title: Falls prevention in hospitals and mental health units: an extended evaluation of the FallSafe quality improvement project.
abstract: BACKGROUND
  inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20-30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle.
  
  
  METHODS
  : data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys.
  
  
  RESULTS
  : in FallSafe units, delivery of seven care bundle components significantly improved; most improvements were sustained after active project support was withdrawn. Twelve-month moving average of reported fall rates showed a consistent downward trend in FallSafe units but not controls. Significant reductions in reported fall rate were found in FallSafe units (adjusted rate ratio (ARR) 0.75, 95% confidence interval (CI) 0.68-0.84 P < 0.001) in the 12 months following full implementation but not in control units (ARR 0.91, 95% CI 0.81-1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71-1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72-1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%.
  
  
  CONCLUSIONS
  : introducing evidence-based care bundles of multifactorial assessment and intervention using a quality improvement approach resulted in improved delivery of multifactorial assessment and intervention and significant reductions in fall rates, but not in injurious fall rates.
authors: NHS England, London, UK.
authors: Frances
authors: F
authors: Healey
authors: Royal College of Physicians, London, UK.
authors: Derek
authors: D
authors: Lowe
authors: Oxford Radcliffe Hospitals, Oxford, UK.
authors: Adam
authors: A
authors: Darowski
authors: Portsmouth Hospitals NHS Trust, Portsmouth, UK.
authors: Julie
authors: J
authors: Windsor
authors: University Hospitals Birmingham, Birmingham, UK.
authors: Jonathan
authors: J
authors: Treml
authors: Great Ormond Street Hospital, London, UK.
authors: Lisa
authors: L
authors: Byrne
authors: Royal College of Physicians, London, UK.
authors: Janet
authors: J
authors: Husk
authors: Southern Health, Southampton, UK.
authors: Jill
authors: J
authors: Phipps
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003625:Data Collection; D006761:Hospitals / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care; D064872:Patient Care Bundles / Q000191:economics / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000592:standards*; D012308:Risk Management
keywords: fall prevention; injury; older people; quality improvement