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Five key factors could reduce falls in hospitals, says regulator

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Five key factors have been identified that could reduce falls in hospitals, according to regulators, though they note that eliminating them completely is an unrealistic target.

NHS Improvement has today published findings from a review of falls incidence and their associated costs across all NHS inpatient settings in England.

“There are broadly five key factors in reducing the number of falls in hospital”

NHS Improvement report

In its report, the regulator said evidence from successful and sustainable falls prevention programmes suggested there were “broadly” five factors that were key to reducing falls in hospital.

These included gaining board and ward level support for falls prevention, such as by establishing a multi-disciplinary strategic falls group and setting an ambitious but achievable target.

In addition, frontline staff needed to be engaged in design of the fall prevention programme to encourage their “buy-in” and also ensure that its implementation was “feasible”.

Education and training was also key to ensure that all staff were appropriately aware of falls risk factors, said the report – titled The incidence and costs of inpatient falls in hospitals.

It added that a “culture change” was necessary to ensure that falls were perceived as a multi-disciplinary issue and prevention was a shared responsibility among staff.

Lastly, it noted the need for good quality data, with accurate and timely falls reporting to identify the scale and nature of the problem and enable accurate monitoring of progress, including adjustment for seasonal variations.

“Our mission now is to build momentum and encourage trusts to share their ideas and innovations”

Ruth May

However, the report stated that, while trusts should be ambitious in setting targets to reducing avoidable falls, reducing falls to zero “will not be a realistic target for any hospital”.

It highlighted that trusts would always have to make a “challenging trade-off” between encouraging patient mobility and independence versus minimising the risks of falls.

In some cases, falls would be a necessary part of a patients’ rehabilitation process, it noted, while adding that the costs of trying to eliminate all falls risk was “likely to be prohibitively high”.

As well as identifying what it described as the “five universal factors that can apply to all trusts when they are looking at reducing the rate of falls”, the review focused on the financial impact of falls.

It was commissioned, said NHS Improvement, to both analyse the number and cost of patients who fall while staying in hospital and to “understand what the scale of the financial cost is on trusts”.

Among the other trends it looked at in the analysis were overall incidence, levels reported in different settings, the age groups most likely to fall and any subsequent harm.

“The report, based on existing evidence and data, provides a picture of the scale of inpatient falls and the benefits to the NHS if the rate of inpatient falls was reduced,” said the regulator.

“Although trusts should be ambitious, reducing falls to zero will not be a realistic target for any hospital”

NHS Improvement

Using 2015-16 data from the National Reporting and Learning System, it found that, as in previous years, falls were the most commonly reported type of incident in acute and community hospitals and the third most commonly reported in mental health hospitals.

In total, during 2015-16, more than 250,000 falls were reported across acute, mental health and community hospital settings.

Of these, 77% happened to patients over the age of 65 who were also more likely to be harmed as a result, according to the review.

“Not only are reported falls among older patients more likely to result in some degree of harm, where harm does result, it is three times more likely to be severe,” said the report.

“Older patients are also likely to be relatively frailer before the fall and therefore more likely to sustain more serious harm as a direct result of the fall,” it stated.

It added: “Reported falls among older patents in acute settings were more likely to result in either moderate or severe harm than falls in either mental health or community hospitals.”

NHS Improvement calculated that the average cost of a fall was £2,600 and the estimated that the total cost of reported inpatient falls in 2015-16 was £630m.

The reviewers calculated that reducing inpatients falls by 25-30% could result in an annual saving of up to £170m.

An annexe published with the report, revealed that £2.8m was paid out in damages during 2015-16 linked to 157 clinical claims relating to falls. A further £8.5m was paid out by the NHS in damages for 687 non-clinical claims.

Commenting on the report, Ruth May, executive director of nursing at NHS Improvement, said: “Falls can have a devastating effect on people, they can set back their recovery and cause them to stay in hospital much longer than they need to.

NHS Improvement

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Ruth May

“No one wants to see a patient suffer harm and I know that trusts are already working round the clock to reduce risks to patient safety and deliver compassionate care,” she said. “But we also know there is more we can do.”

She highlighted that NHS Improvement had launched a falls collaborative in January this year to create a community for trusts to discuss changes they made and to share their findings.

It comprised a network of multi-professional representatives from 19 different pilot trusts, who worked together to share ideas and develop ways to reduce the number of falls in hospital.

The aim of the collaborative was to achieve a 5% reduction in falls rates, comparing whole-year 2017-18 data with a baseline of 2016-17.

Ms May said: “The collaborative that NHS Improvement led shows how some parts of the NHS are improving and reducing the number of patients falling in hospitals.

“Their work is fantastic and our mission now is to build momentum and encourage trusts to share their ideas and innovations so more organisations can work to reduce falls in hospitals,” she said.

She added: “The report that we’ve published today makes it really clear how important it is that collectively we succeed.”

The regulator also highlighted that more information and case examples from the collaborative were available on its website.

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Readers' comments (1)

  • The THIS IS ME leaflet from Alzheimers Society and RCN can be very helpful, if it accompanies the patient and if it is actually implemented. Also, when someone is admitted on an emergency basis, their walking aid needs to accompany them at all times. So if moved from A and E for assessment then it must stay with them. Sounds obvious but in strange surroundings patients can forget their aids, stand up and have a fall, just because their walking aid is still in another hospital department.

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