Quality statement 5: Safe manual handling after an inpatient fall
Quality statement
People who fall during a hospital stay and have signs or symptoms of fracture or potential for spinal injury are moved using safe manual handling methods. [2015]
Rationale
When a person falls, it is important that safe methods are used to move them, to avoid causing pain and/or further injury. This is critical to their chances of making a full recovery. Safe manual handling methods should be included in a post-fall protocol that is followed for all people who fall during a hospital stay.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that hospitals have a post-fall protocol that includes using safe manual handling methods for moving people with signs or symptoms of fracture or potential for spinal injury.
Data source: Data can be collected from information recorded locally by provider organisations, for example, from service or clinical protocols.
Process
Proportion of falls by people during a hospital stay where the person has signs or symptoms of fracture or potential for spinal injury and is moved using safe manual handling methods.
Numerator – the number in the denominator where the person is moved using safe manual handling methods.
Denominator – the number of falls by people during a hospital stay where the person has signs or symptoms of fracture or potential for spinal injury.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The Healthcare Quality Improvement Partnership (HQIP) Falls and fragility fracture audit National Audit of Inpatient Falls reports data on the manual handling method that was used to move the patient after they have had an inpatient fall that resulted in a femoral fracture.
What the quality statement means for different audiences
Service providers (NHS organisations with inpatient beds, such as district hospitals, mental health trusts and specialist hospitals) ensure that staff have access to and follow a post-fall protocol that includes using safe manual handling methods to move people who have fallen in hospital and have signs or symptoms of fracture or potential for spinal injury.
Healthcare professionals use safe manual handling methods to move people who fall in hospital and have signs or symptoms of fracture or potential for spinal injury.
Commissioners ensure that they commission services from providers that have a post-fall protocol that includes using safe manual handling methods to move people who have fallen in hospital and have signs or symptoms of fracture or potential for spinal injury.
People who fall in hospital and who may have a fracture or possible injury to their spine are moved in a safe manner, using suitable equipment if needed.
Source guidance
National Patient Safety Agency. Rapid response report: Essential care after an inpatient fall (2011), recommendation 1. Falls remains part of NHS England's enduring standards that remain valid from previous patient safety alerts (cross-speciality safety).
Definitions of terms used in this quality statement
Fall
A fall is defined as an unexpected event which causes a person to rest on the ground, floor or lower level. [Adapted from NICE's guideline on falls; evidence review B, table 1]
Post-fall protocol
A post-fall protocol should include:
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checks by healthcare professionals for signs or symptoms of fracture and potential for spinal injury before the patient is moved
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safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury (community hospitals and mental health units without the necessary equipment or staff expertise may be able to achieve this in collaboration with emergency services)
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frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (for example, unwitnessed falls) based on the NICE guideline on head injury
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timescales for medical examination after a fall (including fast-track assessment for patients who show signs of serious injury, are highly vulnerable to injury or have been immobilised); medical examination should be completed within a maximum of 12 hours, or 30 minutes if fast-tracked.
The post-fall protocol should be easily accessible (for example, laminated versions at nursing stations). [Adapted from the National Patient Safety Agency's rapid response report on essential care after an inpatient fall, recommendations 1 and 2, and expert opinion]