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12 June 2013

Action needed to reduce hospital falls: a 'one size fits all' approach will not work, warns NICE

NICE is calling on the NHS to reduce the number of older patients who are falling over in hospitals. Doctors and nurses should identify the individual risks of these patients to help reduce serious injury and death.

The National Institute for Health and Care Excellence (NICE) is calling on the NHS to reduce the number of older patients who are falling over in hospitals. Doctors and nurses should identify the individual risks of these patients to help reduce serious injury and death.

Falls cost the NHS an estimated £2.3 billion a year.

Nearly 209,000 falls were reported in hospitals in England between 1 October 2011 and 30 September 2012. While the majority (97%) of these people experienced no or low harm (such as minor cuts and bruises), 90 patients died because of their falls. Around 900 patients experienced severe harm, such as hip fractures and head injuries.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: “Falling over is a serious problem in hospitals, and unfortunately their likelihood increases with age as people become frailer. They can cause distress, pain, injury, a loss of confidence and independence, and in some cases, death.

“While it would be virtually impossible to prevent all hospital falls from happening, our guideline calls for doctors and nurses to address the issues that will reduce the risk of their patients suffering avoidable harm. No two patients are the same and so a “one size fits all” approach will not work.”

NICE advises hospital nurses and doctors to consider all patients aged 65 years and older, as well as all patients aged 50 and above who have dementia, stroke, vision or hearing problems and other underlying conditions, to be at a high risk of falling over while in their care. There are several reasons why these people are more likely to experience a fall and so they should be assessed for their personal risk, such as whether they have fallen previously, the medicines they are taking, and whether they have poor eyesight, problems with balance or with walking.

Doctors and nurses should use these details to create a plan that will reduce each patient's chances of falling while in their care; for example by adjusting their medication, offering alternative footwear and helping them go to the lavatory.

These new recommendations issued by NICE on how to assess and prevent falls in hospitals, have been added to existing guidance from NICE, which advises on falls in the community (i.e. at home or in residential care settings).

Also in the guideline, NICE advises doctors and nurses to encourage their patients to use their bedside calling system and to explain to friends and relatives when and how bed rails might be adjusted.

Professor Damien Longson, a consultant psychiatrist who chaired the group of experts that developed the new recommendations for NICE said: “Many patients who need extra support in carrying out simple tasks, such as reaching to get a drink or going to the bathroom, do not wish to make a fuss or to be seen as a burden to hospital staff. This can lead to them attempting to carry out these activities independently, which puts them at a greater risk of falling. In doing so, they can cause themselves significant harm and end up staying longer in hospital than they otherwise would have needed to.

“The NICE guideline advises doctors and nurses to reassure their patients that it is ok for them to press the call button, and that they are there to help them if needed.”

Dr Peter Carter, Chief Executive & General Secretary of the Royal College of Nursing, said: “We were pleased to contribute to this important guidance. Falls in hospital can make an already distressing time even more difficult for vulnerable patients, and any advice and support which helps reduce these incidents is good news for staff and patients.”


For further information, please contact the NICE press office on 0845 003 7782 /,, or out of hours on 07775 583 813.

Notes to Editors

About the guidance

1. The updated clinical guideline will be available from 00.01 Wednesday 12 June 2013 at: The new recommendations on how to assess and prevent falls in hospitals are on pages 14 to 16. Embargoed copies are available on request from the NICE press office.

2. Table: Slips, trips and falls by degree of harm in an acute setting, as reported to NHS England's National Reporting and Learning System between 1 October 2011 and 30 September 2012 by 30 November 2012.

Degree of harm Number of patient falls in an acute setting
No Harm 147,467
Low 54,631
Moderate 5,634
Severe 898
Death 90
Total 208,720

About NICE

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