As an F1, you will quite frequently get bleeped to review a patient who has had a fall on the ward, particularly if you are working late evening/nights. Falls in hospital can be anything from a simple trip to a collapse/seizure in an acutely unwell patient, so it’s important to keep an open mind! Some hospitals have introduced a falls checklist/pro-forma to help give some structure to the assessment.

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Background

• What are the current issues and PMH?
  • Anything which may predispose to a fall? e.g. delirium/dementia, mobility issues, Parkinson’s, postural hypotension, arrhythmia, visual impairment etc.
• Previous falls?

History

Remember that HCAs/nurses/other patients can often provide collateral history if needed

Pre-fall: 

• What exactly were they doing at the time?
• Any SOB/chest pain/palpitations/dizziness

Fall: 

• Ask them to describe exactly what happened. E.g tripped/weak legs/collapse
• Any LOC?
• Which part of the body took the impact of fall? Did they hit their head?
• Anything to suggest seizure – tongue biting, incontinence, jerking movements?

Post fall: 

• Were they able to get themselves up?
• Any confusion, headache, vomiting?
• Any pain or obvious injuries?

Examination

• Full examination (cardio/resp/abdo)
• Inspect for cuts/bruises/haematomas – especially on the head
• Palpate over hips and femurs- any pain/obvious deformity
• Further examination of any injured/painful joints
• Clearly document GCS and neuro examination findings
• Review obs: and ask for an LSBP and a BM
• Review drug chart
• Any drugs which may have contributed?  E.g. sedatives, anti-hypertensives etc.
• Any anticoagulants?

Plan

This will vary massively based on the above assessment and what the likely cause of the fall was (you may not need to do anything)! Below are some things to consider:

• ECG and bloods: FBC, U&Es, LFTs, Bone Profile, Haematinics (including B12/Folate), Vitamin D & TFTs
• X-ray of any injured bones/joints
• CT head – if significant head injury, abnormal neurology, head injury on anticoagulation etc. (follow NICE guidelines)
• Neuro obs – if any head injury
• If ongoing high falls risk due to confusion- does the patient need 1:1 nursing?
• Treatment/correction of any underlying cause
• Does their anticoagulation need holding?
• As always – consider if the patient needs escalating to a senior

Written by Dr Rosalind Brewster (FY2)