Emergency nurse have vital role in accident prevention strategy

A national strategy to reduce the toll of accidents in England lists 25 recommendations drawn up by the Royal Society for the Prevention of Accidents

A national strategy to reduce the toll of accidents in England lists 25 recommendations drawn up by the Royal Society for the Prevention of Accidents

  • Strategy focuses on health inequalities and prioritising vulnerable road users’ needs
  • Nurses can signpost prevention for children and older people and identify trends
  • 7 million emergency department admissions in England per year due to accidents
Accidents are a leading preventable cause of death, serious injury and disability. Nurses in the emergency department can play a key role in preventing such accidents.
Picture: iStock

Accidents are a leading preventable cause of death, serious injury and long-term disability, and can have a devastating effect on individuals and their families.

As emergency nurses know only too well, accidents send a significant proportion of patients to the UK’s overflowing emergency departments (EDs). An estimated 7 million ED attendances in England each year are due to accidents.

The Royal Society for the Prevention of Accidents (RoSPA) is calling for action on the leading causes of accidents that can affect people at any stage of their lives, including falls, poisoning, road accidents, sports injuries and choking.

‘Accidents are hugely costly in human terms but also in terms of the burden they put on our emergency departments’

Jo Bullock, head of awareness and education at RoSPA

RoSPA head of awareness and education Jo Bullock says: ‘We know that EDs are facing unprecedented demand. When you talk to anyone, they usually know someone who has been, or have attended themselves or taken their children, to ED for an accident in the previous 12 months.

‘It is a real problem. Accidents are hugely costly in human terms but also in terms of the burden they put on our EDs.’

Main causes of accident-related deaths by age

0-14 Road accidents, threats to breathing, drowning, falls and inanimate forces (struck or crushed by an object)

15-24 Road accidents, poisoning, drowning, threats to breathing and falls

25-64 Poisoning, road accidents, falls, threats to breathing and drowning

65 plus Falls, road accidents, threats to breathing, poisoning and fire

She says the cost to the NHS is ‘eye watering’, adding that: ‘For under-fives the combined cost of ED attendances and hospital admission for accidental injury in England is about £140 million a year.’

Step change in accident prevention programmes

To reduce the severe toll of accidents on individuals, communities, health and social care and the economy, RoSPA has published a national strategy for England listing 25 recommendations.

The aim is to achieve a step change in the delivery of evidence-based accident prevention programmes across England, promoting safe and active lives. It was drawn up after two years of consultation with stakeholders including the RCN and the Royal College of Emergency Medicine.

This strategy emphasises that many accidents should never have happened. ‘Relatively few accidents are wholly new or unforeseeable and the majority are preventable through the application of proportionate safety measures,’ it says.

Activity is important, so don't wrap people in cotton wool

But it also stresses the value of activity to people of all ages, and urges against actions that lead to individuals, especially children, being ‘wrapped in cotton wool’.

Detailed data on the causes of accidents that result in people going to ED stopped being recorded in 2002.

‘The majority of accidents are preventable through the application of proportionate safety measures’

RoSPA national strategy document

But a national system implemented from October 2017 for recording how and what urgent and emergency care is provided, the emergency care data set, is starting to improve the quality of information gathered.

The strategy says this information should be made easily accessible to local and national practitioners, so they can monitor injury trends, set priorities and evaluate interventions.

Home is most frequent location for accidents

A study by Oxford University Hospitals NHS Foundation Trust published in March 2017 found that the home was the most frequent location for accidents, accounting for 40% of all accident-related ED visits, and that ‘low-level falls’ were the most common type of injury, accounting for 47% of cases.

Those who are most at risk of accidental injuries are the youngest, the oldest and the most deprived in society, according to RoSPA.

One area of success in injury reduction is road safety, with the number of road injuries falling thanks to rigorous and enduring national strategic approaches.

Increase in falls and accidental poisoning

1 in 3

people aged over 65 have falls each year

But fatal home and leisure accidents, particularly in falls and accidental poisoning, have increased. This increase contributed to an overall rise in deaths from accidents in England from 2013–2016.

Across England each year, an average of 132 children aged 14 and under die as a result of accidents, and more than 100,000 are admitted to hospital because of accidental injuries, of whom 50% are under five.

A RoSPA and Royal College of Emergency Medicine document called Action on Accidents said investing in an initiative on the prevention of unintentional injuries in under-fives would ease pressure on EDs.

Effective and inexpensive ways to reduce hospital admissions

Injury prevention programmes that combine education for parents and professionals, as well as safety equipment for the most vulnerable families, are effective and inexpensive to deliver and have been shown to achieve a 29% reduction in hospital admissions, the paper said.

Poverty is a strong factor in accidents, and children from deprived backgrounds have disproportionately high rates of accidental injury.

When it comes to older patients, falls are the number one cause of accidental death and hospital admissions. About one third of all people aged 65 and over fall each year, increasing to half of those aged 80 and over. More than 4,600 people in England over the age of 65 had a fall recorded as a cause of death in 2016.

7 million

ED attendances in England due to accidents each year

Emergency nurses can make a difference

RoSPA emphasises that emergency nurses, while often picking up the pieces after an accident, can make a difference.

‘Emergency staff help us to develop our priorities by being our eyes and ears on the front line, identifying emerging trends in accidental injury, and can help educate and signpost parents, relatives and carers to information to prevent future accidents,’ Ms Bullock says.

Recurrent accidents initially flagged up by health staff that helped to raise awareness of dangers in the home include children swallowing button batteries or coming into contact with liquid laundry capsules, and a rise in the number of trampoline-related accidents.

Some hospitals are developing special networks, sometimes known as injury prevention networks, to spearhead efforts to reduce injuries.

Preventive measures to reduce accidents would reduce attendances at EDs

Ms Bullock says many trusts develop literature on safety advice or make leaflets available from organisations such as RoSPA. Some hospitals keep a supply of RoSPA’s child safety kits – a small box that includes a cupboard safety latch and a weaning spoon with choking advice – for staff to distribute if they feel it would be beneficial.

RCN Emergency Care Association vice-chair Jamie Cocksedge says preventive measures to reduce accidents would be a welcome move to reduce attendances at EDs and the effect on people concerned.

‘We see patients affected by accidents all the time, especially older people who have fallen, younger children, and sports injuries in adults,’ he says.


children under 15 die in accidents each year

‘Nurses try to give education when possible on discharge, even just giving a contact for Age UK or a local support group can really help. But one problem can be that nurses are not always fully informed about the services that are available, such as admittance avoidance teams for older patients who are at risk of falling again. If nurses are aware that these services exist they can help people access them.’

Every contact with a family is an opportunity for education

At Noah’s Ark Children’s Hospital for Wales in Cardiff, advanced paediatric nurse practitioner Coral Rees sees referrals in ED and belongs to the paediatric resuscitation team.

She says every contact with a family is an opportunity for education that can help keep children safe. ‘As nurses, health promotion is part of our daily clinical roles, therefore injury prevention is something that can be highlighted directly during consultations and indirectly on health promotion boards in the units, wards and departments we are working in.

‘I see every contact with a child and family as an opportunity for raising age-appropriate key issues that will help to improve the health of children and young people.’

Erin Dean is a health journalist

Find out more

This article is for subscribers only