how to prevent access through external fire doors in a way that they can be released and quickly accessed in the event of fire.
Example
A person was identified as being at high falls risk. Risk assessment identified that stairs between the ground and first floor presented a real risk of harm. However, they had capacity to understand the risk of using the stairs and was able to mobilise for themselves, and wished to use them.
As a result of the assessment, improvements were made to provide handrails at the appropriate height on both sides and adequate lighting. The steps and floor coverings were in good condition and did not create a slip or trip risk. The assessment concluded that allowing the stairs to be used allowed for dignified living within the care setting, but the individual's condition, capacity to understand the risk and support of the family were regularly reviewed.
Emergency access
Where access to the stairs is required in the event of an emergency but access needs to be restricted at other times, devices are available which allow for restricted access which are overridden when an alarm sounds. Automatic release systems are available which unlock the door in the event of an emergency. Fail safe automatic systems are preferred.
However, where doors have to be released by members of staff, suitable risk assessment and procedures need to be in place (which are actively monitored) to ensure the system of work is effective and cannot put people at danger in the event of an emergency.
You should consult your local fire authority on emergency evacuation procedures.