Shared learning database

Type and Title of Submission


Stay on your feet! Implementing the Falls clinical guideline


This example was originally submitted to demonstrate implementation of CG21. This guideline has now been replaced by CG161. The practice within this example remains consistent with the updated guidance.


Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG161 - Falls: the assessment and prevention of falls in older people

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?


Description of submission


The overall aim was to update practice in the care and treatment of falls in line with the NICE Clinical Guideline 21, the National Service Framework for Older People (standard 6) and according to recommendations made by the National Patient Safety Agency. This would allow the Trust to identify all patients who had fallen, minimise the risk of patients falling whilst in hospital and thereby reduce the number of patients falling.




A baseline audit, carried out in May 2005, shortly after publication of the NICE guidelines, showed that falls assessment was not carried out for all patients and patients were not routinely referred for a multi factorial falls risk assessment. The main recommendation from this was to ensure that staff were trained in falls assessment and onward referral. At this stage there was no formal falls training within the Trust, neither was there a tool for identifying patients at risk of falls. The Trust took part in the organisational national audit (2005/6) and patient-focused national audit (2006/7), following which local action plans were devised. A Falls Group had been in existence but did not meet regularly.


1.The Morse falls risk assessment tool was implemented in 2005/6. 2.An associated patient care plan was implemented in 2005/6 3.A new Falls Steering Group was set up in 2006 with the remit to monitor fall rates, embed the screening tool and care plans, provide and revise policies and enable training. 4.A "Stay on your feet group" was set up jointly with the local PCT. This includes an exercise class with talks by professionals for patients. 5.Since 2006, we have organised an event on National Falls Day to provide information and advice for patients and staff. Equipment is on display and patients can change their walking aid ferrules. Age concern packs are also available. 6.Local Falls guidelines were revised in line with NICE guidance and NPSA advice in 2007. In conjunction with this, a bed rails policy was produced. 7.New integrated nursing assessment and care plans, including falls, were implemented in summer 2008. 8.Training on falls assessment was offered regularly in 2006/7. Since then a falls assessment e-learning package has been developed to allow staff to undertake training at a time convenient to them. This is the first clinical elearning training within the Trust. 9.A patient leaflet will be available late 2008, giving patients information on how to access services, including multifactorial falls risk assessment. This will further encourage the participation of older people and their carers in falls prevention programmes. 10.A falls alert is sent to the H&S Advisor, Clinical Governance Facilitator and Division Matron when patients have fallen more than once during an episode of care. The alerts are also sent to the Emergency Department so that these patients can be flagged up as "at risk of falls" should they come through the hospital again via A&E.

Results and evaluation

Progress is monitored through a series of clinical audits that assess staff awareness of the guidelines and attendance at training. The audit also reviews the use of the Falls Risk Screening Tool and care planning. Over time, staff awareness of the guideline has increased from 49% in June 2006 to 64% in August 2007. The use of the Falls Risk Screening Tool has risen from 15% in June 2006 to 60% in August 2007. Another audit is now due. Other monitoring is provided by the incident reporting system. Wards are encouraged to complete the electronic incident reporting form within 24 hours. Where falls have caused harm, the H&S Advisor or Clinical Governance Facilitator follows this up. In cases where a fall causes major harm, eg a fracture neck of femur, a full case review is undertaken, and an action plan drawn up and implemented. Falls is a key performance indicator (KPI) reported to the Trust Board. A trend analysis of falls is reported in the quarterly Risk Management Report, which is presented at the Trust's Risk Management Group and Governance Committee. These are also reported at Divisional Board meetings. Additionally, a quarterly falls report is circulated to senior management and discussed at the Falls Steering Group A simple protocol for screening patients at risk of falling is being developed for use in A&E. Patients at risk of falling will be identified to the wards on transfer and a falls risk assessment would then be undertaken by the wards. A new post falls form is being piloted to enable more information to be collected about the circumstances surrounding falls in hospital to try to pinpoint areas of concern so that these can be addressed. The results are published internally and have been included in a poster accepted at the Clinical Audit 2008 conference held in London in February 2008.

Key learning points

The challenges faced included: Staff training 1.A training package was devised by the Occupational Therapist. This took some time because of wanting to include local data, which was not readily available. Once the training was started, it was apparent that department specific traning was required,eg A&E, ITU, medical wards, and the training then had to be adapted, causing a delay in the training roll-out. 2. It soon became apparent that wards found it difficult to free staff to attend the training. To overcome this, the training was taken out to the wards by the Occupational Therapist, Physiotherapist and Nurse Specialist. This approach was partially successful, including training for ITU, Band 5 staff and night staff. However, for areas such as A&E, attendance at taught training is still an issue. 3. It was therefore decided to devise an e-Learning falls training package which staff can access at their convenience. This includes evaluation of learning. Research showed no other elearning falls training that could be utilised and therefore this was devised inhouse, the first clinical elearning training within the Trust. Screening 4. It became apparent that screening for falls was not consistently carried out in the Emergency Department because of pressures in the department. Therefore, a simpler protocol for screening has been developed and this is currently being piloted. Ongoing monitoring 5. It has been important that audit data is collected regularly to ensure that the guidelines are being followed and practice continues to improve. A particular challenge here has been providing enough staff to be involved in the clinical audits. This requires at least 36 staff for one to two hours on each occasion the audit is carried out. The key here is to have committed people to push this forward, eg Matrons, and to plan ahead so that staff know their future commitments. The Steering Group sets deadlines for the audits and keeps the monitoring on track.

View the supporting material

Contact Details

Name:Anne Jones
Job Title:Clinical Audit Manager
Organisation:Kingston Hospital NHS Trust
Address:Galsworthy Road
Town:Kingston upon Thames
Postcode:KT2 7QB


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This page was last updated: 26 September 2008

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.