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New bedside vision check tool to help prevent hospital inpatient falls

A new tool from the Royal College of Physicians (RCP), that enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital, is being made available to trusts and local health boards in England and Wales from today.

Look out! Bedside vision check for falls prevention is an innovatively designed guide which aims to support busy clinical staff in assessing visual impairment in older people. It uses a mixture of questions and visual aids to help doctors, nurses and therapists check eyesight at the patient’s bedside. Results give an indication of the extent of any visual problems, known or unknown, that the patient may have.

The tool has been created through a collaboration between the RCP and the British and Irish Orthoptic Society, the College of Optometrists, the Royal College of Ophthalmologists, the Royal College of Nursing and NHS Improvement.

Created by medical professionals with expertise in vision and eye health, frontline staff and patients were involved in its design and testing. The tool provides a practical solution for all ward staff responsible for patient care. It is not intended to replace expert clinical assessment but, importantly, it can alert staff to potential concerns that can then be relayed to medical teams for further evaluation.

People are deemed as having a visual impairment when their level of vision is below that required to carry out normal everyday activities. Such people are almost twice as likely to fall, and to have recurrent falls and resultant fractures, than people with normal eyesight [1]. Falls in hospital are the most commonly reported patient safety incidents, with more than 600 a day happening in acute hospitals and mental health trusts in England and Wales every year [2]. Although there is no single cause of falls, poor vision in older people is often related to increased risk [3,4].

In spite of this, the RCP’s most recent National Audit of Inpatient Falls revealed that less than half of older patients had a vision assessment when they went into hospital. This is thought to be due to clinicians struggling to find a workable, standardised approach to basic vision assessment that is achievable in an acute hospital setting.

The bedside vision check tool supports learning previously provided in the FallSafe and CareFall eLearning packages.

The tool contains:

  • suggested questions to ask a patient to check vision
  • visual tests for distance and near vision
  • information for clinicians about vision conditions common in older people.

Shelagh O’Riordan, clinical lead for the National Audit of Inpatient Falls, said:

We know that poor vision is closely linked to the risk of an older patient falling or tripping in hospital. It is incredibly important that when people are admitted to hospital, staff are able to quickly assess if they have a problem with their eyesight that needs to be managed, and perhaps even treated, as part of their care.

We believe this new tool will be a  very useful resource for all ward staff. It will enable them to quickly and easily identify vision impairment in a patient. This will alert them to an increased falls risk.

Ruth May, executive director of nursing at NHS Improvement, said:  

It’s crucial we support clinical staff to better identify patients who are the most at risk of falls. This new resource will help NHS staff to quickly assess those with poor vision and enable better decisions to be made about their care. This guide is a great example of how the health sector can work together to develop innovative solutions and we will continue to work alongside our partners to make sure patients’ risk of falls reduce.

Melanie Hingorani, Moorfields consultant and chair of the Royal College of Ophthalmologists Quality and Safety Group, said:

Ward staff who have no ophthalmic experience can struggle to understand how to check vision properly. This tool allows ward staff to take patients through simple step-by-step checks which will flag up visual problems. It can help prevent falls and ensure any potentially serious vision problems are highlighted to medical staff, who can refer if necessary to the eye clinic.

Dr Mary-Ann Sherratt, president of the College of Optometrists, said:

This new vision assessment tool from the Royal College of Physicians, developed in collaboration with the eye health professions, is a great advance in falls prevention. Patients are often unaware of how vulnerable to a fall they are – even a pair of spectacles with an outdated prescription can significantly increase their risk of falling. Arming ward staff with the knowledge of the link between vision and falls is a huge and important step forward.

The tool is being freely offered to all acute hospital trusts in England and Wales. It is also available to download from the RCP website.


  1. Legood R, Scuffham P, Cryer C. Are we blind to injuries in the visually impaired?—a review of the literature. Inj Prev. 2002;8:155–160.
  2. National Patient Safety Agency. Slips, trips and falls data update. London: NPSA, 2010.
  3. Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology 2004;111:857-62.
  4. Lowered vision as a risk factor for injurious accidents in older people. Aging Clin Exp Res 2008;20:25-30.

Notes to editors

The Royal College of Physicians, the British and Irish Orthoptic Society, the College of Optometrists, the Royal College of Ophthalmologists, the Royal College of Nursing and NHS Improvement worked together to produce the Look out! Bedside vision check for falls prevention tool and define what assessments are effective and appropriate.

About the National Audit of Inpatient Falls

The 2015 National Audit for Inpatient Falls revealed that some hospital trusts are achieving good results through carrying out falls risk assessments on inpatients aged over 65 years. However it also noted that there was room for ‘substantial improvement’ in most key areas of falls prevention, such as ensuring walking aids are within easy reach.

The audit reviewed how well hospital trusts and health boards are working to prevent patients falling whilst in hospital, in England and Wales. This was set against the NICE evidence based standards guideline (CG161) on falls assessment and prevention. The report showed data on nearly 5,000 patients aged 65 years or older across 170 hospitals. Poor sight was identified as a risk when in an unfamiliar place but less than half of these patients had an assessment of vision.

The National Audit of Inpatient Falls is part of the Royal College of Physicians’ Falls and Fragility Fracture Audit Programme (FFFAP). Commissioned by the Healthcare Quality Improvement Partnership (HQIP)* as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), this audit builds upon previous pilot and feasibility audits (RCP, 2011, 2014).

*About HQIP, the National Clinical Audit Programme and how it is funded

HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme (NCA), comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh government and, with some individual audits, also funded by the health department of the Scottish government, DHSSPS Northern Ireland and the Channel Islands.