Shared learning database

Portsmouth Hospitals NHS Trust
Published date:
May 2013

To produce easy read patient information leaflets that explained how patients and carers might help to recognise and reduce their own falls risks while in hospital and the potential risks and benefits associated with bedrail usage.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To produce easy read patient information leaflets that explained how patients and carers might help to recognise and reduce their own falls risks while in hospital and the potential risks and benefits associated with bedrail usage.

Like most other acute hospitals, falls is one of our most common reasons for admission and is the most reported inpatient safety incident. Since 2010, our hospital has seen an 18% reduction in inpatient falls and 16% reduction in falls where the patient sustained an injury. We have many falls prevention initiatives and the development of our falls information leaflets is one of them.

When we first set up our Falls Prevention Group we were lucky enough to have patient and carer representation in the group and following discussion with them about what would be useful, readily available and easily identifiable information seemed to be important. We have developed 2 patient information leaflets with input from patients and our ward - based Falls Champions (each ward has at least one nurse or Care Support Worker who takes a lead role and 'champions' a special interest in falls prevention).

One of the leaflets is specifically about bedrails and is designed to help explain their use (or not) and perhaps help allay concerns that relatives particularly have when rails are not used. The second is designed to help patients be involved in how they can help reduce their falls risk factors in hospital. Both leaflets contain further information contacts including our local Falls Clinics.

Reasons for implementing your project

We had routinely given out generic falls information for some time but these were more relevant to older people living in the community. We did not have any falls leaflets specific to inpatient risks. The Falls Prevention Group representatives agreed that something that was more relevant to inpatients would be useful. We used the group to help design the leaflets and started using them on the wards in 2008.

We used the Royal College of Physicians organisational falls audit 2010 as a measure to ascertain how successful we were in providing patients with relevant falls information. The audit results showed us that we were not good at providing information for patients who had been admitted with a fracture let alone those who had not. However, we did do better than most acute hospitals who took part in the audit. There was a specific question in the audit about providing patients with written and oral information on falls prevention; we scored 41% against the national score of 12% for acute hospitals but that still meant that over half of patients who should have been offered information did not receive it.

Feedback from patient's and carers on our hip fracture ward told us that they liked the leaflets and found the information helpful, they particularly liked the hospital falls logo design that made the leaflets easy to spot in a leaflet rack on the wall.

The two leaflets are standard now across the hospital and reprinted by our medical Illustration department, wards just re-order as they need them. They have been updated and improved over time using input from the Falls Prevention Group.

How did you implement the project

I obtained charitable funds from our Patient Experience / Quality Improvement Committee to produce enough leaflets to give all wards an initial supply then worked with each Business Unit to ensure they would be willing to support ongoing printing costs. I then worked with the ward Falls Champions to ensure they ordered more supplies for their ward when stocks got low.

To decide upon the content of the leaflets I went to published studies for inspiration and asked other falls specialists what they were doing in their hospitals. I also asked patients, carers and staff what they thought would be important as I went about my usual daily duties. I also looked at themes that had become apparent following investigations of patients who had fallen and sustained injury and also looked at letters of complaint from families where falls had been a concern.

I came up with a draft then worked with the Falls Prevention Group and our Falls Champions to refine it.

Key findings

Re-audit and monitoring of re-printing orders has shown that the leaflets are used well on most wards. The leaflets have been in use for some years now and are regularly reviewed by patients and relatives and are included as standard in some ward admission packs where there are high numbers of falls related admissions. Staff have commented that they like the falls branding and logo (yellow and black with footprint): that also makes it easy for them to identify the leaflet quickly.

Key learning points

Ask patients and carers what they would like to see in the leaflet, check all content with your information governance team, medical illustration and patient experience groups and who will help you to ensure that the language and design is suitable and meets all regulations. Don't be put off by cost and ask charitable funds to help out even if just to get things off the ground. Once people see the leaflet as successful they are more likely to start funding it for themselves.

Contact details

Julie Windsor
Clinical Nurse Specialist (Falls and Bone Health)
Portsmouth Hospitals NHS Trust

Primary care
Is the example industry-sponsored in any way?