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Walk the talk on inpatient falls prevention, hospitals told

Mismatch between stated policies and care provided; but prevention often simple and cheap

Caroline White

Wednesday, 14 October 2015

All too often there’s a mismatch between the stated policies trusts and local health boards have for falls prevention and the care patients actually receive once admitted, reveals a national Royal College of Physicians audit on the topic, published today.

The National Audit for Inpatient Falls (NAIF) looked for the first time at how well hospital trusts and local health boards prevent inpatient falls in England and Wales, and follow NICE guidance on falls assessment and prevention.

The report draws on data from almost 5000 patients aged 65 years or older across 170 hospitals, and includes an assessment of the patient’s environment and the falls risk assessments they receive. 

It shows that many trusts and local health boards have policies that include the main areas of falls prevention, but that there is often no association between what the policies include and the care patients receive once admitted to hospital.

Most patients had safe footwear available and their immediate environment was free from clutter. But almost a fifth were unable to access their call bell and almost a third could not safely access their walking aid (if they needed one).   

The audit also reveals that while nearly all patients had their level of mobility recorded only 16% had their lying and standing blood pressure recorded.  This is important because some patients may experience a drop in blood pressure on standing which increases their risk of falling. This can be prevented by ensuring the patient is well hydrated and by modifying their medication.

The audit reveals a variation in approach, with some trusts and health boards doing all that they can to prevent falls in hospitals, while others are missing these opportunities and are not assessing patients in the right way, including checking for any visual impairment to help curb the number of falls.

The results also showed that currently there are around 6 people (6.6) per 1000 occupied bed days as a result of a fall in hospitals nationally.

Among the raft of recommendations, the report says that trusts and health boards should review their falls pathways and regard the following groups of inpatients as being at risk: all those aged 65 years or older; those aged 50 to 64 with an underlying condition that heightens their risk of a fall.

Trusts and health boards should regularly audit the use of bed rails against their policy and make changes to ensure appropriate use,  in addition to reviewing whether the call bell and walking aid (if needed) are within easy reach.

All patients over the age of 65 and those over 50 at particular risk should be assessed for visual impairment and a care plan developed if needed and have their lying and standing blood pressure recorded as soon as possible, it recommends.

“Our results show that although there are pockets of really good care, many hospitals are not doing everything they can to prevent falls. I hope this inaugural audit is the first step to help clinical teams work towards reducing the number of falls currently happening in hospitals in England and Wales,” commented Dr Shelagh O’Riordan NAIF Clinical lead.

Falls in hospitals are the most commonly reported patient safety incident and reflect the quality of care given to patients. Previous research has shown that 700 falls occur daily across hospitals in England—equivalent to 250,000 falls every year.

Some falls in hospitals cause serious injuries such as hip fracture (around 3000 a year). Falls in hospitals also increase length of stay so there is an urgent need to minimise the risk of falling and address any deficiencies in patient care, says the report. And they are expensive: inpatient falls were thought to cost trusts £15 million alone in 2007, and will cost more now.

Responding to the findings, Katherine Murphy, Chief Executive of the Patients Association said the report brought a “much needed focus” to the risk of inpatient falls.

“With around 250,000 inpatient falls each year, it remains a significant issue which also has a huge impact on other patient safety issues, such as bed shortages and waiting times, at a considerable additional cost to the NHS,” she said.

She commended the report for putting forward clear and logical recommendations to improve the current situation in many hospitals across the UK, at minimal cost.

“It is therefore particularly concerning that simple failings are being found across the country. Unfortunately this only confirms what we are being told on a daily basis on our National Helpline from patients and the wider public, but there is simply no excuse for poor care. This is why we must also prioritise safe staffing levels, with the right skills and expertise, to ensure that patient safety is not compromised,” she said.

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