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Audit finds mismatch between hospital falls policies and reality

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Falls prevention policies at hospitals in England and Wales often bear no relation to what actually happens when frail and elderly people are admitted, with most still using unsafe methods to predict falls, according to a major national review.

The National Audit of Inpatient Falls published by the Royal College of Physicians features data on nearly 5,000 patients aged 65 and over across 170 hospitals.

“Our results show that, although there are pockets of really good care, many hospitals are not doing everything they can to prevent falls”

Shelagh O’Riordan

It provides the first overview of how well trusts and health boards are complying with official guidance on falls assessment and prevention.

While some organisations were doing all they can to reduce the 250,000 or so falls that happen each year in acute and mental health hospitals in England and Wales, the review found others were failing to carry out vital checks.

Figures published for the first time show the average number of falls per 1,000 occupied bed days in England and Wales is 6.6 – higher than previous smaller-scale audits had shown.

Meanwhile, the average number of falls resulting in moderate harm, severe harm and death was 0.19 per 1,000 occupied bed days.

The report found many organisations had falls prevention policies that included all the key areas of falls prevention.

But the audit data showed this was not translating into practice on the frontline. For example, more than 17% of patients in the study could not reach or see their call bell while nearly a third – 32% – who needed a walking aid could not safely get to it.

Nearly all patients had their level of mobility recorded but only 16% had their lying and standing blood pressure document, even though a rapid drop in blood pressure on standing can increase the risk of a fall.

Less than half – 48% – had their sight checked or the need for visual aids, like glasses, written down on their records.

Worryingly the vast majority of hospitals were still using falls risk prediction tools, despite the fact guidance issued by the National Institute for Health and Care Excellence specifically stated these should not be used.

Such tools aim to identify patients who are at low, medium or high risk of falling during a hospital stay, but have been found not to work well.

“We found that 73% of organisations are still using these types of tools and therefore they may be focusing their attention away from some patients who are at risk of falling in hospital,” stated the report, which urged organisations to stop using such tools “with immediate effect”.

As well as highlighting areas of concern, the report identified several examples of best practice often involving a specialist nurses taking the lead on falls prevention.

At Portsmouth Hospitals NHS Trust, a falls and fragility clinical nurse specialist has worked with other specialist clinicians to ensure all patients entering hospital are assessed and measures taken to reduce their likelihood of falling.

The trust’s FallSafe programme introduced three years ago includes nurses acting as “FallSafe champions” and promoting good practice on their wards.

Meanwhile, at City Hospitals Sunderland NHS Foundation Trust a specialist nurse was trained in neurocardiovascular investigations and falls prevention, and now trains healthcare assistants to measure postural blood pressure. She also visits high risk wards and checks patient care plans.

The audit team made a series of recommendations for clinical staff, urging them to follow best practice and make improvements especially in those organisations with higher than average falls rates.

“Our results show that, although there are pockets of really good care, many hospitals are not doing everything they can to prevent falls,” said the audit’s clinical lead Dr Shelagh O’Riordan.

“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,” she said.

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Readers' comments (1)

  • Whiteboards can remain blank when it should be stated that a patient is hearing impaired and in which ear they hear better, if at all, or sight impaired and the best field of vision available, if they are high risk for falls, and people get moved from admission to other wards whilst their zimmer gets left behind….

    Likewise , the "This Is Me" Alzheimers Society aid gets left behind. Less haste, more speed.

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