Quality statement 4: Checks for injury after an inpatient fall
Quality statement
People who fall during a hospital stay are checked for signs or symptoms of fracture and potential for spinal injury before they are moved. [2015]
Rationale
When a person falls, it is important that they are assessed and examined promptly to see if they are injured. This will help to inform decisions about safe handling and ensure that any injuries are treated in a timely manner. Checks for injury should be included in a post-fall protocol that is followed for all people who fall during a hospital stay.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that hospitals have a post-fall protocol that includes checks for signs or symptoms of fracture and potential for spinal injury before the person is moved.
Data source: Data can be collected from information recorded locally by provider organisations, for example, from service or clinical protocols.
Process
Proportion of falls by people during a hospital stay where the person is checked for signs or symptoms of fracture and potential for spinal injury before they are moved.
Numerator – the number in the denominator where the person is checked for signs or symptoms of fracture and potential for spinal injury before they are moved.
Denominator – the number of falls in people during a hospital stay.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The Healthcare Quality Improvement Partnership (HQIP) Falls and fragility fracture audit National Audit of Inpatient Falls reports data on whether people who have had an inpatient fall that resulted in a femoral fracture had a check for signs and symptoms of potential for spinal injury and fracture before they were moved.
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 undertaking checks for signs or symptoms of fracture and potential for spinal injury before moving someone who has fallen.
Healthcare professionals check people who fall in hospital for signs or symptoms of fracture and potential for spinal injury before moving them.
Commissioners ensure that they commission services from providers that have a post-fall protocol that includes undertaking checks for signs or symptoms of fracture and potential for spinal injury before moving a person who has fallen.
People who fall in hospital are checked for fractures and possible injury to their spine before they are moved.
Source guidance
National Patient Safety Agency. Rapid response report: Essential care after an inpatient fall (2011), recommendation 1. Falls remains part of NHS England's enduring standards that remain valid from previous patient safety alerts (cross-speciality safety).
Definitions of terms used in this quality statement
Fall
A fall is defined as an unexpected event which causes a person to rest on the ground, floor or lower level. [Adapted from NICE's guideline on falls; evidence review B, table 1]
Post-fall protocol
A post-fall protocol should include:
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checks by healthcare professionals for signs or symptoms of fracture and potential for spinal injury before the patient is moved
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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)
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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
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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 opinion]