NAIF audit report 2015

Key recommendations

Recommendations for trusts and local health boards:

• Falls steering group – We recommend that all trusts and health boards have a board-level falls steering group that has representation from and reports to the organisation’s board. This group should regularly review their data on falls and moderate harm, severe harm and deaths per 1,000 occupied bed days (OBDs) and assess the success of their practice against trends in these figures.
• Falls multidisciplinary working group – We recommend that all trusts and health boards have a falls multidisciplinary working group that meets regularly, and that they review the activities of this group to ensure it is fit for purpose and functioning appropriately. This group should monitor interventions to improve prevention of falls in hospital and use proven methods to embed these changes.
• Do not use a fall risk prediction tool – We recommend that trusts and health boards review their falls pathway to see whether they are still using a fall risk prediction tool. If they are, they should stop using it with immediate effect, regard the following groups of inpatients as being at risk of falling in hospital, and manage their care accordingly as per NICE CG161:
  • all patients aged 65 years or older
  • patients aged 50–64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition.*
• Audit bed rail use – We recommend that trusts and health boards regularly audit the use of bed rails against their policy and embed changes to ensure appropriate use.
• Review multifactorial falls risk assessments (MFRAs) – We recommend that all trusts and health boards review their MFRA and associated interventions to include all the domains in this audit. This will then need to be linked to quality improvement projects to ensure that what is included in the policy actually translates into what happens on the ward.

Key indicator recommendations:

• Dementia and delirium – We recommend that all trusts and health boards review their dementia and delirium policies to embed the use of standardised tools and documented relevant care plans. Falls teams should work closely with dementia and delirium teams (if present) to ensure team working for these high-risk patients.
• Blood pressure – We recommend that all patients aged over 65 years have a lying and standing blood pressure performed as soon as practicable, and that actions are taken if there is a substantial drop in blood pressure on standing.
• Medication review – We recommend that all patients aged over 65 years have a medication review, looking particularly for medications that are likely to increase risks of falling.
• Visual impairment – We recommend that all patients aged over 65 years are assessed for visual impairment and, if present, that their care plan takes this into account.
• Walking aids – We recommend that trusts and health boards develop a workable policy to ensure that all patients who need walking aids have access to the most appropriate walking aid from the time of admission. Regular audits should be undertaken to assess whether the policy is working and whether mobility aids are within the patient’s reach, if they are needed.
• Continence care plan – We recommend that all patients aged over 65 years have a continence care plan developed if there are continence issues, and that the care plan takes into account and mitigates against the risks of falling.
• Call bells – We recommend that all trusts and health boards regularly audit whether the call bell is within reach of the patient and embed change in practice if needed.

*Please note that only patients aged 65 or over were included in this audit. However, NICE CG161 also applies to people aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition, and all patients aged 65 and over.