Introduction: Falls are a major cause of disability and the leading cause of mortality resulting from injury in older adults in the UK [Close, Ellis and Hooper (1999, Lancer, 353, 93–97)]. Evidence shows that substantial numbers of falls among elderly people can be prevented through timely multi-factorial risk assessment and appropriately skilled management [Gillespie, Roberson, Gillespie et al. (2008, Cochrane Database System Rev, 2, CD007146)]. NICE Clinical Guideline 21 states that older patients who present with a fall should be offered a multi-factorial falls risk assessment.
This audit assessed, by means of a prospective case notes review, whether patients transferred to the orthogeriatric ward following falls complicated by fractures had undergone a multi-factorial falls risk assessment following NICE guidelines.
Change strategy: Following Cycle 1, a formal ‘Falls Risk Assessment Tool’ was introduced. This was a paper form with domains for completion by different members of the multi-disciplinary team (MDT), based on NICE guideline. It was agreed with the Consultant and MDT prior to implementation. Staff within the MDT were encouraged to use them for each patient.
Change effects: Following the introduction of the ‘Falls Risk Assessment Tool’, there was an improvement in documentation of 8 of the 12 domains. Documentation of visual assessment increased from 27 to 88%, formal cognitive assessment from 24 to 60%, continence assessment for incontinent patients from 24 to 66%, documentation of number of falls from 0 to 60%, medication review from 80 to 96%, neurological examination from 29 to 44%, prescription of osteoporosis medications from 59 to 68% and physiotherapy assessment from 97.5 to 100%.
Conclusions: Our audit demonstrates that the introduction of a formal risk assessment tool, where each domain can be ‘ticked off’ when completed, is effective at encouraging a change in practice and improving adherence to recommended guidelines.