Improving Hospital Fall Management: Findings from a Second-Cycle Quality Improvement Project

Introduction

Falls are a significant cause of patient harm in hospitals. Effective fall management requires timely assessment, early identification of risk factors, intervention, and thorough documentation. A quality improvement project (QIP) assessed compliance with key fall management measures through audit cycles. The second audit cycle evaluated progress following interventions implemented after the first audit.

Methods

A retrospective audit was conducted to assess adherence to post-fall assessment protocols. Key areas examined included timeliness of assessment, documentation of vital parameters, sepsis and delirium screening, medication reviews, and reliance on paper-based records. Findings from the second audit cycle were compared to initial audit results.

Results

Marginal improvements were observed in timely assessments and sepsis/delirium documentation. However, major deficiencies persisted. Blood pressure (BP) checks, electrocardiogram (ECG) documentation, and neurological observations remained suboptimal. Only 41% of patients with head injuries had clear neurological observations recorded. ECG documentation was absent in 92% of cases, and BP assessments were incomplete in 68%. Reliance on paper documentation remained high at 86%, and only 22% of patients had medications reviewed post-fall.

Conclusion

Despite interventions, significant documentation gaps remain, potentially leading to missed opportunities for early detection of complications such as arrhythmias, hypoglycaemia, or neurological deterioration. Further measures, including mandatory digital documentation fields, real-time audit feedback, and enhanced staff training, are recommended to improve compliance and patient safety outcomes.