Abstract
Introduction:
Visual impairment is a key yet often neglected risk factor for falls in older adults. National guidance recommends that vision be assessed routinely as part of a multifactorial falls risk evaluation. This audit aimed to evaluate whether vision was appropriately assessed and documented in patients admitted with falls at Croydon University Hospital.
Methods:
A retrospective audit was conducted on patients admitted under the acute medical take following a fall between the 1st-12th of February 2025. Patient records were reviewed for documentation of vision assessment, history of previous falls, known visual issues, and hospital length of stay. Patients were tracked throughout their admission.
Results:
33 patients were included.
- 48% (16/33) had a documented vision assessment.
- All were recorded as part of a cranial nerve examination, with 75% (12/16) simply described as “NAD” or "grossly intact", lacking detail on visual acuity, fields, or pupillary responses.
- 27% (9/33) had a known visual or ophthalmic condition, including cataracts, glaucoma, or registered blindness.
- 49% (16/33) had a documented history of previous falls.
- 7 patients (21%) remained inpatients by the end of February, underscoring the significant hospital burden associated with falls.
Conclusions:
Visual assessments were inconsistently performed and poorly documented. Despite a high proportion of patients with known visual impairment and recurrent falls, vision was rarely evaluated in a structured or meaningful way.
Recommendations include introducing a dedicated checklist for falls work-up on Cerner, improving access to bedside testing tools in the emergency department and care of the elderly wards, and providing targeted education for staff. A re-audit is planned following implementation of these changes to assess improvements in practice.
Comments
This is really interesting…
This is really interesting and directly related to my PhD which is on the implementation of vision screening in older adults who attend hospital following a fall. It will be great to see re-audit results after recommendations have been implemented.
It would be good to know how staff are recommended to assess vision, including which tests and if this is to be standardised (on the proforma).
Great subject for a quality improvement topic
Hello. Thank you for presenting data on this important piece of work. How much time do you think undertaking a visual assessment would add to the clerking? What other barriers can you foresee that may prevent visual assessments being done? As aishah.baig says, I would also be interested to see the re-audit results.
Excellent job and thanks for the poster.
This is an excellent audit highlighting an often under-recognised contributor to falls. I particularly value the practical recommendations — embedding a checklist within Cerner, ensuring bedside tools are available, and staff education — as these directly target the gaps you identified.
How do you see the balance between improving documentation on Cerner versus ensuring clinicians carry out meaningful vision assessments at the bedside?