Standard 68: Falls Prevention (Version 11)

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.

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.

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.

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.

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.

Immediate fail (any one means the criterion is not met). Falls on one ward rise for three quarters, but the reviews record no action.