Improving Compliance with Vision Assessment in Older Adults admitted with falls: A Quality Improvement Project

Introduction:

Falls are a leading cause of morbidity in older adults. NICE guidelines recommend that all older patients admitted with a fall undergo a vision assessment as part of the multifactorial falls risk evaluation. Despite this, compliance in clinical practice is often suboptimal. We undertook a quality improvement (QI) project to assess and improve adherence to this guideline at Wythenshawe Hospital.

Method:

A retrospective audit of case notes and electronic records was conducted over a 3-month period to evaluate the proportion of patients admitted with falls who had a documented vision assessment. Following baseline analysis, interventions were introduced:

1. Educational posters displayed on wards and nurse stations.

2. Development of a user-friendly vision assessment tool within the electronic patient record (EPR) system.

3. Incorporation of vision assessment into the comprehensive geriatric assessment (CGA) template.

A repeat audit was carried out over a subsequent 3-month period to evaluate impact.

Results:

At baseline, compliance with vision assessment was 2%. Following the interventions, compliance improved to 22%. While this represents a marked improvement, documentation of vision assessment remains below the recommended standard, highlighting ongoing challenges in embedding this practice into routine care.

Conclusion(s):

Simple educational interventions and integration of prompts into electronic systems can substantially improve compliance with guideline-recommended vision assessment in older adults admitted with falls. However, further work is needed to sustain and build on these gains. Potential strategies include staff training sessions, audit-feedback cycles, and making vision assessment a mandatory component of admission clerking. Improving adherence has the potential to optimize falls risk evaluation and ultimately enhance patient outcomes.