Zoë Packman: A team approach to reducing inpatient falls

Making the ward environment safer for patients should be a primary aim for nurses and clinical teams. Adopting improvement methodologies can make a real difference, says NHS Improvement's Zoe Packman

Making the ward environment safer for patients should be a primary aim for nurses and clinical teams. Adopting improvement methodologies can make a real difference, says NHS Improvement's Zoe Packman

Picture: Alamy

As nurses, we have a key role to play in ensuring patients do not experience safety incidents while they are in hospital. Taking steps to reduce the likelihood of the most common incidents occurring should be a routine part of what nurses and other hospital staff do, particularly as work by NHS Improvement (NHSI) on patient safety and falls shows that such interventions can make a difference.

According to the National Reporting and Learning System (NRLS), falls in hospitals are the most commonly reported patient safety incident across acute, mental health and community hospital settings. Data from the NRLS show there were more than 250,000 inpatient falls in 2015-16 alone.

Effect on confidence

However, it is the impact of falls on patients’ well-being and hospital resources that should demand our attention. For older people in particular, falls can have a detrimental effect on their confidence as well as their health. Charities such as Age UK have associated falls with an increase in the risk of isolation, reduced independence and the need for residential care.

Falls also represent a significant cost to acute hospitals and other healthcare settings. Analysis by the healthcare think tank the King’s Fund estimates that the cost to the NHS of falls among older people is more than £2 billion a year.

Showing leadership

But this situation can change for the better. There is good evidence (for example, the FallSafe programme run by the Royal College of Physicians in partnership with the RCN and others) that falls could be reduced by 25-30%, particularly on wards with older patients.

The delivery of high quality leadership skills puts nurses in a prime position to promote patient safety initiatives. These skills are already acknowledged by the wider NHS.

For example, among the highlights of NHS England’s Five Year Forward View, Leading Change, Adding Value, and AHPs (Allied Health Professionals) into Action are:

  • The value and contribution of nurses, midwives, allied health professionals and wider multi-professional teams in the delivery of safe, high-quality care.
  • The dissemination and adoption of best and innovative practice.
  • Deploying the right people with the right skills in the right place and at the right time.

Collaborative programme

Last year, NHSI’s completion of a collaborative programme involving 19 trusts showed that a reduction in falls can be achieved. The programme had several aims, including: 

  • Improving falls reporting in trusts.
  • Ensuring that hospitals have information and tools to reduce injurious inpatient falls.
  • Reducing the number of falls on participating wards.
  • Encouraging a move away from regarding falls as a mainly nursing or patient safety issue and towards a multi-professional focus.

At the end of the programme a review showed: 

  • 88% of those involved felt the trust had improved its performance in key areas of falls management. 
  • At the start of the programme, 16% of trusts felt they had no issues with the under-reporting of falls reporting so did not take part in the under-reporting audit. Of the remaining trusts, 25% saw more consistent reporting of falls over the lifetime of the project or an increase in falls reporting. 
  • 73% reported that the improvement skills gained during the programme had supported their work to enable local improvements. 
  • 85% reported improved multidisciplinary working.

Learning communities

On the wards participating in the programme, the percentage of patients who fell was reduced from 2.65% to 2.36%, despite a small overall rise in the number of falls nationwide. There was a similar pattern in falls that resulted in harm, where the rate declined from 0.79% to 0.57% on wards in the programme, and from 0.44% to 0.43% in the rest of the country.

These are great results. However, they were only possible because clinical teams adopted improvement methodologies in their everyday work, and created learning communities within their organisations.

Zoë Packman is head of professional development, NHS Improvement




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