Evidence-base: Visual impairment (VI) is a well- established risk factor for falls. Compared with normal-sighted people, people with VI are almost twice as likely to fall and have recurrent falls with subsequent fractures.1 Poor vision is commonly under-recognised, and elderly patients often fail to attend for free NHS eye examinations. The NICE guideline on falls prevention recommends that all patients undergoing falls assessment are screened for visual impairment.2
Change-strategies: The initial audit assessed current visual assessments and follow up in patients undergoing falls assessment in a day hospital, by prospective case note review over an 8 week period. Following this, an education session on a newly designed assessment tool, referral pathway guideline and provision of a standardised referral letter to optometry services, was delivered to the multidisciplinary day hospital team. A re-audit was then conducted over the same time frame and statistical analysis performed.
Change effects: 'There were 87 patients in Cycle 1, and 99 patients in Cycle 2. Following the intervention, significantly more patients underwent assessment of visual acuity (99% vs 87%, p = 0.0023). Of those identified with VI, there was a significant improvement in referral to optometry services (55% vs 33%, p = 0.0028) and less patients with VI were discharged from the day hospital without any follow-up (7% vs 33%, p = 0.0001).
Conclusions: The interventions that were introduced led to a statistically significant improvement in the assessment of visual acuity. More patients identified with visual impairment were referred for ongoing assessment by their optometrist and fewer patients were left without follow-up. These results were presented back to the day hospital team in order to reinforce the new protocols for assessment and onward referral.