Abstract
A Project on Inpatient Falls: Are We Adequately Addressing Bone Health?
Introduction
Inpatient falls in older adults frequently lead to fragility fractures, with femoral fractures occurring in up to 82% of cases (RCP, NAIF 2023). These injuries significantly impact long-term morbidity and cost the NHS an estimated £4.4 billion annually (ROS, 2022). Despite tools like FRAX and national guidance (NOGG, 2021; NICE, 2022), bone health assessments remain inconsistently performed in the inpatient setting after a fall.
Objectives
To evaluate whether inpatients who experienced falls received appropriate fracture risk assessment and bone protection in line with NICE and NOGG recommendations.
Methods
We conducted a retrospective review of 35 randomly selected inpatients who fell during admission (April–May 2023) in a UK Trust. Cases were identified via DATIX. A structured proforma was used to review falls documentation, FRAX calculation, risk categorisation, bone protection prescribing, and relevant blood tests.
Results
Falls assessments were completed in over 80% of cases. However, only 33.3% had a documented FRAX score. Of these, 60% were intermediate risk, 20% high risk, and 10% very high risk. Among high-risk patients, only half received oral bisphosphonates. Retrospective FRAX calculations showed that 60% of unassessed patients would have been very high risk. Vitamin D levels were more consistently checked, but overall practice remained below national standards. Renal impairment limited bisphosphonate use in over half of eligible cases.
Conclusion
Bone health is under-assessed in older inpatients following falls. Improved adherence to NOGG and NICE guidance, particularly the routine use of FRAX and careful consideration of renal function, is needed. Simple interventions such as falls alert stickers and focused education for clinicians may enhance practice and reduce fracture risk.
Comments
Inpatient Falls
Hello. Thank you for showcasing your quality improvement work. Who inserts the sticker into the notes and where does it go in the notes (outside the front of the notes or at the current inpatient page? What are your thoughts on inserting the results / scores on the sticker?
Hi, thank you for your…
Hi, thank you for your comment and interest.
The clinician who assesses the patient after a fall and completes the Falls Assessment Proforma will place the sticker in the medical notes. The sticker is positioned at the point where the next entry in the notes is expected, so that if a fall occurs out of hours and the on-call doctor is unable to assess bone health due to the acute nature of their duties, the day team will not overlook the sticker. The results of the bone health assessment are documented directly on the sticker.
Thank you for your comment…
Thank you for your comment and interest.
The clinician who assesses the patient after a fall and completes the Falls Assessment Proforma will place a sticker in the medical notes. The sticker is positioned at the point where the next entry is expected, so that if a fall occurs out of hours and the on-call doctor is unable to assess bone health due to the acute nature of their duties, the day team will be prompted to review it. The results of the bone health assessment are documented directly on the sticker.
Thank you for the poster, do…
Thank you for the poster, do you feel there would be value in utilising these stickers or an equivalent checklist for those who would be considered at risk rather than waiting for the fall to occur?
Thank you for your comment…
Thank you for your comment and for taking an interest in the poster. That’s a great idea and definitely worth exploring further. The current project focused on assessing bone health following inpatient falls, but I agree that utilising these stickers for patients identified as high risk of falls could be a valuable approach. It could encourage clinicians to assess bone health proactively and serve as a useful screening tool. This might also help increase bone health assessments in non-geriatric wards, where such checks are not done as routinely as in geriatric wards.