The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

patient-falls-preventionHow good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data. The organisational audit showed that all hospitals have written policies about assessment and preventative actions and most of these cover the territory quite well. Most (85%) have a Multidisciplinary Falls Group, although curiously 21% of these don’t actually review their falls rates. Contrary to NICE guidance, 73% use a falls risk tool to identify higher risk patients. Unfortunately there’s no evidence that this helps reduce overall falls rates, which is why the guidance suggests individual risk assessments instead, linked to specific targeted action.

The RCP falls audit focused on what measures were undertaken (and recorded) in practice for a sample group of acute patients. Some things were found to be generally done well, but glaring deficiencies were evident for others; Only 16% of patients had a lying and standing blood pressure done within 2 days of admission, 48% had a vision assessment and a third of patients who needed a walking aid could not reach it from where they were sitting on the ward.

In October the falls audit team published a new booklet: “Falls Prevention in Hospital: a Guide for Patients, their Families and Carers”. It is designed for older hospital patients, or those planning to go into hospital. It describes some easy to follow measures patients, and their visitors and carers, can take to reduce risks. It’s in an easy to read format and includes a visual checklist tool. It also informs patients about what hospital staff should be doing and when it is important for them to ask staff for help. It’s free to download from the RCP website, so please use it and distribute in relevant clinics and on your wards.

E-learning tools for nurses and doctors, Fallsafe and CareFall can also be downloaded from the RCP website. If you haven’t seen these tools before please use them with your falls prevention management.

If you’d like to get involved with us, or find out more about the National Audit of Inpatient Falls, please contact

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