A fall is the most commonly reported safety incident in inpatients and occurs in all adult clinical areas. There is a growing interest in prevention strategies and, as part of this, in risk assessment tools. These may be useful if the aim is to flag up common risk factors or causes of falls and prompt interventions that are actually delivered. However, although tools may raise awareness and focus
A fall is the most commonly reported safety incident in inpatients and occurs in all adult clinical areas. There is a growing interest in prevention strategies and, as part of this, in risk assessment tools. These may be useful if the aim is to flag up common risk factors or causes of falls and prompt interventions that are actually delivered. However, although tools may raise awareness and focus the minds of staff on the problem, health professionals need to be far more sceptical about their strengths and weaknesses. The article challenges thinking about which tools are being used, why they are being used and what they can and cannot do.
Background: In 2007, the National Patient Safety Agency (NPSA) published ‘Slips trips and falls in hospital’ and ‘Using bedrails safely and effectively’.
Objectives: This observational study aimed to identify changes in local policies in hospitals in England and Wales following these publications. Method: policies in place during 2006 and 2009 were requested from 50 randomly selected acute hospital trusts and their content was categorised by a single reviewer using defined criteria.
Results: Thirty-seven trusts responded. Trusts with an inpatient falls prevention policy increased from 65 to 100%, the use of unreferenced numerical falls risk assessments reduced from 50 to 19%, and trusts with a bedrail policy increased from 49 to 89%. It was concerning to find that by 2009 advice on clinical checks after a fall was available in only 51% of trusts, and only 46% of trust policies included specific guidance on avoiding bedrail entrapment gaps.
Conclusions: The observed changes in policy content were likely to have been influenced not only by the NPSA publications but also by contemporaneous publications from the Royal College of Physicians' National Audit of Falls and Bone Health,
(Publisher abstract)
Background: In 2007, the National Patient Safety Agency (NPSA) published ‘Slips trips and falls in hospital’ and ‘Using bedrails safely and effectively’.
Objectives: This observational study aimed to identify changes in local policies in hospitals in England and Wales following these publications. Method: policies in place during 2006 and 2009 were requested from 50 randomly selected acute hospital trusts and their content was categorised by a single reviewer using defined criteria.
Results: Thirty-seven trusts responded. Trusts with an inpatient falls prevention policy increased from 65 to 100%, the use of unreferenced numerical falls risk assessments reduced from 50 to 19%, and trusts with a bedrail policy increased from 49 to 89%. It was concerning to find that by 2009 advice on clinical checks after a fall was available in only 51% of trusts, and only 46% of trust policies included specific guidance on avoiding bedrail entrapment gaps.
Conclusions: The observed changes in policy content were likely to have been influenced not only by the NPSA publications but also by contemporaneous publications from the Royal College of Physicians' National Audit of Falls and Bone Health, and the Medicines and Healthcare products Regulatory Agency. Most areas of local policy indicated substantial improvement, but further improvements are required.
(Publisher abstract)
Subject terms:
falls, prevention, hospitals, accidents, restraint, older people;
This article outlines the development of a national project on bedrail safety in acute hospitals, community hospitals and mental health units. Evidence from the literature, national reporting systems, litigation, patient focus groups and surveys of policy and practice is described. The project resulted in the release of a safer practice notice intended to ensure the safe and effective use of bedrails, and a set of resources to help frontline staff bring local policy into practice.
This article outlines the development of a national project on bedrail safety in acute hospitals, community hospitals and mental health units. Evidence from the literature, national reporting systems, litigation, patient focus groups and surveys of policy and practice is described. The project resulted in the release of a safer practice notice intended to ensure the safe and effective use of bedrails, and a set of resources to help frontline staff bring local policy into practice.
Background: Inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20–30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle.
Methods: Data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys.
Results: In FallSafe units, delivery of seven care bundle components significantly improved; most but not in control units (ARR 0.91, 95% CI 0.81–1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71–1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72–1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%.
Conclusion: Introducing evidence-based care bundles of multifactorial assessment and intervention using
(Publisher abstract)
Background: Inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20–30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle.
Methods: Data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys.
Results: In FallSafe units, delivery of seven care bundle components significantly improved; most improvements were sustained after active project support was withdrawn. Twelve-month moving average of reported fall rates showed a consistent downward trend in FallSafe units but not controls. Significant reductions in reported fall rate were found in FallSafe units (adjusted rate ratio (ARR) 0.75, 95% confidence interval (CI) 0.68–0.84 P < 0.001) in the 12 months following full implementation but not in control units (ARR 0.91, 95% CI 0.81–1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71–1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72–1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%.
Conclusion: Introducing evidence-based care bundles of multifactorial assessment and intervention using a quality improvement approach resulted in improved delivery of multifactorial assessment and intervention and significant reductions in fall rates, but not in injurious fall rates.
(Publisher abstract)
Subject terms:
falls, prevention, hospitals, mental health services, evaluation, safety, older people, injuries, evidence-based practice;