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Abstract
Falls among older inpatients are a significant cause for concern, yet currently there is no national guidance on falls prevention programmes, and little evidence from the research literature on the effectiveness of hospital prevention programmes. This article explores the unique problems associated with falls in hospital, particularly the issues related to observation and supervision of patients with cognitive impairment. The evidence base for falls risk assessment and prevention strategies is examined. An interprofessional, multidimensional approach to falls and injury prevention is suggested as the most likely approach to be effective in hospital, and the contribution of specific strategies such as exercise and hip protection are examined. Ethical issues are considered and the role of restraint in falls management is rejected. The Kings College Hospital inpatient falls prevention programme is described as a practice example of an interprofessional, multidimensional approach. Finally, the nurse's role in implementing falls prevention strategies and leading future practice development is identified.
Key words: Accident prevention * Elderly: accidents * Risk management
A fall is defined as: 'An event which results in a person unintentionally coming to rest on the ground or another lower level, not as a result of a major intrinsic event (such as a stroke) or overwhelming hazard' (Tinetti et al, 1988).
Hospitals can be very dangerous places for older people: the frequency of falls is considerably higher in hospital than for people living in their own homes, and has been cited as between 2.9 and 13 falls per 1000 bed days (days on which beds are occupied) (Morse, 1996). The consequences for hospital patients may be serious - death, fractures, non-bony injuries, loss of confidence, fear of falling and increased dependency may all result from a fall in hospital.
For patients who are already ill or debilitated, injuries such as hip fractures can be particularly significant. For example, at the author's acute trust, 12 inpatient hip fractures occurred on acute wards for older people within 1 year (unpublished accident report data to July 2001). This resulted in increased length of stay, pain and distress to the patients and an estimated cost to the NHS trust of between £5340 and £12 500 per patient for additional treatment and aftercare. It is this type of statistic that can...