Falls and Fragility Audit Programme
• learning from the national audit of inpatient falls
• an update from the falls and fragility audit programme
• current developments
In her presentation Julie discussed the national audit of inpatient falls and the 7 key indicators identified as important for preventing falls. She discussed the key indicator recommendations for making improvements.
Abstract of Julie’s presentation
Falls in hospital are the most commonly reported patient safety incidents, with more than 240,000 reported in acute hospitals and mental health trusts in England and Wales every year. Tackling the problem of inpatient falls is challenging. There are no single or easily defined interventions which, when done on their own, are shown to reduce falls. However, research has shown that multiple interventions performed by the multidisciplinary team and tailored to the individual patient can reduce falls by 20–30%.
The audit was created to measure against the National Institute for Health and Care Excellence’s (NICE’s) guidance on falls assessment and prevention (NICE clinical guidance 161 (CG161)) and other patient safety guidance on preventing falls in hospital. The audit was open to all acute hospitals in England and Wales.
The organisational audit collected background details of the organisation including occupied bed days (OBDs) and number of falls as well as policies, protocols and paperwork and leadership and service provision.
The clinical audit was a snapshot of the care provided to a sample of up to 30 patients (15 consecutively admitted patients over 2 days) aged over 65, who were in hospital for over 48 hours, for a non-elective reason. The clinical audit consisted of; evidence of assessment and intervention in case notes and observation at bedside/patient environment.
The participation rate for this audit was high.
Many organisations had falls prevention policies and most policies included all the main areas of falls prevention. However, for many of these areas there was no association between what the policies included and the assessments that a patient received once they were admitted to hospital, as shown by our clinical audit data.
NICE clinical guidance specifically recommends that falls risk prediction tools are not used in hospital. These tools aim to identify patients as either ‘at risk/not at risk’ or at ‘low/medium/high risk’ but are not sufficiently predictive of who will fall in hospital. 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.
We report, for the first time, current falls rates across most hospitals in England and Wales. The average number of falls per 1,000 OBDs is 6.63. The average number of falls resulting in moderate harm, severe harm and death per 1,000 OBDs is 0.19.
Some organisations are managing to perform most of the elements of a successful falls prevention assessment. However, overall there is room for substantial improvement in most key areas of falls prevention.
The NAIF workstream has developed key recommendations for organisations and clinicians. The second round of audit will take place in September / October 2016.
Julie's full presentation is available for download at the end of this page.
Julie Whitney is a physiotherapist with in interest in falls prevention. She is currently a NIHR clinical lecturer at King’s College Hospital where she combines research and clinical work. Julie is on the falls workstream of the RCP falls and fragility fracture audit programme.
Qualifications: BSc hons physiotherapy, MSc, PhD.
Future events of interest
Measuring, Understanding and Acting on Patient Experience Insight
Masterclass: Developing your Leadership Skills
Measuring & Monitoring Clinical Quality
Hip Fracture: Meeting the NICE Quality Standard and Learning from the NHFD Findings
Setting up and running an Effective Falls Service
Download: Julie Whitney full presentation2 December 2015