NHS Ayrshire & Arran guidelines
This document provides the recommended action and interventions for the prevention and management of falls in adult in-patients. The aim of this guideline is to support staff improve safe, effective, person centred care in all adult inpatient wards and departments by preventing and managing inpatient falls.
A fall is a symptom, not a diagnosis, which may indicate deteriorating health, acute illness or frailty. Falls can occur at any age; however, they become more common as people get older. Around a third of people aged 65 and over, and around a half of people aged 80 and over, fall at least once a year. The impact of falls, especially in people aged 65 and over, can include distress, pain, injury including fractures, loss of confidence, loss of independence, and mortality.
Falls can occur in any setting. They are the most reported patient safety incidents in acute hospitals. The impact of inpatient falls on the NHS include increased morbidity, longer stays in hospital and can result in the patient not being able to return home. Whilst it is acknowledged that not all falls can be prevented, this guideline contains evidence-based interventions that allow staff to identify and manage the risk as effectively as possible. Falls in hospital can have an impact on the patient, their families, staff members and the organisation.
Reducing the risk of falls is a multi-disciplinary challenge as falls are complex and often multi-factorial in nature. A fall may be a consequence of an underlying condition, including intrinsic patient risk factors (gait, balance, cognition, acute illness etc.) and extrinsic risk factors (obstacles, wet floors, poor lighting, unsuitable footwear etc.) There are often multiple factors that can increase the risk of falling in hospital. Patient safety is a priority and multi-professional involvement is essential.
It is important that any interventions put in place to reduce the risk of falls are person centred. However, it should be balanced with the patient’s right to choose, rehabilitation, independence, privacy and dignity.
Evidence indicates that multidisciplinary intervention of nursing, medical, physiotherapy, occupational therapy and pharmacy staff working together is effective at reducing the risk. Other useful interventions include the involvement of the falls coordinator (acute inpatient wards), podiatry, optometry and bone health services.
NHS Ayrshire and Arran participated in The Scottish Patient Safety Programme (SPSP) collaborative from 2021-2024. The falls driver diagram and change package remains a useful resource for the management and reduction of falls in hospital.
The aim of the falls change package is to provide evidence-based guidance to support the delivery of falls reduction for patients in acute hospital settings. A change package consists of a number of high-level outcomes supported by activities that when tested and implemented, bring about improvement. It brings together what is known about best practice and processes based on evidence from literature, research, and the experiences of others (SPSP 2021).
1.1 Definition of a fall
“A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.”
(World Health Organisation October, 2012)
The definition includes witnessed, unwitnessed and controlled falls, including those resulting from environmental factors and medical events (e.g. collapse, postural hypotension and seizures).
1.2 Definition of a fall with harm
“Any instance where a fall with harm is identified. Harm will be where another secondary care intervention is necessary (steri-strip, suture, and/or management of dislocation, fracture, head injury, death), and/or a patient has fallen and received harm or injury requiring radiological investigation (x-ray, ultrasound, MRI or CT) with a confirmed harm.”
N.B: Occurrence of a radiological investigation must not lead to an automatic categorisation of ‘harm’ (harm must be confirmed by the investigation). Minor harms (e.g. grazes, light bruising, small cuts) would be excluded.
(Scottish Patient Safety Programme, 2012)
A detailed Datix must be completed for all inpatient falls (this includes controlled falls). If the patient sustains an injury, this must be included on the Datix. Falls resulting in significant injury e.g. fractured femur and sub dural haemorrhage must be escalated in line with adverse event review policy and guidance available on the Athena intranet: Policies and Guidelines
