Falls prevention in hospitals across England and Wales has improved slightly but many are still using ineffective screening tools and failing to carry out key checks, including for delirium, it has been revealed.
This year’s National Audit for Inpatient Falls includes data from over 5,000 patients aged 65 and over at 138 (97%) of all eligible acute hospital trusts and local health boards.
“Many hospitals are still not doing everything they can to prevent falls”
The audit revealed that there had been a fall in the number of acute providers using falls risk screening tools over the last two years, down from 74% to 34%.
But the auditors questioned why a third were still using them, when the National Institute for Health and Care Excellence had advised for around four years against the use of such tools due to a lack of evidence for their effectiveness.
Instead, NICE said all inpatients aged 65 and older should have their care managed as “if they were at risk of falling”, on the basis that they often had risk factors that heightened the likelihood of a fall, such as acute illness, delirium, impaired mobility and taking medication.
The latest NICE guidance on falls prevenion and assessment, dating from 2013, also stated that all patients should be considered for a multi-factorial falls risk assessment.
The new falls prevention audit, carried out by the Royal College of Physicians, also found a small improvement in the proportion of delirium assessments being carried out since the last one was carried out in 2015, but warned that more action was needed.
In 2017, 40% of patients were assessed for delirium, compared with 37% in 2015, said the National Audit of Inpatient Falls Report 2017, published today.
It stated that, while clinical judgement may sometimes deem certain assessments not required, some were likely to be “nearly always relevant in the acute stage” of admission, for example, when assessing for evidence of cognitive impairment or delirium.
The report called for all trusts and health boards to review their dementia and delirium policies to “embed the use of standardised tools, and link assessments to related clinical issues such as falls”.
Meanwhile, 72% of patients had a mobility aid in reach, compared with 68% in 2015, and 19% of patients had their lying and standing blood pressure measured, compared with 16% two years ago.
“I hope this audit can help clinical teams work towards reducing the number of falls”
However, in other areas that helped to prevent falls in hospital, no overall significant improvements were found by the auditors.
The proportion of patients with continence care plans (67%), who had vision assessments (46%), a call bell in reach (81%), and who had been assessed for medication that increased their falls risk (48%) remained virtually unchanged since 2015.
But the report highlighted that this overall finding masked the fact that some trusts and boards had seen improvements in a number of key indicators, which showed good practice was possible.
As reported earlier this month by Nursing Times, nurses have successfully introduced a series of measures to reduce patient falls at one hospital trust in the North West.
Over the past four years, University Hospitals of Morecambe Bay NHS Foundation Trust said it had steadily reduced the number of falls that resulted in patient harm.
Meanwhile, the audit report stated: “There was substantial change for many audit items in most hospitals. Even allowing for sampling errors, it is likely that there is inconsistency in practice, and changes – a mix of improvement and decline – since 2015 in most hospitals.
“This merits detailed scrutiny of the local results to identify where certain areas of practice are improving or slipping,” noted the report.
Dr Shelagh O’Riordan, clinical lead for the audit, said: “This is the second time there has been a national audit of falls prevention in hospitals across England and Wales.
“Our results show that, although there are areas of really good care, and significant improvements have been made by some hospitals, many hospitals are still not doing everything they can to prevent falls,” she said.
“I hope this audit can help clinical teams work towards reducing the number of falls currently happening in hospitals in England and Wales,” she added.