Abstract
Introduction
Inpatient falls in older adults frequently lead to fragility fractures, with femoral fractures occurring in up to 82% of cases (RCP, NAIF 2023). These injuries significantly impact long-term morbidity and cost the NHS £4.4 billion annually (ROS, 2022). Despite tools like FRAX and national guidance (NOGG, 2021; NICE, 2022), bone health assessments remain inconsistently performed after a fall.
Objectives
To evaluate whether inpatients who fell received appropriate fracture risk assessment and bone protection in line with NICE and NOGG recommendations.
Methods
We conducted a retrospective review of 35 randomly selected inpatients who fell (April–May 2023) in a UK Trust. Cases were identified via DATIX. A structured proforma was used to review falls documentation, FRAX calculation, risk categorisation, bone protection prescribing, and relevant blood tests.
Results
Falls assessments were completed in over 80% of cases. However, only 33.3% had a documented FRAX score. Of these, 60% were intermediate risk, 20% high risk, and 10% very high risk. Among high-risk patients, only half received oral bisphosphonates. Retrospective FRAX calculations showed that 60% of unassessed patients would have been very high risk. Vitamin D was more consistently checked, but overall practice remained below national standards. Renal impairment limited bisphosphonate use in over half of eligible cases.
Conclusion
Overall, poor assessment of bone health after inpatient falls was observed. This led to our first intervention: the introduction of a falls alert sticker to be placed in the medical notes. A re-audit to assess the effectiveness of the above measure is ongoing. In the longer term, the Trust-wide proforma used for assessing inpatient falls is being rewritten to incorporate better signposting to the Trust and NOGG guidance. We hope that improved adherence to NOGG and NICE guidance, particularly the routine use of FRAX will allow more comprehensive assessments and timely treatment where appropriate.
Comments
Excellent demonstration of bone health assessment
You have demonstrated well how bone health assessment should be incorporated on inpatient falls. This is being missed on my experience and could potentially prevent re-admissions and refractures. I need to echo this in our local orthogeriatrics service and senior managers since we do not deal with inpatient falls due to not enough staffing. Well done!
Thank you so much for your…
Thank you so much for your interest in the work. We have a trust wide post falls assessment proforma which has to be completed by both nursing and medical team. Our current aim is to integrate bone health assessment into that proforma.