The Royal College of Physicians’ Fallsafe care bundles applied trustwide: the Northumbria experience 2013

Editor – Richardson and colleagues should be applauded on widely implementing the RCP Fallsafe care bundles in Northumbria and for the large audit that was carried out.¹ They showed an improvement in compliance with the measures recorded before and after the introduction of the bundle. This mirrors the RCP Fallsafe project itself.

However, despite a slight decrease in falls, the number of falls per 1,000 bed days increased in this audit. This is an identical reflection of the RCP original assessment of the falls care bundle wherein there was an actual increase of 12% in falls after the introduction of the bundle. The reported falls per occupied bed days showed an increase consistently with and without harm in the acute and community settings but not in mental health.² The RCP document explained that was due to ‘under-reporting’ before the project and therefore calculated that rather than being harmful this was actually beneficial by correcting for likely under-reporting.

A reproduction of the RCP care bundle in Northumbria in fact shows an increased harm, ie an increase in the number of falls confirming what the initial RCP project showed ie an increase in the number of falls notwithstanding the calculation for under-reporting. Is it time to abandon the Fallsafe bundle and for the RCP to at least attempt a review if not a randomised controlled trial to finally clarify whether the bundle is harmful (as it appears at present on both the initial RCP data and the Northumbria experience) or beneficial? Our patients deserve better – in the case of falls, it seems masterly inactivity may be best, ie continuing current simple measures like blood pressure lying and standing checks, reviewing medication and encouraging therapists – without the cumbersome introduction of the comprehensive bundle with all the personnel and the paperwork associated with it.

Indeed, Richardson and colleagues aptly conclude at the end: Fallsafe advocates, falls teams, trust board members and clinical commissioning groups (CCGs) should be aware of possible confounding influences and limitations when setting possible target measures for inpatient fall reduction. These are wise words for CCGs.