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
This is a well-conceived…
This is a well-conceived quality improvement project addressing a critical risk in hospital care — inpatient falls. By shifting the responsibility for completing a falls risk assessment (MFRA) to doctors at admission and embedding it as a one-page proforma in the ward notes, the authors have demonstrated a pragmatic approach to improving compliance. Their results are encouraging: over 90 % completion in key domains (cognition, vision, mobility, ECG, medication review) and a meaningful drop in falls from 15 to 7 over a few months (November → February).
This is an well-structured…
This is an well-structured QIP addressing a key aspect of inpatient safety. The project demonstrates clear use of QI methodology, measurable improvement in compliance and outcomes, and strong focus on sustainability through education and system integration.