The Royal College of Physicians National Audit for Inpatient Falls (NAIF) today, reviews how well hospital trusts and local health boards prevent inpatient falls in England and Wales, which are set against the NICE guideline (CG161) on falls assessment and prevention.* This is the first time this has been reviewed.
The NAIF report reveals that many trusts and local health boards have policies that include the main areas of falls prevention. However, there is often no association between what the policies include and the care patients received once admitted to hospital.
The report shows data on nearly 5,000 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.
The report reveals that most patients had safe footwear available and their immediate environment was free from clutter. However, almost one-fifth of patients in this study were unable to access their call bell and almost one-third of patients observed could not safely access their walking aid (if they needed one), which would limit their ability to mobilise safely.
The report also reveals that while nearly all patients had their level of mobility recorded only 16% of patients had their lying and standing blood pressure recorded. This is important because some patients may suffer from 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 report also highlights that some trusts and health boards are doing all that they can to prevent falls in hospitals. Other trusts and health boards however, are missing these opportunities and are not assessing patients in the right way, such as checking for any visual impairment to help reduce the number of falls.
The results also showed that currently there are around 6 people (6.6) per 1,000 occupied bed days (OBD) fall in hospitals nationally. The full report can be found at: www.rcplondon.ac.uk/fffap
Other recommendations include:
trusts and health boards should review their falls pathway and regard the following groups of inpatients as being at risk of falling in hospital and manage their care for:
- all patients aged 65 years or older
- patients aged 50 to 64 who are assessed by a clinician to be at higher risk of falling because of an underlying condition
- trusts and health boards should regularly audit the use of bed rails against their policy and make changes to ensure appropriate use
- trusts and health boards should regularly audit whether the call bell and walking aid (if needed) is within reach of the patient
- all patients over 65 years old (and those over 50 at particular risk) are assessed for visual impairment and a care plan developed if needed
- all patients over 65 years (and those over 50 at particular risk) have a lying and standing blood pressure performed as soon as practicable and actions taken if there is a significant drop in blood pressure on standing.
Dr Shelagh O'Riordan NAIF Clinical lead, said:
This is the first time there has been a national audit of falls prevention in hospitals across England and Wales. 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.
Inpatient falls are common and remain a great challenge to the NHS. Falls in hospitals are the most commonly reported patient safety incident and is an ideal marker on the quality and care given to patients. Previous research has shown that 700 falls occur daily across hospitals in England - this equates to 250,000 falls every year.
Some falls in hospitals result in serious injuries such as hip fracture (around 3,000 per year). Falls in hospitals also result in patients staying longer so there is an urgent need to minimise the risk of falling, the risk of harm arising, and to minimise any deficiencies in patient care.
The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Inpatient falls were thought to cost £15 million to trusts alone in 2007 and will be more expensive now. Therefore falling has an impact on quality of life, health and healthcare costs.
Research has shown that through collaborative care planning to support patients, for example, identifying visual deficits or cardiac conditions; falls can be reduced by 20-30%. This is particularly important for patients with dementia or delirium.
The NAIF is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP)**. The NAIF is managed by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians as part of the Falls and Fragility Fracture Audit Programme.