The National Institute for Health and Care Excellence clinical guidance CG161 recommends
that all patients admitted to hospital over the age of 65 and those with specific
underlying conditions between the age of 50 and 64 are considered at high risk of falls
and a documented falls risk assessment is undertaken on admission. However, whilst
advising the use of an appropriate multifactorial risk assessment (MFA) NICE also
acknowledges that there is no evidence of the efficacy of most falls prevention methods
in hospital and that high quality randomised controlled trials (RCT) conducted in the UK
are required to improve the existing evidence base.
Falls are referred to as accidents but statistically they have been shown not to
demonstrate a pattern of chance which suggests a causal process. Contributing factors
leading to falls have been recognised as; postural stability, gait, sensory deficit,
neuromuscular impairment, psychological conditions, impact of medications, environmental
risks and medical risks such as stroke and cardiac issues. Significant research has been
undertaken in relation to falls in the community and as such there are useful clinical
guidelines published by both NICE and World Falls Guidelines for preventing and managing
patients falls in their home. Whilst patients may be at less risk in their own
environment, when admitted to hospital usually single or multiple risk factors apply,
even if only for a limited period due to the nature of their presenting condition. It is
therefore necessary to assess all patients who are admitted to hospital to establish the
level of risk they face and to prescribe interventions with the goal of preventing an
accidental fall.
In the UK, 30 - 50% of accidental falls in hospital lead to some injury and 1-3% of those
sustain a fracture. In-patient falls are a significant cause of morbidity and mortality,
with an estimated 247,000 occurring annually at a cost of £2.3billion to the NHS.
In-patient falls have consistently been the biggest single category of reported incidents
since the 1940's. Little has changed in the 39 years since the that paper and with falls
accounting for 85% of all hospital acquired conditions in the USA it is safe to say this
is a global issue. A recent Australian study estimated that the annual cost of attempts
to prevent in-hospital falls across six health services consumed AU$590 million per year
in resources. The areas of greatest investment were 18% physiotherapy, 14% 24 hour
observation, 12% falls assessments and 11% falls prevention alarms and there is a lack of
quality research to support their efficacy as falls prevention strategies. The
generalisable level of success of these strategies is still not known. It seems that
health services across the world are investing time and effort in strategies for which
there is an absence of evidence. The recently published World Guidelines for Falls
Prevention has confirmed there remains no research supporting the use of technology such
as falls alarms or nonslip socks (NSS) in hospitals and as such recommends only standard
falls prevention methods. As a result of increasing reimbursement costs for hospital
treatments, in 2008 the Centres for Medicaid & Medicare Services, health insurance
companies in the United States of America (US), removed reimbursement to hospitals for
costs incurred by patient falls and any associated trauma resulting in increasing
financial burden to hospitals. The impact on staff suffering 'second victim phenomena' as
a result of adverse incidents and the cost to patients who suffer pain, disability, and
death is incalculable.