Any Moderate or Severe Harm fall will under go a Root Cause Analysis

(RCA)

The RCA will be conducted by the ward manager and matron and will look

more closely at the circumstances leading up to, during and after the fall

from all AHP's perspectives to determine what was done well, what could

have been improved and can be learnt from the incident.

Following the RCA a decision will be made by the matron and Head of

Nursing as to whether the incident needs to be investigated as a Serious

Incident (SI).

The Head of Nursing will chair an SI meeting to determine if the incident

needs to be reported as a SI to the CQC.