Inpatient Fall

A fall is a symptom, not a diagnosis. Structured response: injury first (head, hip, long lie), then cause (drugs, orthostatic hypotension, arrhythmia, infection, delirium), then prevention. Anticoagulated patients need a CT head within 8 hours after…

Post-Fall Assessment Pathway

The pathway

1 · A-E + obs + glucose

Full set including glucose
Do not move until spinal/hip injury considered if found on floor

2 · Injury survey

Head: any impact? GCS, pupils
Hip: shortened/externally rotated → X-ray (MRI if occult)
Wrists, ribs, spine, skin tears

3 · CT head rule

Anticoagulated + head injury → CT within 8h (NICE NG232)
GCS <15, vomiting, focal signs → CT within 1h
Serial neuro obs

4 · Long lie check

On floor >1h → CK + U&Es (rhabdomyolysis/AKI)
Skin: sacrum + heels
Temperature

5 · Find the cause

Lying/standing BP (drop ≥20 systolic)
ECG — arrhythmia, blocks, QT
Medication review: sedatives, antihypertensives, opioids, anticholinergics
Infection/delirium screen (4AT)

6 · Prevent the next one

Bed low, call bell in reach, footwear
Deprescribe sedatives — never add them
Physio/OT, bone health (FRAX, vitamin D)
Datix + duty of candour

Drugs

Drug	Dose	Route	Notes
Paracetamol	1g QDS (reduce if <50kg)	PO/IV	First-line analgesia post-injury in the elderly.
Colecalciferol	800–4000 units OD	PO	Bone health — most elderly fallers are deficient.
AVOID: night sedation	—	—	Zopiclone/benzodiazepines increase falls. Do not prescribe for 'settling'.

When to escalate

Head injury on anticoagulation — CT within 8 hours, sooner if red flags,Suspected NOF fracture — analgesia, orthopaedics, surgery within 36h,CK significantly raised or rising creatinine after long lie,Recurrent inpatient falls — senior review + enhanced supervision,New confusion — delirium screen, not sedation

Reference: NICE NG232 Head Injury / NICE CG161 Falls / NAIF audit standards

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