Standard 61: Falls Prevention

Why it matters. Falls are among the most common incidents in hospitals, and a leading cause of injury in older people. The WHO Global Report on Falls Prevention in Older Age (2007) recommends a multifactorial risk assessment followed by individual interventions. A written, individual plan turns that assessment into action at the bedside.

Sample. Review the falls prevention plans of every inpatient assessed as at risk in the last 3 months. Where there are more than 20 such patients, take a random sample of 20, and include every patient who fell.

1. Each patient at risk of a fall has a written individual prevention plan.

Method. For each sampled at-risk patient, check the chart for the plan, its date, and the signature of the responsible clinician.

Evidence to show. Falls prevention in hospital patients (PSF-GDL-001, existing, reused); falls risk assessment and prevention (PSF-SOP-001, existing, reused); falls risk assessment tool (PSF-FRM-002, existing, reused).

Pass when. Every sampled at-risk patient has a dated and signed plan.

2. The plan names the specific risks found, with an action for each.

Method. Compare each plan with its falls risk assessment and check that every risk scored has a matching action in the plan.

Evidence to show. Falls risk assessment tool (PSF-FRM-002, existing, reused).

Pass when. Every scored risk has a matching action in the plan.

3. The plan is in use and is updated after any change.

Method. Observe the plan on the sampled wards on two separate days. Check that the plan was updated within 24 hours of any fall or medicine change in the sample period.

Evidence to show. Falls prevention in hospital patients (PSF-GDL-001, existing, reused).

Pass when. The plan is in use on each observed day, and every fall or medicine change has an updated plan within 24 hours.

Immediate fail (any one means the criterion is not met)

• A patient starts a sedative and is at high risk of falling, but no supervision plan is written, and the patient falls at night.
• A patient falls twice in one week, and the plan is not reviewed after the first fall.

Why it matters. Environmental hazards such as wet floors, poor lighting, trailing cables, faulty beds and unstable mobility aids contribute to a large share of in-hospital falls. Routine, documented checks are a low-cost and well-established control (WHO Global Report on Falls Prevention, 2007).

Sample. Review the environmental surveys, the bed and mobility equipment checks and the open hazard records for every inpatient ward and bathroom in the last 6 months.

1. Each ward and bathroom is surveyed for falls hazards at the set interval.

Method. Compare the most recent survey date for each ward and bathroom with the interval set in the survey procedure.

Evidence to show. Environmental falls-risk survey and hazard control (ACS-SOP-001, existing, reused); environmental falls-risk survey record (ACS-FRM-001, existing, reused).

Pass when. Every ward and bathroom was surveyed within the interval.

2. Beds, bed rails and mobility equipment are checked on time.

Method. Check the mobility equipment register and the sampled bed records for the last check date and its result.

Evidence to show. Beds and mobility equipment check (ACS-SOP-002, existing, reused); bed, mobility equipment and call system check (ACS-FRM-003, existing, reused); mobility equipment register (ACS-REG-001, existing, reused).

Pass when. Every bed and mobility item was checked within its interval and passed, or was removed from use.

3. Each hazard is corrected, or recorded as open with an owner and a target date.

Method. Check each hazard in the survey record for a correction date, or for an open entry with an owner and a target date.

Evidence to show. Environmental falls-risk survey record (ACS-FRM-001, existing, reused).

Pass when. Every hazard has a correction date, or an open entry with an owner and a target date.

Immediate fail (any one means the criterion is not met)

• A bed rail is broken for three weeks, and a confused patient falls from the bed.
• A wet bathroom floor with no warning sign causes a fall, and the hazard is absent from the last survey.

Why it matters. Prompt recording and an injury check detect serious harm, such as a head injury or a fracture, early. Reviewing each fall is how a ward learns to prevent the next one. Incident reporting supports organisational learning, as set out in the WHO Global Patient Safety Action Plan 2021 to 2030.

Sample. Review the falls log and the event record for every fall in the last 6 months, including falls with and without injury.

1. Each fall is recorded in the falls log on the day it happened.

Method. Compare the date of each fall in the chart and incident report with the date of the falls log entry.

Evidence to show. Falls log (PSF-FRM-001, existing, reused).

Pass when. Every sampled fall is in the log on the day it happened.

2. The patient is checked for injury by a clinician, and the team is told.

Method. For each sampled fall, check for a documented injury check, the time it was done, and a record that the responsible doctor was informed.

Evidence to show. Falls log (PSF-FRM-001, existing, reused); review of falls, pressure injury and handover events (HOV-SOP-001, existing, reused).

Pass when. Every sampled fall has a documented injury check within the time set, and the responsible doctor informed.

3. Each fall is reviewed within the set time, and the plan is changed where needed.

Method. Check the review date for each fall against the set time. Check that the plan was changed, or that the reason no change was needed is recorded.

Evidence to show. Review of falls, pressure injury and handover events (HOV-SOP-001, existing, reused).

Pass when. Every fall has a review within the set time, with the plan change or the reason recorded.

Immediate fail (any one means the criterion is not met)

• A patient falls and hits their head, and no injury check is recorded before the next shift.
• A fall with a fracture is not entered in the falls log or the incident system.

Why it matters. Most falls happen when staff are not aware of a patient’s risk, or when assistance is not given as the plan says. Training and competence are part of the WHO guidance on health workforce education and training (2013), which supports safe care.

Sample. Review the training records for all staff on a sample of three inpatient wards in the last 12 months, including staff appointed in that period.

1. All clinical and support staff complete training on induction.

Method. Compare the start date of each sampled staff member with the induction training record.

Evidence to show. Falls prevention training record (WRK-REG-005, existing, reused).

Pass when. Every sampled staff member has induction training recorded within the first 30 days of work.

2. Training is repeated at the set interval.

Method. Check the date of each sampled staff member’s last training against the interval.

Evidence to show. Falls prevention training record (WRK-REG-005, existing, reused).

Pass when. Every sampled staff member is within the training interval.

3. Staff can describe the response to a fall.

Method. Ask two staff members per sampled ward to describe the steps after a fall, and check their answers against the falls prevention guidance.

Evidence to show. Falls prevention in hospital patients (PSF-GDL-001, existing, reused).

Pass when. Both staff describe the injury check, the record and the notification of the team.

Immediate fail (any one means the criterion is not met)

• A new support worker with no falls training moves a patient without assistance, and the patient falls.

Why it matters. Trend data show whether prevention is working and where effort is needed. Without regular review, a rise in falls can continue unnoticed. Review and action are the feedback step of any quality improvement cycle, and are part of the WHO falls prevention guidance (2007).

Sample. Review the quarterly falls reports, the governance meeting minutes and the agreed actions for each ward in the last 12 months.

1. Falls rates are reviewed each quarter for each ward.

Method. Check that each ward has a recorded quarterly review that includes the falls rate and the proportion of falls with injury.

Evidence to show. Review of falls, pressure injury and handover events (HOV-SOP-001, existing, reused); falls log (PSF-FRM-001, existing, reused).

Pass when. Every ward has each quarter recorded.

2. Agreed actions have an owner, a date and a follow-up.

Method. Check each action in the minutes for an owner, a target date and the follow-up at the next review.

Evidence to show. Review of falls, pressure injury and handover events (HOV-SOP-001, existing, reused).

Pass when. Every action has an owner, a target date and a follow-up recorded.

3. The effect of each action is checked at the next review.

Method. Compare the falls rate before and after each action at the next quarterly review.

Evidence to show. Review of falls, pressure injury and handover events (HOV-SOP-001, existing, reused).

Pass when. Each action has a recorded outcome at the next review.

Immediate fail (any one means the criterion is not met)

• Falls on one ward rise for three quarters, but the reviews record no action.