‘Look out’ – assessing a patient’s vision for falls prevention, what should it look like?

Dr Kawa Amin represents the BGS on the advisory group for the National Audit of Inpatient Falls (NAIF). He is a Consultant Geriatrician, Consultant lead for falls service and Geriatrics Departmental Lead for Safety & Quality at Barking, Havering and Redbridge University Hospitals NHS Trust.

As part of my role on the NAIF advisory group I have been involved in the development of a new bedside vision assessment tool which enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.

Being acutely unwell is and in a different environment, is a stressful experience.  Even with reassuring care from clinical teams treating them, older people often need extra support in a ward environment.  Can you imagine how frightening such an experience might be for a patient with visual impairment?  It’s perhaps no wonder that poor vision is a risk for delirium.  

There is also an established link between patients’ vision and the risk of falling while in hospital. People with poor vision are twice as likely to fall as those with normal eyesight falls in hospital are the most commonly reported patient safety incident. The National Patient Safety Agency  has reported that there are around 600 falls a day in acute hospitals and mental health trusts in England and Wales every year, many of these resulting in serious injury such as hip fracture.

So how can you help address this huge problem in your day to day practice? All older patients should receive a vision assessment on admission to hospital as part of their care plan (NICE CG 161), however the latest National Audit of Inpatient Falls revealed that only 48% of patients are receiving this.  Furthermore until now there has been no guidance on standard vision assessment and how it should be performed.  More objective assessment is needed than just asking the patient if they wear glasses and ensuring they have them to hand.  Even with glasses, some patients can be nearly blind and this is information we need to know in order to look after them safely.  This is why the RCP, in collaboration with experts in ophthalmic and eye health, has produced a vision assessment tool which is purposely designed to be used at a patient’s bedside. The tool, which can be printed off on a few pages of A4 paper, is being made available by the RCP to all ward staff, to help them quickly and effectively establish if a patient has an undetected vision problem. It is purposely designed to be used by staff with no expertise in eye health.

The tool looks simple. In fact it took many hours of collaboration between the RCP and experts from British and Irish Orthoptic Society, The College of Optometrists, The Royal College of Ophthalmologists, the Royal College of Nursing  and NHS Improvement to produce. The tool contains supports learning previously provided in the FallSafe and CareFall e-learning packages and contains suggested questions to ask a patient to check vision and visual tests for distance and near vision.

Initial trials at a number of acute and community hospitals have produced positive feedback and the RCP is planning further evaluation later this year.  In the meantime we are urging clinical staff to make use of the tool when carrying out vision assessments of elderly people on wards.  A patient’s whole care plan will change once a problem with eyesight is identified and part of this plan will include taking measures to compensate for the poor vision to minimise the risk of a fall.

The tool is available on the RCP website. For further information or for a hard copy of the bedside vision assessment tool, please contact +44 (0)20 3075 1511 or email falls@rcplondon.ac.uk.

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