Please note: Where the NHS Evidence Accredited Provider logo is used NICE has accredited the process used by NPSA to produce its rapid response reports. Accreditation is valid from July 2010 to July 2015. More information on accreditation can be viewed at www.nice.org.uk/accreditation.
When a serious injury occurs as a result of an inpatient fall, safe manual handling and prompt assessment and treatment is critical to the patient’s chances of making a full recovery. This Rapid Response Report aims to ensure that local protocols and systems help staff to consistently achieve this.
NHS organisations with inpatient beds should ensure that:
1. They have a post-fall protocol that includes:
a) checks by nursing staff for signs or symptoms of fracture or potential for spinal injury before the patient is moved;
b) safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury*;
c) frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (e.g. unwitnessed falls) based on National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 56: Head Injury;
d) timescales for medical examination following a fall (including fast track assessment for patients with signs of serious injury, or high vulnerability to injury, or who have been immobilised).
2. Their post-fall protocol is easily accessible (e.g. laminated versions at nursing stations).
3. Their staff have access to clear guidance and
formats for recording neurological observations using a 15 point version of the Glasgow Coma Scale (GCS) and that changes in the GCS that should trigger urgent medical review are highlighted.
4. Their staff have access at all times to special equipment (e.g. hard collars, flat-lifting equipment, scoops)* and colleagues with the expertise to use it, for patients with suspected fracture or potential for spinal injury.
5. Systems are in place allowing inpatients injured in a fall access to investigation and specialist treatment* that is equal in speed and quality to that provided in emergency departments and conforms to NICE Clinical Guideline 56: Head Injury.
* Community hospitals and mental health units without the equipment or expertise may be able to achieve this in collaboration with emergency services.