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Falls in older people: assessing risk and prevention [CG161]

Measuring the use of this guidance

Recommendation: 1.1.2.1

Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment. This assessment should be performed by a healthcare professional with appropriate skills and experience, normally in the setting of a specialist falls service. This assessment should be part of an individualised, multifactorial intervention. [2004]

What was measured: People with hip fracture receive a falls assessment prior to discharge.
Data collection end: December 2014
96.1%
Data collection end: December 2015
97%
Data collection end: December 2016
96.1%
Data collection end: December 2017
95.7%
Data collection end: December 2018
95.1%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.

What was measured: Proportion of patients aged 50 years and over who had sustained a fragility fracture who received or were referred for a falls risk assessment.
Data collection end: December 2016
40%
Data collection end: December 2017
46%
Area covered: England and Wales
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) clinical audit


Recommendation: 1.1.2.2

Multifactorial assessment may include the following: identification of falls history assessment of gait, balance and mobility, and muscle weakness assessment of osteoporosis risk assessment of the older person's perceived functional ability and fear relating to falling assessment of visual impairment assessment of cognitive impairment and neurological examination assessment of urinary incontinence assessment of home hazards cardiovascular examination and medication review. [2004]

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included an assessment of a history of falls.
Data collection end: December 2014
84.6%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included an assessment of gait, balance and mobility.
Data collection end: December 2014
61.5%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included an assessement of fear of falling.
Data collection end: December 2014
80.8%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included an evaluation of vision.
Data collection end: December 2014
30.8%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included a formal assessment of cognition.
Data collection end: December 2014
42.3%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included an assessment of continence and toileting.
Data collection end: December 2014
50%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit

What was measured: The proportion of fracture liaison services that provided a falls risk assessment that included a review of all medications and combinations of medications that increase falls risk.
Data collection end: December 2014
65.4%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit


Recommendation: 1.1.3.1

All older people with recurrent falls or assessed as being at increased risk of falling should be considered for an individualised multifactorial intervention. [2004] In successful multifactorial intervention programmes the following specific components are common (against a background of the general diagnosis and management of causes and recognised risk factors): • strength and balance training • home hazard assessment and intervention • vision assessment and referral • medication review with modification/withdrawal. [2004]

What was measured: The proportion of fracture liaison services who refer patients to exercise programmes refer to one that includes strength and balance training.
Data collection end: December 2014
94%
Area covered: England
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) Facilities audit


Recommendation: 1.1.4.1

Strength and balance training is recommended. Those most likely to benefit are older people living in the community with a history of recurrent falls and/or balance and gait deficit. A muscle-strengthening and balance programme should be offered. This should be individually prescribed and monitored by an appropriately trained professional.

What was measured: Proportion of patients aged 75 years and over (and prescribed anti-osteoporosis medication or referred for further clinical opinion or to their GP) who had sustained a fragility fracture who had started strength and balance training by 16 weeks post fracture.
Data collection end: December 2016
4%
Area covered: England and Wales
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) clinical audit

What was measured: Proportion of patients aged 50 years and over (and prescribed anti-osteoporosis medication or referred for further clinical opinion or to their GP) who had sustained a fragility fracture who had started strength and balance training by 16 weeks post fracture.
Data collection end: December 2016
3%
Area covered: England and Wales
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) clinical audit

What was measured: Proportion of patients aged 50 years and over who had sustained a non-hip fracture fragility fracture who had started strength and balance training within 16 weeks of their fracture
Data collection end: December 2017
4%
Area covered: England and Wales
Source: Royal College of Physicians. Fracture Liaison Service Database (FLS-DB) clinical audit


Recommendation: 1.2.1.1

Do not use fall risk prediction tools to predict inpatients' risk of falling in hospital. [new 2013]

What was measured: Proportion of hospital trusts/health boards who are not using falls risk prediction tools.
Data collection end: May 2015
27%
Data collection end: December 2016
66%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.


Recommendation: 1.2.1.2

Regard the following groups of inpatients as being at risk of falling in hospital and manage their care according to recommendations 1.2.2.1 to 1.2.3.2: • all patients aged 65 years or older • patients aged 50 to 64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition. [new 2013]

What was measured: Proportion of reported patients in an acute setting who had a fall resulting in harm.
Data collection end: May 2014
0.7%
Data collection end: May 2015
0.6%
Data collection end: May 2016
0.6%
Data collection end: May 2017
0.53%
Data collection end: May 2018
0.35%
Area covered: England
Source: NHS Safety Thermometer: Classic

What was measured: Proportion of reported patients in an acute setting who had a fall with or without harm.
Data collection end: May 2015
1.61%
Data collection end: May 2016
1.58%
Data collection end: May 2017
1.49%
Data collection end: May 2018
1.47%
Area covered: England
Source: NHS Safety Thermometer: Classic


Recommendation: 1.2.2.1

Ensure that aspects of the inpatient environment (including flooring, lighting, furniture and fittings such as hand holds) that could affect patients' risk of falling are systematically identified and addressed. [new 2013]

What was measured: Proportion of patients who's immediate environment was reported as being free from clutter/trip/slip hazards.
Data collection end: May 2015
67.6%
Data collection end: December 2016
88.8%
Number that met the criteria: 3941 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.


Recommendation: 1.2.2.3

Ensure that any multifactorial assessment identifies the patient's individual risk factors for falling in hospital that can be treated, improved or managed during their expected stay. These may include: - cognitive impairment - continence problems - falls history, including causes and consequences (such as injury and fear of falling) - footwear that is unsuitable or missing - health problems that may increase their risk of falling - medication - postural instability, mobility problems and/or balance problems - syncope syndrome - visual impairment. [new 2013]

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial falls risk assessment included an assessment of continence and toileting.
Data collection end: May 2015
95.6%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients who had a urinary continence assessment documented in their case notes.
Data collection end: May 2015
84%
Number that met the criteria: 3894 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial risk assessment included a formal assessment of cognition.
Data collection end: May 2015
76.5%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial risk assessment included assessment of a history of falls.
Data collection end: May 2015
98.5%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial risk assessment included assessment of history of blackouts or syncope.
Data collection end: May 2015
55.9%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose multifactorial risk assessment included assessment of footwear.
Data collection end: May 2015
89.7%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial risk assessment included a review of all medication for medications that increase risk of falls.
Data collection end: May 2015
88.2%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial risk assessment included an assessment of gait, balance and mobility.
Data collection end: May 2015
93.4%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial risk assessment included an evaluation of vision.
Data collection end: May 2015
66.9%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had been asked about any history of falls documented in their case notes.
Data collection end: May 2015
81.2%
Number that met the criteria: 3757 / 4846
Data collection end: December 2016
79.6%
Number that met the criteria: 4100 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had any assessment of cognitive impairment documented in their case notes.
Data collection end: May 2015
57.9%
Number that met the criteria: 2571 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had any assessment of fear of falling documented in their case notes.
Data collection end: May 2015
49.4%
Number that met the criteria: 2150 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had a record of level of mobility documented in their case notes.
Data collection end: May 2015
94.6%
Number that met the criteria: 4441 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had an assessment for medications that increase falls risk documented in their case notes.
Data collection end: May 2015
45.9%
Number that met the criteria: 1893 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had any assessment of vision and/or need for visual aids, including spectacles documented in their case notes.
Data collection end: May 2015
48.3%
Number that met the criteria: 2210 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had any assessment of cognitive impairment documented in their case notes.
Data collection end: December 2016
58.5%
Number that met the criteria: 2898 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients who had a urinary continence assessment documented in their case notes.
Data collection end: December 2016
85.4%
Number that met the criteria: 4435 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had any assessment of fear of falling documented in their case notes.
Data collection end: December 2016
55.2%
Number that met the criteria: 2742 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had a record of level of mobility documented in their case notes.
Data collection end: December 2016
94.8%
Number that met the criteria: 4934 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had an assessment for medications that increase falls risk documented in their case notes.
Data collection end: December 2016
47.8%
Number that met the criteria: 2268 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had any assessment of vision documented in their case notes.
Data collection end: December 2016
46.2%
Number that met the criteria: 2308 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients who were wearing safe footwear on their feet.
Data collection end: May 2015
86.7%
Data collection end: December 2016
87.4%
Number that met the criteria: 2842 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.


Recommendation: 1.2.2.4

Ensure that any multifactorial intervention: •promptly addresses the patient's identified individual risk factors for falling in hospital and •takes into account whether the risk factors can be treated, improved or managed during the patient's expected stay. [new 2013]

What was measured: The proportion of patients who were assessed as having medications that increase falls risk and had a medication review (beyond medicine reconciliation) documented in their case notes.
Data collection end: May 2015
72.9%
Number that met the criteria: 1079 / 1893
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had been assessed as having cognitive impairment and had a care plan documented in the notes.
Data collection end: May 2015
32.6%
Data collection end: December 2016
43.7%
Number that met the criteria: 572 / 1308
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who had been assessed as needing a continence or toileting care plan, and had a tailored care plan documented in their notes.
Data collection end: May 2015
69.4%
Data collection end: December 2016
66.9%
Number that met the criteria: 1635 / 2443
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients who required a mobility care plan, had one documented in their notes.
Data collection end: December 2016
78.8%
Number that met the criteria: 3043 / 3862
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who were assessed as having medications that increase falls risk and had a medication review (beyond medicine reconciliation) documented in their case notes.
Data collection end: December 2016
74.9%
Number that met the criteria: 1362 / 1818
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: The proportion of patients who were assessed as needing a vision care plan and had one documented in their notes.
Data collection end: December 2016
52%
Number that met the criteria: 555 / 1068
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.


Recommendation: 1.2.3.1

Provide relevant oral and written information and support for patients, and their family members and carers if the patient agrees. Take into account the patient's ability to understand and retain information. Information should include: - explaining about the patient's individual risk factors for falling in hospital - showing the patient how to use the nurse call system and encouraging them to use it when they need help - informing family members and carers about when and how to raise and lower bed rails - providing consistent messages about when a patient should ask for help before getting up or moving about - helping the patient to engage in any multifactorial intervention aimed at addressing their individual risk factors. [new 2013]

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial falls intervention included written information on falls for the patient.
Data collection end: May 2015
80.9%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of hospital trusts/health boards whose inpatient multifactorial falls intervention included written information on falls for the family/informal carers.
Data collection end: May 2015
76.5%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients/families/carers given oral and written information about falls risk or falls prevention.
Data collection end: May 2015
6.5%
Number that met the criteria: 314 / 4846
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients and/or family/carers who were given written information about falls risk or fall prevention.
Data collection end: December 2016
14.9%
Number that met the criteria: 705 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients and/or family/carers who were given oral information about falls risk or fall prevention.
Data collection end: December 2016
19.4%
Number that met the criteria: 913 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

What was measured: Proportion of patients who have a call bell in sight and reach.
Data collection end: May 2015
82.3%
Data collection end: December 2016
81.3%
Number that met the criteria: 3994 / 5387
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.



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