Improving the number of inpatient falls by introducing inpatient falls risk assessment by doctors in geriatric wards.

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Mohammed Jamali, Phyu Phyu Thant, Siddique Adnan, Abdelmoniem Elmustafa, Thayapary Sivagnanam, Shaha Pennadam Sheriff and Dissanayake Paranathala
Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, Wales, UK.
Clinical Quality
SP - Falls
Falls

Abstract

Introduction

Inpatient falls remain a major healthcare challenge, with an average rate of 6.6 per 1,000 occupied bed-days in NHS England and Wales hospitals. Prevention of falls during hospital stay based on identifying and managing the modifiable risks are challenging. Multifactorial falls risk assessment and prevention action plan (MFRA FPAP) is a proforma booklet adopted by ABUHB. 

Methodology

The initial QIP (2022–2024) revealed incomplete and poor-quality MFRA. Falls champions were introduced for a period of time, it showed an improvement, but was not sustained. Due to a rise in in-patient falls, the QIP was repeated. Eighty patients across three COTE wards were reviewed. Data collection included patient interviews, collateral histories, clinical notes, electronic systems (CWS), and GP records. Bone health was assessed using the FRAX UK score, and falls risk evaluated via MFRA, following NICE 2013 guidelines. We again identified ongoing gaps in MFRA and bone health. To address this, we introduced posters and teaching sessions to raise awareness of falls risk and implemented a one-page falls risk assessment proforma within the ward admission notes, to be completed by doctors along with an action plan.

Results

D4E ward had good compliance with the proforma. Notes of 48 patients (December–March) revealed over 90% completion in MFRA, cognitive, visual, auditory, mobility, footwear assessments, and ECG. Medication review was completed in 100% of cases. Lying/standing BP recordings improved significantly from 32% to 81%. However, bone health and sarcopenia assessments showed slight improvement. Nearly all reviewed elements had corresponding action plans. Falls data showed a reduction from 15 incidents in November to 7 in February.

Conclusion

The quality of falls risk assessment has significantly improved. We plan to extend the proforma to other wards, assign a physician associate to enhance compliance, and include it in our yearly induction programme to sustain improvement.

Comments

Hello. Thank you for the poster about your work. How long does it take to complete this falls assessment? What barriers were there to its completion? How was quadriceps strength measured?

Submitted by alasdair.macrae on

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Thanks for viewing the poster , appreciation for work and asking questions,

Over all it took 6 months.

The 1st cycle was done  during Sept to October 2024, when we  identified ongoing gaps in MFRA and bone health.  In late October and early November 2024, we introduced posters and teaching sessions and implemented a one-page falls risk assessment proforma within the ward admission notes. Thereafter, 2nd cycle was done in December to early March 2025.

Regarding barrier, the major task was  completion of Falls checklist ,we found the doctor's non-compliance likely the major  factor was time needed for assessing these factors , filling the list  and putting action plan in place.

We measured Quadriceps strength by functional status (like standing from seated position etc)and manual resistance test(power).

Thank your for your time to view the poster and asking question.

We believe that Falls check list proforma along with MFRA(filled by nurses) is very crucial  in preventing fall , bone health risk assessment and preventing fractures. But, mostly doctors say, it is overwhelming, time taking, so compliance was poor in 3 out of 4 wards. That is reason, the trust is assigning some physician associates for this job.

 

Thanks.

Thank you for your poster, were you able to review what the outcomes were after MFA in terms of outcomes such as medication changes, onward referrals etc?

Submitted by samdavidolden_27620 on

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Thank your for your time to view the poster and asking question.

After introducing the falls risk assessment proforma  check list along with MFRA , in all 48 patients medications were reviewed and action plan was in place (withhold, stop, start new ones, alternatives, dose changes,  replacing etc) which was encouraging. 

Regarding referrals ,if it is for bone health related ,10% pts were already on bone protection, 90% patients have FRAX UK score calculated and over 90% were actioned as per guidelines(for DEXA scan, start bone protection and referral to bone health team) .

Thanks.

 

Thank you for your poster and how informative it is. Would you think of including this assessment in all patients >65 admitted with a fall?

Submitted by hjweir189@gmail.com on

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Thank you for  your time to view the poster and for asking question,

As per NICE 2013 guidelines , we will consider assessing  following vulnerable patients. 

  1. All adults aged 65 or over with a history of two or more falls in the past year.
   2. with co-morbidities or taking drug therapies commonly associated with increased fracture risk.
 
Thanks.
 
 

Thank you for the wonderful work.may Iask you how did you manage postural hypotension as most of the patients are on anti-htn drugs and have concommitant orthostatic hypotension.Postural instability is one of the major causes of the falls and  lead to the delay in the hospital discharge .

Submitted by mehreenanis@ho… on

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Thank you very much for your kind feedback and for raising such an important point. 

 

You are absolutely right—postural hypotension is a significant contributor to falls and can delay recovery and discharge, particularly in patients already on antihypertensive medications.

In our pathway, postural hypotension is routinely assessed as part of the Multifactorial Risk Assessment (MFRA) and double check in single page falls checklist proforma. When identified, medication review is carried out in collaboration with the medical team to adjust or deprescribe antihypertensives where clinically appropriate. In addition, non-pharmacological measures such as gradual mobilization, hydration, and use of compression stockings are recommended. Nurses and physiotherapists also play a key role in monitoring blood pressure and supporting safe mobilization.

This multidisciplinary approach has been essential in managing postural hypotension while still maintaining good blood pressure control.

 

Thanks

Interesting idea. I can see that you've mentioned that the biggest barrier was that it was time consuming for doctors and that this proforma was included with admission notes. Over what period of time is this expected to be completed over  e.g. are all components to be completed within 24h? I imagine if different staff are present each day it may be quite difficult to have to check for all patients or hand this over between teams. Is there a possibility of putting this on electronic notes?

Submitted by ealish.brew_30367 on

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Thank you for viewing the poster and for your very good question.

 

Ideally, the MFRA is completed within 48–72 hours, while the one-page Falls Proforma is completed in the same timeframe with an action plan in place. Although occasional delays occur, it still adds clinical value. The form does not necessarily need to be filled by a single doctor; it can be updated by different doctors or health professionals as actions are taken. While it can be completed electronically and printed for notes, it is not yet integrated into our trust’s electronic system and is therefore mainly used in paper format.

 

Thanks,

These  include the  following high risk patients as well,

  1. Age ≥50 with a new fragility fracture

   2. Age ≥50 with a vertebral fracture

Thanks

Submitted by muhammadrahib… on

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This was an interesting poster. Were doctors involved in all the assessments and the data collection exercise? How did your staffing levels allow this given other clinical commitments of residents on the wards? Would be helpful to know as I imagine all those interviews etc will be time consuming!

Submitted by aloysius.d_souza on

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