The Fallsafe Project

Introduction to Fallsafe

All hospital staff, from Chief Executive to Care Assistant, express a wish to make their patients’ stay in hospital safer, and to reduce the risk of adverse events such as inpatient falls. Despite these sentiments, effective change has been the exception.

There are several reasons for this. Falls prevention is just one of a seemingly endless stream of initiatives and priorities for ward staff to cope with. There has been no clear statement or guideline of what falls reduction among inpatients consists of, and exactly what needs to be done, how, and by whom. Often there is no clear clinical leadership. There is a general feeling of despondency that inpatient falls cannot be prevented, that a lot is already done, with a lack of faith in further interventions. There is a need for training of staff in falls prevention, but currently such training is not readily available, and the number of people to be trained is enormous.

The Project

The FallSafe project was designed to overcome this stalemate, taking the elements of care found in successful Random Control Trials (RCT) of inpatient falls reduction from the review by Oliver et al1, and putting them together in a care bundle. The care bundle is evidence based in that individual elements have been used in successful studies of multifactorial interventions to reduce inpatient falls (but not in the sense that the whole bundle has been subjected to an RCT).

We know that in RCTs of multifactorial inpatient falls prevention, reductions in fall rates of 20-30% can be attained.

We recruited 16 wards of a variety of types (rehabilitation, psychiatry, trauma, medicine, surgery) across 12 hospitals in South Central Region. A band 5 or band 6 nurse (called a FallSafe lead) takes responsibility for introducing the elements of the care bundle onto the ward over several months, training and encouraging the ward team to use it, and auditing its introduction. Falls are recorded through the hospital risk management systems in the usual way.

We have provided training for the FallSafe leads, with about 8 training days over the two year period. Around half the time is spent on clinical aspects of falls prevention and half on improvement skills. There is support and encouragement from a project manager, peer support at our training days and through a website, and extra sessions for wider ward teams. Members of the project team have visited some of the wards to support the FallSafe leads, and to resolve local issues. We have also provided two additional resources: a plan of what to do after a fall (sent out by the NPSA as an alert to all Trusts, and published in the BMJ (2)), and evidence based guidance on what a medication review in the context of falls means.

All the wards have started from different baselines and there have been marked improvements in processes, including reductions in use of night sedation and increases in screening for UTIs and postural hypotension, and we hope that will continue until the project finishes in March 2012 (and beyond!). Outcomes in terms of falls will not be available for six more months – we are trying to avoid a common problem of falls prevention projects - claiming success too soon.

Using the FallSafe Care Bundle in Safety Express

Many geriatricians will be involved with a project called Safety Express (Box 2). One part of this aims to reduce inpatient falls using a care bundle approach. Despite the fact that our project is not yet finished, we have agreed to share our care bundle with Safety Express. It is based on the best available evidence, supported by simple process measures, and has been shown to be feasible to implement in a wide range of wards. We hope that will enable Safety Express to be implemented more easily, and contribute to its success.

The package consists of 4 parts:

• the care bundle
• guidance notes on the details of the care bundle and its implementation
• evidence based guidance for doctors regarding medications and falls
• guidance on procedures to follow after an inpatient fall

These will be available on the BGS website and can be downloaded. They have been endorsed by the BGS, and we encourage their dissemination and use.