A fall is an event that results in a person coming to rest unintentionally on the ground, the floor or other lower level (CSP [24]).

Falls among inpatients are the most frequently reported safety incident in NHS hospitals. Between 30% and 50% of falls result in physical injury, and fractures occur in 1–3% of falls. No fall is harmless, with psychological sequelae leading to lost confidence, delays in functional recovery and prolonged hospitalization (Morris and O'Riordan [76]).

Falls from the bed account for 30% of falls and this must be considered when positioning a patient in bed (Richardson and Carter [107]). Preventing falls in older people has been well described in national guidance and all prevention programmes should include particular reference to the care of older people (Age UK [5]). The causes of falls are complex and elderly hospital patients are particularly likely to be vulnerable to falling due to medical conditions including delirium; cardiac, neurological or musculoskeletal conditions; side‐effects from medication; or problems with their balance, strength, mobility and/or eyesight. Problems such as reduced or poor memory can lead to disorientation and therefore create a greater risk of falls when someone is out of their normal environment and on a hospital ward. Continence problems can mean patients are vulnerable to falling while making urgent journeys to the toilet. However, patient safety has to be balanced with independence, rehabilitation, privacy and dignity. A patient who is not allowed to walk alone will very quickly become a patient who is unable to walk alone. Specialist exercise programmes include STEEP (the Staying Steady Exercise and Education Programme), which consists of advice and an exercise session run over a 7‐week period (NICE [89]). The prevention of falls requires a systematic multiprofessional approach in order to nurture a culture of vigilant safety consciousness by all staff (Morris and O'Riordan [76]). Individual needs and the various environmental factors associated with different settings – for example, home, care home or hospital – will need to be assessed regularly.

Increasing patient awareness by advising and educating on reducing the risk of falls should be encouraged. The use of booklets such as Falls Prevention in Hospital: A Guide for Patients, Their Families and Carers (Royal College of Physicians [111]) clearly outlines ways to reduce the risk factors. It is the responsibility of all staff to report any environmental hazards within their working areas and to ensure that spillages are removed and appropriate signage is used to warn people of hazards.

It is important to consider the risk of falls when undertaking a manual handling risk assessment on patient admission. The patient's risk of falls should be reconsidered at weekly intervals, or if the patient experiences a fall or their condition changes significantly. Risk factors can be broadly divided into intrinsic and extrinsic risks (Table 7.1).

Once the risk has been assessed, any identified risk factors need to be addressed and managed. In order to reduce the risk, it is important to investigate every fall that does occur and understand the circumstances surrounding it. A useful way of analysing falls is to categorize them and to map areas on the ward or areas in the hospital where more than one patient has fallen. Common themes can then be identified and strategies can be implemented to reduce the risk.