Falls re‐audit

Abstract

PurposeThe economic burden and health consequences of falls are underestimated. Forty per cent of over 65 year olds will fall at least once each year, with half of these having multiple episodes. Visual impairment is common in the elderly and is associated with a higher falls risk. NICE recommends visual testing as part of a ‘multifactorial falls risk assessment’. However, during a recent audit on three elderly care wards at a central London teaching hospital, only 11% of patients who presented with a fall had visual assessment during their admission.MethodsA series of interventions were delivered in December 2016 to ‘Educate, Equip, and Emphasise’ clinicians. These included displaying posters on the wards, checking whether bedside equipment e.g. Snellen charts were available and facilitating replacement if missing, and a teaching presentation delivered to the elderly care team. A re‐audit was performed in February 2017 to ‘close the audit loop’.ResultsIn this cross‐sectional re‐audit, 9/64 of patients on the three wards (14%) originally presented with a fall (mean age 85.9 years; 6 were female; 3 were aided (i.e. used spectacles). 9/9 (100%) were visually impaired (best corrected visual acuity ≤ 6/12), most to a significant degree, however 0/9 (0%) had an assessment of vision during their admission. None of these patients were known to ophthalmic services previously.ConclusionsThe interventions were shown to be unsuccessful in improving adherence to guidelines. This highlights the need for awareness of the association between visual impairment and falls, and suggests education in training programmes may be necessary. The small sample size is a limitation to extrapolating the results on a national scale. Visual assessment and prompt referral to the eye clinic when necessary may prevent patients having future falls and readmissions to hospital.