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Practice Safety Alerts

Essential care after an inpatient fall: summary of a safety report from the National Patient Safety Agency

BMJ 2011; 342 doi: (Published 28 January 2011) Cite this as: BMJ 2011;342:d329
  1. Frances Healey, joint head of patient safety (Response/Medical Specialties)1,
  2. Adam Darowski, consultant physician and falls lead2,
  3. Tara Lamont, special adviser1,
  4. Sukhmeet Panesar, clinical adviser1,
  5. Susan Poulton, consultant geriatrician3,
  6. Jonathan Treml, consultant geriatrician4,
  7. Martin Wiese, consultant in emergency medicine5
  1. 1National Patient Safety Agency, London W1T 5HD, UK
  2. 2John Radcliffe Hospital, Oxford OX3 9DU, UK
  3. 3Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK
  4. 4University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
  5. 5Leicester Royal Infirmary, Leicester LE1 5WW, UK

As many as one million patient falls are estimated to occur in hospitals each year in the United States, with similar rates reported from most other developed countries.1 In England and Wales about 280 000 patient falls are recorded annually from acute hospitals, community hospitals, and mental health units.2 This is likely to be an underestimate, as all reporting systems are known to under-report.3 Although over 96% of these falls result in only minor or no physical harm, 1390 caused fractures (including 840 hip fractures) and 30 led to intracranial injuries (mostly subdural haematomas).2

Inpatients are particularly vulnerable to falling owing to acute medical problems such as delirium, stroke, systemic infections, and cardiovascular and musculoskeletal conditions and to adverse effects from medications. In addition, the unfamiliar hospital environment may exacerbate the impact of conditions such as dementia and problems with continence, balance, strength, mobility, or eyesight.1

Prevention of falls is a crucial element of patient safety, and resources to help identify and reduce risk factors for falls are widely available.4 However, what happens after a fall is equally important. In particular, early detection and treatment of any injuries sustained, such as subdural haematoma5 and hip fracture,6 may affect outcome critically.

Twelve months of reports to the National Patient Safety Agency before 25 March 2010 indicate that about 200 patients who sustained fractures or intracranial injuries after a fall in hospital experienced some shortfalls of care after their fall. This is likely to be an underestimate owing to under-reporting and minimal detail in many reports on care after the fall. The reviewed incidents suggest that failure to recognise the risks …

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