Hospital Dr News

Prevention of inpatient falls has improved but further change is needed, report says

While the prevention of inpatient falls across hospitals in England and Wales has improved slightly, many patients are still not receiving the required assessments which can help significantly.

Everyone over the age of 65 should be regarded as being at risk of falling in hospital and considered for a multi-factorial falls risk assessment (MFRA), as recommended by NICE guidelines.

The MFRA aims to uncover anything that might make a person more likely to fall and to see whether there are specific things that can be done to prevent this. This may include checking their eyesight, looking at any prescribed medications and checking their balance and mobility.

The RCP annual report also shows that while nearly all patients had their level of mobility recorded (72%), only 40% of patients were assessed for the presence of delirium. Delirium is a change in a person’s mental state or consciousness, which is often observed as confusion, difficulties with understanding, problems with memory, as well as a change in personality.

It is strongly associated with falls in hospital and can be prevented and treated if dealt with urgently.

Falls in hospitals result in longer hospital stays for patients and falls risk assessments can help in saving trusts’ resources at a time they are overstretched. NICE estimates the total cost of all falls to the NHS to be £2.3 billion.

Overall, the report highlights that some trusts and health boards are doing all they can to prevent falls in hospitals and they did improve in some or most of the key indicators. This shows that good practice is possible and should be prioritised in all trusts.

There are three key indicators that improved for patients most at risk between 2015 and 2017, including:

  • mobility aids in patient’s reach improved from 68% to 72%
  • delirium assessment improved from 37% to 40%
  • lying and standing blood pressure from 16% to 19%

However, there was no overall change in other areas to prevent falls in hospital including: continence and visual assessment, call bells within reach and medication reviews.

Key recommendations of the report include:

  • Do not use a fall risk prediction tool – these tools do not sufficiently predict who will fall in hospital.
  • Walking aids – trusts and LHBs to consider developing a workable policy to ensure that all patients who need walking aids have access to the most appropriate type from the time of admission, 24/7.
  • Visual impairment – if rates are low in the local audit result, consider using the RCP clinical practice tool to standardise practice.

Dr Shelagh O’Riordan, NAIF Clinical lead, 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.

“I hope this audit can help clinical teams work towards reducing the number of falls currently happening in hospitals in England and Wales.”

Read the full report.

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