Supporting Safer Falls Management Through Guideline Implementation at the Whittington Hospital, London

Introduction:
Inpatient falls are a common cause of harm in hospitalised older adults. National guidance from the 2024 National Audit of Inpatient Falls (NAIF) and Royal College of Physicians (RCP) outlines standards for timely and structured post-falls care. This quality improvement project aimed to assess local adherence to these standards and to implement a guideline to support safer, more consistent inpatient falls management.

Method:
A retrospective audit reviewed all inpatient falls reported via the Datix system in May 2024. Falls in clinical areas requiring medical review were included. Electronic CareFlow documentation was used to analyse post-falls assessment, documentation, and delirium recognition. Following this, an inpatient falls guideline was created in alignment with national audit standards and clinical best practice, with the aim to improve the medical assessment of patients following a fall. Additionally, pre- and post-intervention surveys were distributed to junior doctors to evaluate confidence and engagement with the guideline.

Results:
The audit found that 73% of patients received post-fall injury assessments, and documentation was present in 73% of cases, both aligning with national averages. However, only 42% with suspected injury were reviewed within the recommended 30-minute timeframe, and only 11% used the recommended falls proforma, highlighting a gap in structured post-fall assessment. We identified key areas where improvements were needed to meet national standards and enhance patient safety.

Pre-intervention surveys revealed gaps in awareness and confidence, with 45% unaware of existing falls guidance and only 25% ever having used it. After guideline implementation, 75% were aware of the new guideline, and 100% of users rated it highly useful. Most respondents reported increased confidence, particularly in knowing when to escalate and what investigations to request.

Conclusion:
The implementation of a structured inpatient falls guideline improved junior doctors’ confidence and identified key areas for clinical improvement. Embedding the guideline into digital platforms remains essential to ensure sustained engagement and impact.