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National Patient Safety Agency

Essential care after an inpatient fall

Thursday 27 January 2011


The National Patient Safety Agency (NPSA) has issued guidance to NHS organisations in England and Wales, aimed at improving care after a patient has suffered a fall in a clinical setting.


NHS organisations with inpatient beds are encouraged to ensure safe manual handling and  prompt assessment and treatment of a patient after a fall has happened as this greatly increases the chances of a patient making a full recovery.


Each year around 282,000 patient falls are reported to the NPSA. This latest Rapid Response Report (RRR) has been produced because a proportion of the patients suffering injuries did not receive prompt and correct diagnosis and treatment of their injuries. A significant number of these result in death, severe or moderate injury, including around 840 fractured hips, 550 other types of fracture and 30 intracranial injuries1.


This RRR asks NHS organisations with inpatient beds to ensure that:


  • they have a post-fall protocol that includes:

a) checks by nursing staff for signs or symptoms of fracture or potential for spinal injury before the patient is moved;

b) safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury*;

c) frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (e.g. unwitnessed falls) based on National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 56: Head Injury;

d) timescales for medical examination following a fall (including fast track assessment for patients with signs of serious injury, or high vulnerability to injury, or who have been immobilised).   

  • their post-fall protocol is easily accessible (e.g. laminated versions at nursing stations).

  • their staff have access to clear guidance and formats for recording neurological observations using a 15 point version of the Glasgow Coma Scale (GCS) and that changes in the GCS that should trigger urgent medical review are highlighted. 

  • NHS organisations should also ensure that staff have access at all times to special equipment (e.g. hard collars, flat-lifting equipment, scoops)* and colleagues with the expertise to use it, for patients with suspected fracture or potential for spinal injury.

  • systems are in place allowing inpatients injured in a fall access to investigation and specialist treatment* that is equal in speed and quality to that provided in emergency departments and conforms to NICE Clinical Guideline 56: Head Injury.

Frances Healy, Joint Head of Patient Safety (Response/Medical Specialties) at the NPSA, said:


“A patient falling is the most common patient safety incident reported to the National Reporting and Learning System. Although some falls cannot be prevented without unacceptable restrictions to patients’ rehabilitation, privacy or dignity, many falls can and should be prevented. The NPSA has previously produced a range of resources to support staff in their efforts to reduce the risk of falls and injury.


"Even where staff cannot prevent a fall, they can make sure the patient receives a prompt and effective response that gives them the best possible chance of recovering from any injury and avoiding future falls. More can be done to ensure that patients are appropriately cared for after a fall and this RRR supports the NHS in achieving this.”


For a copy of this latest RRR, please visit http://www.nrls.npsa.nhs.uk/resources/type/alerts


Reference 1: National Patient Safety Agency. 2010 Slips trips and falls data update NPSA: London http://www.nrls.npsa.nhs.uk/resources




Notes to editors


1. Media enquiries to the NPSA Press Office:


020 7927 9362 / press.office@npsa.nhs.uk


Out of hours – 0788 411 5956


2. Following the publication of the Arms Length Body Review on 26 July 2010, the NPSA has stressed the importance for all NHS organisations across England and Wales to continue reporting patient safety incidents through the National Reporting and Learning System. This is so that trends in safety incidents can be identified and acted upon as early as possible.  This aspect of our work will continue within the new proposed structure of the NHS Commissioning Board and we will continue to work together in partnership with NHS organisations to make services even safer for patients. We will continue to monitor the implementation of all patient safety alerts and guidance.


3. * Community hospitals and mental health units without equipment or expertise may be able to achieve this in collaboration with emergency services.