Implementation of the Multifactorial Assessment to Optimise Safe Activity (MASA) to Reduce Inpatient Falls in Older Adults

Introduction: Hospital-acquired deconditioning is a major contributor to inpatient falls, with evidence showing that immobility imposed to prevent falls can paradoxically increase fall risk. In response, the 2024 National Audit of Inpatient Falls (NAIF) advocates a shift from falls prevention to promoting safe activity through a structured Multifactorial Assessment to Optimise Safe Activity (MASA), encompassing six domains: vision, lying and standing blood pressure (LSBP), medication review, delirium, mobility, and continence.

Method: A two-cycle quality improvement project was conducted on three Elderly Care wards and one stroke rehabilitation ward at St Thomas’ Hospital. In November 2024, we audited the assessment of MASA components in 112 inpatients. Interventions included integrating vision and delirium assessments into the Comprehensive Geriatric Assessment (CGA) tab for admitting clinicians, and discussing inclusion of measuring LSBP into the admissions nursing proformas. Cycle 2 re-audited the same wards in March 2025.

Results: At baseline, MASA components showed varied completion: vision 25%, LSBP 9.4%, medication review 100%, delirium 67%, mobility 97%, and continence 100%. Post-intervention, improvements were seen in vision (73%, p < 0.001) and delirium (81%, p = 0.14); however, LSBP remained low at 12% (p = 0.53). Medication, mobility, and continence assessments remained high across both cycles. Compared to the NAIF national data, our post-intervention figures exceeded national benchmarks for all domains except LSBP.

Conclusion: This project supports the feasibility and benefit of using MASA to promote safe activity and reduce fall risk. Significant improvement in vision and delirium assessments was achieved, reflecting the impact of integrating the CGA in admission clerkings. Persistent underassessment of LSBP highlights the need for further systems-level changes. Embedding MASA within routine clinical pathways may enhance patient safety by addressing deconditioning-related falls risk proactively.