Table 2.

RCP FallSafe care bundle measures in Northumbria Healthcare NHS Foundation Trust (Continued)

RCP FallSafe care bundle measureNHCFT adaptation/method of data collection
Bundle for all patients
A history of previous falls and of fear of falling is taken at the time of admissionRecorded in the adult nursing documentation (electronic software NerveCentre). A positive answer to this question then directs the nursing team to complete the falls care plan in NerveCentre. This measure can be audited remotely
Urinalysis is conducted on admissionUrinalysis has now been removed from the RCP FallSafe care bundle in line with NHSI CQUIN 2019/2020
New prescriptions of night sedation are avoidedNo prescriptions of night sedation. NHCFT now uses the electronic software MedChart for all inpatient medication prescription. All medications listed as a hypnotic or sedative in the BNF have an alert, so that if prescribed on admission or during the inpatient stay, the prescriber is alerted to the fact that this medication is a falls risk factor and that they need to identify a rationale for its new prescription or its continuation, before it can be prescribed in hospital in compliance with NHSI CQUIN 2019/2020. This measure can be audited remotely
A call bell is in reachMeasure usually audited at the patient's bed space. Some patients, who were freely ambulant, were not included when using day rooms or sitting areas. However, immobile patients, or patients who required assistance to mobilise, who were placed in such areas are audited
Appropriate footwear is available and in useA significant number of elderly patients are admitted without suitable or appropriate footwear. For those without appropriate footwear, the trust has purchased supplies of slipperettes. These come in three sizes and have a sole with rubber grips, which, if worn appropriately, make mobilising on the shiny hospital floors less hazardous. In addition, for those who require slippers but cannot source them, a limited supply is available after a physiotherapy review
There is immediate assessment for and provision of walking aidsMeasure audited at the patient's bed space. We initially found there was a misplaced perception that by taking the walking aid away from a confused patient you will stop them attempting to mobilise. This had led to the walking aids being tidied at the end of the bay or deliberately placed away from the patient's immediate reach. Where this problem was encountered additional education was provided to the ward and therapy staff by the falls team
Bundle for older and more vulnerable patients
A cognitive assessment (Montreal cognitive assessment (MoCA) or abbreviated mental test score (AMTS)) is conducted in all admissions aged >70 yearsAssessed by reviewing the information recorded in the ED admission document and the adult nursing documentation (electronic software NerveCentre) – part of an existing trust CQUIN project
Those at risk are tested for delirium (confusion assessment method (CAM))Assessed by reviewing the information recorded in the ED admission document and the adult nursing documentation (electronic software NerveCentre) – part of an existing trust CQUIN project
An assessment of risk versus benefit for use of a bedrail is conductedAssessed by reviewing the ‘bed height, rail and mat matrix’ included in the adult nursing documentation (electronic software NerveCentre)
Visual assessment is conductedSpectacles are within sight and reach: this measure was added into the care bundle for all patients and audited at the patient's bed space
Visual assessment: the first two parts of the RCP visual assessment are recorded in the adult nursing documentation (electronic software NerveCentre)
Lying and standing blood pressure are taken with a manual sphygmomanometerRecorded using automated blood pressure monitoring devices as per a specific protocol included in the adult nursing documentation (electronic software NerveCentre). Additional training and support for ward teams is provided from the NHCFT falls team
Medication is reviewed with respect to cardiovascular and central nervous system acting medicationsAssessed by review of the patient's drug charts (electronic software MedChart) and comparing the medication list to Medicines and falls in hospital: guidance sheet11
Based on observation, toileting arrangements are assessed and planned (tailored to needs rather than the standard 2-hourly arrangement)Assessed by reviewing the continence pathway included in the adult nursing documentation (electronic software NerveCentre)
Bundle for after a fall
After a fall, appropriate assessments and procedures are followed, including neurological observations in those who have hit their head or had an unwitnessed fallThe falls team had previously modified a Nottingham University Hospitals template for a medical report following a fall and produced a sticker, which is inserted into the medical notes and is completed by the doctor or nurse practitioner after reviewing the patient who has fallen
A post-fall review (how can further falls be prevented for this patient) is conductedThis sticker and the medical and nursing responses to the fall, are audited by members of the NHCFT falls team against the measures recommended
  • BNF = British National Formulary; ED = emergency department; CQUIN = Commissioning for Quality and Innovation; NHCFT = Northumbria Healthcare NHS Foundation Trust; NHSI = NHS Improvement; RCP = Royal College of Physicians.