Falls prevention in hospital: a guide for patients, their families and carers

How to use this guide

The aim of this guide is to provide you with information on your care, and to let you know what effective falls prevention looks like in hospitals in England and Wales.

We encourage you to ask questions to the doctors and nurses looking after you, and to discuss what can be done to reduce the risk of falls.

Can we prevent falls?

Just like in general life, it is not possible to prevent all falls in hospital. However, we can work together to reduce the chances of this happening.

Research has shown that when staff such as doctors, nurses and therapists work together, they can reduce falls by 20 to 30%. You and your family can also help by being aware of the risks and the actions you can take, as well as talking to the people looking after you about falls prevention.

What can I do?

The following twelve-point checklist can be used by patients and their carers, and families.

Tell the nurse or doctor looking after you if you have fallen in the past year, are worried about falling, or have a history of falls.
Use your call bell if you need help to move, in particular, if you need help going to the toilet.
Make sure glasses (spectacles) are clean and used as prescribed. Ask for help if you are having trouble seeing.
Use your usual walking aid, keep it close by and check for wear and tear on the rubber feet. Never lean on hospital furniture as it is often on wheels.

When getting up:

Sit upright for a few moments on the edge of your bed before standing.
Get up slowly and make sure you feel steady before walking.
Do some simple leg exercises before getting up from your bed or chair:
- point your toes and release a few times
- tighten the muscles in your calves and then release them
- move your legs up and down if you can, to get the circulation going.
If you feel dizzy – stop, sit down, and let the ward staff know.
Drink regularly and eat well.
Be familiar with your bedside environment. Ask for clutter to be moved if your path is not clear.
Make sure your shoes or slippers fit well, grip well and cannot fall off.
Take care in the bathroom and toilet. Ask for help if you need assistance.

It is also important to make sure that you receive a falls risk assessment.

What can be done on the ward?

The following recommendations can help on the ward:

Recommendation	Call bells should always be within reach of a patient.
How does this help?	If you cannot move safely without help, it is essential that you can use your call bell, if you are able, to ask for assistance. If you are not able to use a call bell for any reason, staff may find another way for you to alert them.
Recommendation	Patients may have a simple vision assessment when staying in hospital.
How does this help?	If you can’t see where you’re going, it makes it difficult to avoid obstacles. Even if you wear glasses, you should still have your vision assessed.
Recommendation	Patients should have their medications reviewed and changed if appropriate.
How does this help?	Some medications – or combinations of medications – make people dizzy and increase the chances that they will fall over. A doctor or a pharmacist can sometimes adjust the medications to make these side effects less likely.
Recommendation	Patients who need walking aids should be able to reach them.
How does this help?	If you need a walking aid to walk safely, it’s important you have it before you start walking.
Recommendation	Patients should have their lying and standing blood pressure measured.
How does this help?	Some people experience a drop in blood pressure when they stand up. This makes them dizzy and can cause them to faint. If the people treating you are aware that you get dizzy when you stand up, they may be able to change parts of your care or give you tips to prevent this from happening.
Recommendation	Tests should be made to check for dementia or delirium (confusion).
How does this help?	Dementia is a syndrome that causes memory loss and difficulties with daily life. Delirium is a state of mental confusion that can happen if you become medically unwell.
Recommendation	Patients with delirium or dementia should have a special care plan.
How does this help?	If you’re confused and having trouble remembering things, an unfamiliar environment can be particularly tricky. Patients who have dementia or delirium need special care to help with their stay in hospital.
Recommendation	Patients who have continence issues should have a continence care plan.
How does this help?	If you have difficulties with bladder and/or bowel control, there needs to be a plan in place to help you move regularly and safely to the toilet.
Recommendation	Safe footwear should should be worn.
How does this help?	Well fitted shoes or slippers with gripping soles will help you move safely while in hospital.
Recommendation	Immediate bedside environments should be clear from clutter and hazards.
How does this help?	Keeping the space around your bed and the route to the nearest toilet clear makes it easier to move around safely.

How can others help?

Your family, friends, or carers can also help reduce the risk of falls with this checklist.

Do tell the ward staff:

if you think your relative/friend is at risk of falling
if your relative/friend:
- has fallen in the past year
- is feeling dizzy, confused or not their normal selves (could this be delirium?)
- has dementia
- has a vision impairment
if there is a spillage that may cause a slip hazard.

What should family, friends or carers do before they leave?

Before family, friends or carers leave they should:

Check the bed space – and area around it – is clear of obstacles.
Make sure the call bell, walking aid and glasses are within reach.
Ensure they take any belongings that are not needed with them.

Adapted with permission from HQIP 2023 Falls prevention in hospital: a guide for patients, their families and carers. Published by The Royal College of Physicians, 11 St Andrews Place, Regent’s Park, London, NW11 4LE

The information in this leaflet is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.