Standards › Standard 1 › Guidelines
Clinical guideline · PSF-GDL-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 1.4
Key recommendations at a glance
- R1. Assess every patient for falls risk on admission and after any change (Strong, EC).
- R2. Review medicines that increase falls risk for every high-risk patient (Conditional, EC).
- R3. Set an individual intervention for each risk factor and record it in the care plan (Strong, EC).
- R4. Treat every fall as a learning event; review it within 72 hours (Strong, EC).
1. Purpose and users
To give clinicians and managers one set of recommendations on preventing falls in hospital, which the falls SOP (PSF-SOP-001) and the falls forms carry out.
| Who should use it | Nurses, doctors, pharmacists, physiotherapists and occupational therapists; ward and quality managers |
| Who should not rely on it alone | Clinicians managing patients with specialist falls problems (for example, after a head injury or with a seizure disorder), who must follow specialist advice |
2. Definitions
| Term | Meaning |
|---|---|
| Falls risk | The chance that a patient will fall during their stay, based on individual factors |
| Multifactorial assessment | An assessment that looks at several risk factors together, not one alone |
3. Background
WHO identifies falls as a major and preventable cause of injury, especially in older people. Its global report recommends a multifactorial approach: assessing individual risk, tailoring interventions, reviewing medicines, and improving the environment and staff practice [E-008].
In hospital, the risk is higher for patients who are new to the ward, confused, on sedating or blood-pressure medicines, or who have reduced mobility.
4. Recommendations
| No. | Recommendation | Strength | Certainty | Evidence |
|---|---|---|---|---|
| R1 | Assess every adult patient for falls risk within the first hours of admission, and again daily and after any change in condition or medicine. | Strong | EC | E-008, E-009 |
| R2 | Review all medicines that increase falls risk (sedatives, antihypertensives, diuretics, opioids, hypoglycaemic agents) for every patient classed as high risk. | Conditional | EC | E-008, E-009 |
| R3 | Set an individual intervention for each positive risk factor, and record it in the care plan. Do not use a generic list without checking each patient. | Strong | EC | E-008, E-009 |
| R4 | Do not use restraint as a falls intervention. | Strong | EC | E-009 |
| R5 | Review every fall within 72 hours to find the cause and change the intervention. Record the review. | Strong | EC | E-009 |
5. How the evidence was assessed
Recommendations are drawn from the WHO global report on falls prevention [E-008]. Strength and certainty are graded by the ASF Expert Committee.
The ASF Expert Committee will confirm the thresholds, assessment times and review intervals in the falls SOP and the score bands in PSF-FRM-002.
6. Implementation
| Area | What to do | Who |
|---|---|---|
| Staff training | Induction and annual falls training for all clinical staff | Clinical education lead |
| Assessment tool | Use PSF-FRM-002; check it is in every ward file | Chief nurse |
| Medicine review | Pharmacist reviews high-risk patients within 24 hours | Pharmacist in charge |
| Equipment | Low beds, call bells, footwear and walking aids available on each ward | Facilities manager |
7. Linked SOPs and forms
| Recommendation | SOP or form that carries it out |
|---|---|
| R1 (assessment) | PSF-SOP-001, PSF-FRM-002 |
| R2 (medicines) | PSF-SOP-001 step 3; pharmacist review (SOP-044 generic) |
| R3 (interventions) | PSF-SOP-001 step 2 |
| R4 (restraint) | Restraint policy (generic) |
| R5 (review of falls) | PSF-SOP-001 step 6; PSF-FRM-001 |
8. Monitoring
| Indicator | Target | Frequency | Who |
|---|---|---|---|
| High-risk patients with interventions in the care plan | 100% | Monthly | Chief nurse |
| Falls per 1,000 patient days | Trend reported; target set by committee | Monthly | Chief nurse |
| Falls reviewed within 72 hours | 100% | Monthly | Quality lead |
9. Limits, exceptions and advice
- This guideline applies to adults in hospital. Children and people in community settings need their own adaptation.
- Specialist advice is needed for patients with complex neurological or cardiac causes of falls.
- Where a recommendation conflicts with a patient’s own wishes, discuss the risk and document the decision.
10. Review
Review every 12 months, or sooner when new evidence is published, after a serious falls event, or when a linked SOP changes.
11. Evidence
| Reference | Note |
|---|---|
| E-008 | World Health Organization. Global Report on Falls Prevention in Older Age (2007). |
| E-009 | ASF Expert Committee consensus. |
12. Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version linked to PSF-SOP-001 | Approved by the ASF Expert Committee |
| 1.1 | the date of approval | Internal quality review: corrected cross-references, status wording and document control | Approved by the ASF Expert Committee |
E-learning for this document
- Slip, Trip & Fall Prevention (FALL-01)
Planned course: Hospital falls prevention, based on the falls guideline. New course planned.
References
- World Health Organization (2007). WHO Global Report on Falls Prevention in Older Age. Geneva: WHO. Open source (E-008)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)