Frontline-Led Innovation in Dementia Care: A Falls Prevention Pilot Delivering Measurable Impact and Scalable Solutions

Introduction

Inpatient falls among older adults living with dementia are a significant patient safety challenge in acute hospital settings. Disorientation in unfamiliar environments and variable staff confidence in mobilisation contribute to avoidable harm, distress, and increased healthcare costs. This quality improvement project aimed to test the feasibility and early impact of a dementia-friendly environmental and training intervention on an acute elderly care ward.

Method

A quality improvement pilot was conducted on Hardy Ward, an acute elderly care ward within a large NHS Trust. Using a pre–post design, falls data from March–June 2025 were compared with a pilot implementation period from July–October 2025. The intervention combined dementia-friendly environmental cues (signage and orientation clocks), introduction of a structured early mobilisation and safe transfer assessment tool, and staff education delivered using a Train-the-Trainer model. Falls incidence, location (bay versus side room), contributory factors, patient relatives and staff feedback were analysed using routinely collected incident reporting data. Outcomes were benchmarked against two comparable elderly care wards without the intervention.

Results

The pilot achieved a 6.7% reduction in inpatient falls, exceeding the predefined improvement target of 5%. During the pilot period, Hardy Ward recorded the lowest average monthly fall rate compared with comparator wards. Notably, 29% of remaining falls occurred in side rooms where dementia-friendly signage could not be installed due to environmental constraints. Staff reported improved confidence in mobilisation, Patient relatives and staff reported reduced patient agitation, and a calmer ward environment. Using NHS Improvement cost estimates (£2,600 per fall), early cost avoidance was demonstrated with projected annual savings exceeding £50,000 if sustained.

Conclusion(s)

This pilot demonstrates that dementia-friendly environmental cues combined with structured staff training can improve patient safety and staff confidence in acute older people’s care. Implementation learning has informed a phased Trust-wide rollout strategy. The intervention is low-cost, scalable, and transferable to other inpatient and community settings.