Patient safety: falls prevention

Across England and Wales, approximately 152,000 falls are reported in acute hospitals every year, with a further 26,000 falls reported in mental health trust units and 28,000 from community hospitals.

The issue of patients who fall or are at risk of falling is a serious one.

A significant number of falls result in death or severe or moderate injury, which the National Patient Safety Agency estimates costs the NHS £15m per annum for immediate healthcare treatment alone.

This is likely to be a significant underestimation of the overall burden from falls on the NHS once the costs of rehabilitation and social care are taken into account, as up to 90 per cent of older patients who fracture their neck of femur fail to recover their previous level of mobility or independence.

Human cost

In addition to these financial pressures, there are costs that are more difficult to quantify. The human cost of falling includes distress, pain, injury, loss of confidence and loss of independence, as well as the anxiety caused to patients, relatives, carers and hospital staff.  

Although there will always be a risk of falls in hospital, given the nature of the patients that are admitted, there is much that can be done to reduce the risk and minimise harm, while properly allowing patients freedom and mobilisation during their stay in hospital.    

To help address this issue, Patient Safety First has created The ‘how to’ guide for reducing harm from falls. The guide is aimed at managers and teams involved in leading and implementing changes to reduce harm.   

It is important for managers and clinicians to bear in mind that patients of all ages can suffer a fall and that in busy clinical areas there are many factors that can contribute to their frequency and severity. Reducing harm in this area is a complex and important issue that organisations across all care settings can and should address.  However, patient safety has to be balanced with independence, rehabilitation, privacy and dignity - a patient who is not allowed to walk alone will very quickly become a patient who is unable to walk alone.

Complex problem

Addressing inpatient falls and fall-related injuries is therefore a challenge for all healthcare organisations.

Unfortunately there are few “quick fixes” for a problem as complex as falls, and every care setting is different. 

Rotherham hospital foundation trust has worked actively over the last year to bring down the number of its patients who fall.

Deputy chief of quality and standards Trisha Bain explains that the trust realised it needed a whole systems approach to falls.

“The most radical thing we have done is remove risk scoring and replaced this with full falls assessments that includes an action plan which addresses all modifiable risk factors,” she says.

Dr Bain says the trust has made it imperative to involve as many hospital staff as possible in identifying falls risk factors, from those working in estates and facilities management, to clinical staff and managers. 

National Patient Safety Agency head of medical specialties Frances Healey, who is one of the authors of the Patient Safety First “how to” guide, says the problem of patients falling in hospital has for too often been seen as a “Cinderella” issue.

“One of the key messages we are trying to get  across to help reduce harm from falls is that there has been too much emphasis on counting patients’ risk factors, whereas the evidence suggests that we need to be identifying the risks that we can actively do something about,” she says.

Steering groups

Ms Healey also warns against thinking that there is one package of measures that can apply to all patients who are at a high risk of falling.

Organisations should also be establishing multi-professional steering groups. Addressing falls risks should not be left solely to nurses or geriatricians.

A formal group should be established which includes estates and facilities and pharmacists as well as doctors, nurses, physiotherapists and occupational therapists, all discussing what can be done to prevent patients from falling.