NAIF audit report 2017

Key recommendations

Recommendations for trust boards and executive teams

• Leadership on patient safety – We recommend that all trusts and LHBs have a trust‐ or hospitalwide patient safety group, which includes falls prevention in its remit and reports to the board. This group should regularly review their trust’s 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. These groups should be overseen by a member of the executive and non‐executive team, and outcomes should be discussed at board level.
• Assessment of patients – There has been highly variable progress on falls prevention activities, and nationally overall, minimal progress has been made. We therefore recommend that procedures are put in place for rapid assessment of acutely ill older people to ensure that assessments are timely, and matched to the major clinical risks including falls.
• Falls resulting in hip fracture – Ensure that all falls in hospital resulting in hip fractures are reported as severe, as recommended by the NRLS. Do not adjust the level of harm according to the circumstances of the fall.
• Numbers of falls – Look to see whether there is a gap between the number of reported falls and actual falls. This is an indicator of a trust’s reporting culture and helps interpretation of data on falls per 1,000 OBDs.
• Dementia and delirium* – We recommend that trusts and LHBs review their dementia and delirium policies to embed the use of standardised tools and link assessments to related clinical issues such as falls.
• Walking aids* – We recommend that trusts and LHBs develop a workable policy to ensure that all patients who need walking aids have access to the most appropriate type from the time of admission, 24/7.

Recommendations for clinical teams

• Falls multidisciplinary working group – We recommend that the local and national results of this audit are studied, and that the group reflects on the changes locally since 2015. The group should reflect on its methods of quality improvement in the light of the overall picture.

• Do not use a falls risk prediction tool* – Where these are still in use, we suggest that the group reviews the strong evidence and logic underpinning the NICE guidance, reviews the place of falls risk assessment and prevention in the acute care processes, and works with colleagues to remove these where necessary.
• Audit against NICE QS86 quality statements 4–6 – These statements identify how you manage a patient following a fall and how to audit against these statements. This will identify areas of weakness and improve the care of these vulnerable patients.
• Lying and standing blood pressure – If rates are low in the local audit result, consider using the RCP clinical practice tool to standardise practice. 
• Medication review – Where rates of documented medication reviews and adjustments are low, we recommend working with colleagues locally, including pharmacy, to review the approach to relevant documentation, ensuring that the reasons for changes are clearly recorded and communicated to the GP on hospital discharge.
• Visual impairment – If rates are low in the local audit result, consider using the RCP clinical practice tool to standardise practice. 
• Walking aids* – 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 for patients with lower urinary tract symptoms such as frequency, urgency, nocturia or incontinence, the implication for falls risk is considered and reflected in the care plan.
• Call bells – The highly variable rates for patients having easy access to the call bell suggests that this simple safety measure is receiving scant attention in some hospitals. We recommend a hospitalwide approach to address this.