Assessing vision reduces the risk of inpatient falls

Being a patient in hospital can be a frightening experience for older people. Even with reassuring care from clinical teams treating them, elderly patients often need extra support in a ward environment.  It is difficult to imagine how much more frightening the experience is if the elderly patient also has poor eyesight. Of equal concern to ward staff is the increased risk to a patient that poor vision brings. There is an established link between patient vision and the risk of an older person tripping or falling while in hospital. People with poor vision are twice as likely to fall as those with normal eyesight(1) and falls in hospital are the most commonly reported patient safety incident(2). The National Patient Safety Agency has evidenced that there are around 600 falls a day in acute hospitals and mental health trusts in England and Wales every year, many of these resulting in serious injury such as hip fracture(2).

As clinicians, we know how important it is that we do as much as we can to minimise the risk of inpatient falls. All older patients should receive a vision assessment on admission to hospital as part of their care plan (NICE CG 161), however the latest National Audit of Inpatient Falls revealed that only 48% of patients are receiving this. Furthermore until now there has been no guidance about what a uniform ward-based vision assessment is and how it should be undertaken.

We obviously need to do more than just ask the patient if they wear glasses and ensure they have them to hand. Even with glasses, some patients can be nearly blind and this is information we need to know in order to look after them safely. This is why the RCP, in collaboration with experts in ophthalmic and eye health, has produced Look out! Bedside vision check for falls prevention, a vision assessment tool which is purposely designed to be used at a patient’s bedside. The tool, which can be printed off on a few pages of A4 paper, is being made available by the RCP to all ward staff, to help them quickly and effectively establish if a patient has an undetected vision problem. It is purposely designed to be used by staff with no expertise in eye health.

The tool looks simple. In fact it took many hours of collaboration between the RCP and experts from British and Irish Orthoptic Society, The College of Optometrists, The Royal College of Ophthalmologists, the Royal College of Nursing  and NHS Improvement to produce. Initial trials at a number of acute and community hospitals have produced positive feedback and the RCP is planning further evaluation later this year. In the meantime we are urging clinical staff to make use of the tool when carrying out vision assessments of elderly people on wards. A patient’s whole care plan will change once a problem with eyesight is identified and part of this plan will include taking measures to compensate for the poor vision to minimise the risk of a fall.

Shelagh O'Riordan, clinical lead for the National Audit of Inpatient Falls

1. Legood R, Scuffham P, Cryer C. Are we blind to injuries in the visually impaired?—a review of the literature. Inj Prev. 2002;8:155–1602.
2. National Patient Safety Agency. Slips, trips and falls data update. London: NPSA, 2010.