Quality statement 5: Safe manual handling after an inpatient fall

Quality statement

Older people who fall during a hospital stay and have signs or symptoms of fracture or potential for spinal injury are moved using safe manual handling methods. [2015]

Rationale

When a person falls, it is important that safe methods are used to move them, to avoid causing pain and/or further injury. This is critical to their chances of making a full recovery. Safe manual handling methods should be included in a post-fall protocol that is followed for all older people who fall during a hospital stay.

Quality measures

Structure

Evidence of local arrangements to ensure that hospitals have a post-fall protocol that includes using safe manual handling methods for moving older people with signs or symptoms of fracture or potential for spinal injury.

Data source: Local data collection. Results for 2011 were collected by the pilot audit by the Royal College of Physicians (2012) Report of the 2011 inpatient falls pilot audit, section 2: Policy, protocol and paperwork, table 2.5.1 (b).

Process

Proportion of falls by older people during a hospital stay where the person has signs or symptoms of fracture or potential for spinal injury and is moved using safe manual handling methods.

Numerator – the number in the denominator where the person is moved using safe manual handling methods.

Denominator – the number of falls by older people during a hospital stay where the person has signs or symptoms of fracture or potential for spinal injury.

Data source: Local data collection.

Outcome

Level of harm caused by falls in hospital in people aged 65 and over.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (NHS organisations with inpatient beds, such as district hospitals, mental health trusts and specialist hospitals) ensure that staff have access to and follow a post-fall protocol that includes using safe manual handling methods to move older people who have fallen in hospital and have signs or symptoms of fracture or potential for spinal injury.

Healthcare professionals use safe manual handling methods to move older people who fall in hospital and have signs or symptoms of fracture or potential for spinal injury.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers that have a post-fall protocol that includes using safe manual handling methods to move older people who have fallen in hospital and have signs or symptoms of fracture or potential for spinal injury.

Older people who fall in hospital and who may have a fracture or possible injury to their spine are moved in a safe manner, using suitable equipment if needed.

Source guidance

National Patient Safety Agency (2011) Rapid response report: Essential care after an inpatient fall, recommendation 1

Definitions of terms used in this quality statement

Fall

A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.

[NICE's clinical knowledge summary on falls – risk assessment]

Post-fall protocol

A post-fall protocol should include:

  • checks by healthcare professionals for signs or symptoms of fracture and potential for spinal injury before the patient is moved

  • safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury (community hospitals and mental health units without the necessary equipment or staff expertise may be able to achieve this in collaboration with emergency services)

  • frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (for example, unwitnessed falls) based on the NICE guideline on head injury

  • timescales for medical examination after a fall (including fast-track assessment for patients who show signs of serious injury, are highly vulnerable to injury or have been immobilised); medical examination should be completed within a maximum of 12 hours, or 30 minutes if fast-tracked.

The post-fall protocol should be easily accessible (for example, laminated versions at nursing stations).

[Adapted from the National Patient Safety Agency's rapid response report on essential care after an inpatient fall, recommendations 1 and 2, and expert consensus]