In this blog, Jayne Flood, Falls Prevention Practitioner at East Kent Hospitals NHS Foundation Trust, describes how her team introduced ‘yellow kits’ to assist patients at high risk of falls in A&E, and evaluated their impact.
In 2020-21, the number of people visiting the A&E department at the East Kent University Hospital Trust (EKHUFT), one of the largest trusts in the south east, increased by up to 25%. At that time, we noted a surge in cases of falls in A&E, particularly those resulting in severe harm.
The risk factors were clear:
- A&E departments were busier than they had ever been
- The quality of health in patients seeking help at A&E was declining
- Those seeking help had longer-than-usual waiting times in A&E departments
- There was no clear way for staff to indicate which patients they had assessed as having a high risk of falling
Falls with harm are not only devastating to patients and families, but they also have considerable financial implications for healthcare providers. For example, the estimated cost of a single fractured neck of femur (NoF) or hip is £26,000. In 2020 alone, EKHUFT recorded five NoF cases in just one A&E department, representing a bill of £130,000, excluding possible litigation costs.
Implementing Yellow Kits to prevent falls in A&E
To try and tackle the increasing number of falls we were seeing, we decided to trial the use of yellow kits in A&E. These kits act as a visual cue for staff, helping them to quickly identify patients at risk of falling. Each yellow kit contains a small yellow fleece blanket and a pair of yellow double-tread falls prevention slipper socks.
We used our FallStop four-step approach to introduce the yellow kits:
Step 1: Ensure you have the support of everyone in the department and senior management
It is very hard to identify effectively, at a glance, whether a patient is at risk of falling, and I am aware of how upsetting patient falls incidents can be for staff. Issues often arise at handover as it happens very quickly and information about patients most at risk of falling is often not passed on - until it’s too late. I knew A&E staff would welcome an intervention to help raise their awareness and keep them vigilant.
We made sure we had the support of all A&E staff - senior management, healthcare workers, porters and housekeeping staff - which meant that as the results of the evaluation emerged, everyone involved could see the benefit and share in the success of the initiative.
Step 2: Integrate visual cues into the care protocol to help staff manage patients at high risk of falling
We chose blankets and socks for the yellow kits as they are items that stay with the patient throughout hospitalisation, regardless of location. They can also go home with the patient.
The bright yellow colour reminds all staff that extra precautions need to be taken with particular patients, and that they should act decisively if they see these patients trying to move around unassisted or attempting to get off the trolley. The yellow kits also help ward staff during patient transfers, as each patient has already been identified as a falls risk, triggering a full fall risk assessment, in line with Trust guidelines.
Step 3: Make the case for the financial impact of not taking action
There is nothing more frustrating than knowing there is a simple solution that works, and being unable to implement it as others - whose support you need - just see additional costs.
I needed to show the financial burden of ignoring the problem, or only addressing its symptoms, to hospital management. As mentioned, the total cost of care for a hip fracture is £26,000 and there have been five NoF fractures in our A&E during 2020.
We needed to prove the effectiveness and value of visual cueing as an intervention, so we developed a single site evaluation of the intervention, with clear outcomes. The program started to develop its own momentum as we demonstrated that yellow kits could help us protect our patients and cut long-term costs at the same time.
Step 4: Ensure education before, during and after the intervention
To make the intervention effective, we spent time with staff in A&E, particularly in the early stages, to ensure they fully understood when to use the kits and what they mean. We ensured that all staff in the department knew which patients they should issue yellow kits to. We developed a clear protocol for issuing kits:
- Presenting due to a fall
- Acutely unwell (for example, respiratory compromised, diabetic ketoacidosis, heart problems)
- Patients with confusion due to dementia or delirium with any of the following features: agitation, wandering, inability to use the call bell reliably, challenging behaviour, reduced safety awareness and disorientation
- Likely to attempt to mobilise on their own and unsafe to do so
- Alcohol or drug misuse causing challenging behaviour
We also ensured that staff from other departments working with A&E understood the need for extra vigilance around patients with yellow kits. Medline, the company that supplies the kits, provides educational materials such as posters for staff notice boards, storerooms and public spaces, which we used to promote the initiative. We also involved our communications team to help promote yellow kits through the staff newsletter and intranet, and even got our Chief Executive on board to promote the project through her podcast!
The impact of yellow kits on falls in hospital
So, did the yellow kits work? In short, 100% yes! The kits empowered A&E staff to think and work differently, and they were pleased to be part of this highly effective initiative.
The trial ran for six weeks, and over this period, we lowered the number of falls by 50%. In fact, the only patients who fell were those who did not have a yellow kit.
The story was the same for patients admitted to wards - not one fell in the first 24 hours, which is the period when most falls would usually happen on wards. Since the evaluation, we have continued using the kits in A&E and have also been given funding to use them in our Acute Medical Unit.
I shared the results of the trial on Twitter and the yellow kits went global! There are now yellow kits being used in A&E departments up and down the UK and some trusts are trialling the scheme in their frailty units. There are also hospitals in Chile, Spain and Australia now using yellow kits.
To find out more about yellow kits and the FallStop programme, follow Jayne on Twitter.
East Kent Hospitals University NHS Foundation Trust's FallStop programme
FallStop: Winner of the 'Professionalising patient safety' category 2019
National Audit of Inpatient Falls (NAIF) Annual report 2021
How do occupational therapists contribute to patient safety?
Community thread: Red walking aids
1 NHS Digital. October 2021
About the Author
Jayne has worked as a Falls Prevention Practitioner at East Kent Hospitals NHS Foundation Trust for the last five years, and before that she was an Associate Practitioner on the emergency floor. She has always been passionate about patient safety, especially preventing patient falls. She recently completed an online falls prevention course and has helped establish the falls service at her Trust.
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