Our recently formed Royal Academy of Improvement aims to facilitate staff led change and development throughout the hospital and there are many schemes and ideas which are taking shape throughout every department or area of Chesterfield Royal Hospital every day. Our staff are able to suggest, and grow, ideas which will improve or change the environment or processes for our patients and colleagues. There have been many successes; in March we held a successful celebration event to showcase some of those achievements and we had a record number of 50 staff teams who shared their ideas with colleagues.

Falls are always a main concern within any hospital and Chesterfield Royal is no different.

After experiencing its second fall with harm earlier this year - the first was a gentleman who sustained a fractured hip, the second a lady who sustained a head injury – our Emergency Department began to look into why these were happening and how they could be prevented.

Research showed there was little in the way of national guidance for fall risk assessments in an Emergency Department setting, and whilst every patient admitted onto our wards receives a falls risk assessment as part of their admission, it’s a lengthy document and some parts are not suitable for ED practice.

With this in mind our ED Matron and Senior Matron spent some observational time in the department looking specifically at where patients were nursed (due to the layout of the department it is difficult have patients in sight at all times) and also observing if relatives were being allowed to sit with patients and ensuring they had a nurse call buzzer to hand.

From this it was apparent that communication plays a big part in reducing falls – not only communication between colleagues, but also with relatives. Simple things like understanding patients’ toilet needs can make all the difference in reducing falls particularly if a patient is suffering with confusion.

Posters were displayed around the department asking staff for their professional opinion on how falls could be reduced and in the next round of nurse interviews the  question ‘how can we reduce the risk of falls in a busy emergency department?’ was asked.

This led to three questions forming the basis of any initial assessment –

Does the patient have any medical condition which predisposes falls?

Is the admission due to, or does the patient have a history of falls?

Do they have any confusion including dementia or delirium?

If the answer is yes to any one of these three questions then our patient would be deemed a falls risk - this will be communicated to the named nurse and documented on their whiteboard - and the safest place to nurse them will be determined. The patient will be given a yellow wrist label, alerting staff to the fact that they may need more assistance.

Practicalities come into play too – if a patient is wearing shoes they are encouraged to keep them on whilst in the department. If they aren’t then slipper socks will be provided.

Charitable funds have meant that two high / low trollies have been purchased. These can be lowered to the floor in order to reduce harm, and provide security for any patients who are accessed as a falls risk.

Staff meetings always include a discussion on falls audits and look at the ‘at risk’ patients within the department to ensure that all measures have been followed in keeping them safe.

The information is also shared at 9am huddles.

On leaving ED to transfer to a ward the usual Trust falls risk assessment is carried out by the receiving area – to continue good practice of reviewing risk within a new environment.

Kaye Smedley, Matron of ED commented: ‘We were determined to proactively reduce falls in our department. Once we knew there were no generic guidance we took matters into our own hands and conducted research which led us to producing a set of guidelines which were staff led and very unique to our department. It was great to be able to take ownership of this and work as a team to achieve an effective result. We are also extremely grateful to the charity for funding trollies which will support us in this’