Inpatient falls and pressure ulcers

Background

Falls are a significant cause of emergency admissions to hospital for older people, and a major factor in people moving into nursing homes or residential care. Many falls are preventable by removing hazards, addressing deterioration in muscle strength, balance and vision, and being vigilant for issues caused by medication. 

Most falls occur in people’s homes, care homes or outside. However, some falls happen to people who are already in hospital, where inpatient falls represent one of the most commonly reported patient safety incidents. These patients are already unwell and have a greater risk of falling. Measures to ensure that call bells, walking aids and slippers are within easy reach, and that patients are helped when they need the toilet, are important.

Hip fracture is one of the most common serious injuries in older people, and often requires emergency anaesthesia and surgery. Being immobile with a hip fracture can cause injury to the skin of frail patients and is one of the reasons why prompt surgery and mobilisation is so important. Hip fractures can take weeks or months to heal, and often leave the individual confined to bed and unable to perform their daily activities. This can increase the risk of developing a pressure ulcer (also known as bed sores), that are areas of damage to the skin. All patients should be offered help with repositioning in the bed and be considered for pressure-relieving mattresses to avoid developing pressure ulcers.

Falls in hospital

Patients who are physically and psychologically frail should receive the help and support they need to prevent falls and injuries such as hip fractures. The percentage of hip fractures that happen in hospital (rather than in homes, care homes and outside) is a measure of safety and the quality of care that older people are receiving in hospital.

In England, the percentage of hip fractures that were the result of an inpatient fall has decreased from 5% in April 2012 to 3% in October 2022. In Northern Ireland, the percentage remained very low (<0.5%) until 2014 when it began to increase, reaching 2.8% in January 2017. Since then, levels have fluctuated but have remained lower than the percentage reported for England. In October 2022, 2.6% of hip fractures in Northern Ireland were the result of an inpatient fall. Wales has recorded higher levels than both England and Northern Ireland since data collection began; a peak of 7.7% was reached in November 2013, but it has since decreased to 4.8% in October 2022. Note that it is the 12-month rolling average figures that are being reported here.

Pressure ulcers following a hip fracture

In England, the proportion of patients who are reported to have developed a pressure ulcer (grade 2 or above) following a hip fracture decreased from 3.7% in April 2012 to 2.2% in July 2019. However, the percentage has since increased slightly to 2.8% in October 2022. In Wales, the proportion fluctuated around 3% before increasing to 4.7% in September 2021. Since then, it has declined to match the percentage reported in England for October 2022 (2.8%). The proportion has also fluctuated in Northern Ireland, with sharp increases and decreases over time. In the most recent years, the percentage fell from 2.8% in December 2018 to 0.6% in October 2022. 

Collecting data on pressure ulcer occurrence is one step to encouraging routine assessment of pressure sore risk. The identification and documentation of pressure sores may be one factor that could influence the data shown here.