‘Decaf by Default’ and Its Wider Impact: Reducing Toileting Falls, Supporting Continence and a Positive Care Environment

Introduction
Caffeine can adversely affect patient safety by increasing bladder urgency and agitation, raising fall risk, especially among older people. NICE guidance (2019) recommends reducing caffeine intake for individuals with overactive bladder. However, caffeinated drinks often remain the default in healthcare settings. In 2021, University Hospitals of Leicester NHS Trust (UHL) achieved a 30% reduction in toileting-related falls after making decaffeinated hot drinks the standard. In 2023, staff at Northumbria Healthcare NHS Foundation Trust (Northumbria) identified similar concerns. A local audit revealed 25% of falls were toileting-related, prompting collaboration with UHL to understand and adapt their approach.

Method
Northumbria applied Quality Improvement methodology, running two Plan-Do-Study-Act (PDSA) cycles across 15 inpatient areas. Key outcomes measured included reduction in toileting-related falls, increased staff advocacy for decaffeinated options, preservation of patient autonomy, and improvements in sleep and agitation. UHL embedded patient education through a “Taste the Difference” campaign; among 699 surveys, 50% reported no taste difference, and 76% preferred decaf when informed of health benefits. Northumbria followed a similar approach, with comparable feedback.

Results
At UHL, 63% of patients with overactive bladder reported symptom improvement. Northumbria’s pilot care home saw a 20% reduction in overnight pad usage. Toileting-related falls at Northumbria decreased by about 20%, with seven wards achieving reductions over 50%. No clear trends emerged by ward specialty or time of day. Additionally, 70% of ward managers reported improved patient sleep and reduced agitation. UHL noted similar anecdotal improvements, especially among patients with mental health conditions.

Conclusion
This initiative suggests that switching to decaffeinated drinks as the default can significantly improve patient safety, continence, and care experience. The collaborative model empowered staff, elevated patient voices, and promoted safer, person-centred care.

National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. 2019. https://www.nice.org.uk/guidance/ng123