The Falls toolkit bundle aims to support a reduction of inpatient falls and falls with harm.
What is a bundle?
A bundle is a structured way of improving the processes of care and patient outcomes: a small, straightforward set of evidence-based practices that, when performed collectively and reliably, have been proven to improve patient outcomes. (SPSP Pioneering Patient Safety)
For All Patients:
All adult inpatients must have a falls risk assessment within 24 hours of admission and the following actions must be completed in that time period:
- Complete and document the screen for more vulnerable patients (5Qs – see below)
- On admission, immediately document assessment of mobility.
- Provision of walking aid as required and that it is within easy reach.
- A working Call bell is in reach.
- The patient is wearing or has appropriate footwear.
- If glasses and hearing aids are required and are in use.
5 Questions (5Qs)
If the patient answers “yes” to any of the five questions, the patient is identified as “more vulnerable” to falls.
- Has the patient fallen in the last 6 months – including during this admission?
- Does the patient have a 4AT greater than 0 or acute confusion (delirium)?
- Does the patient attempt to walk alone although unsteady or unsafe?
- Does the patient or their relative/s have fear or anxiety re falling?
- Based on your clinical judgement, is this patient at high risk of falling
Safety Bundle for more vulnerable patients (and all in care of elderly wards)
- Communicate mobility status for walking and transfers (safety brief)
- Chair and bed consistently at best height for individual, to enable safe transfers
- Identify patients with cognitive impairment and/or with poor mobility and known not to ask for assistance, and provide close observation whilst using the commode, toilet, in bath or shower
- For patients known to take risks with mobility, clearly document intensity of observation required (positioning of bed; cohorting; 1:1, care and comfort rounds
- Assess for bedrails using a decision making tool / algorithm and use if indicated
Multidisciplinary Assessment and Intervention Bundle (for Vulnerable patients and all in care of elderly wards)
- A documented cognitive assessment and delirium screen, with findings recorded and action plan initiated
- Bladder and bowel dysfunction with diagnosis, treatment / management plan recorded
- A documented assessment of postural hypotension and arrythmias, with management plan recorded
- A documented medication review for medications that can increase the risk of falls, with management plan recorded (1-4 of this bundle parralels the Comprehensive Geriatric Assessment) see * below.
- Multidisciplinary review of further falls risk factors with management plan recorded
*In addition to bundle components 1-4 this includes a falls history, (including causes and consequences such as injury and fear of falling), health problems that may increase their risk of falling, postural instability, mobility problems and/or balance problems, syncope syndrome, visual impairment and assessment of fracture/osteoporosis risk.
Post fall bundle
- Assess for signs and symptoms of fracture or potential spinal injury before the patient is moved
- Safe manual handling methods for patients with signs and symptoms of fracture or potential for spinal injury
- Frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (e.g. un-witnessed falls) based on guidance
- Adhere to agreed timescales for medical examination following a fall or high vulnerability to injury, or who have been immobilised
- Conduct a post fall review / rapid root cause analysis (to learn how further falls can be prevented for the patient and annotate during report of incident for wider learning).
