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The Royal College of Surgeons of Edinburgh (RCSEd) have drawn up their top 10 tips for surgical safety using the SEIPS (Safety Engineering Initiative for Patient Safety) model. Click on image to enlarge or download from the attachment below: See also: Safety in surgery series Top 10 priorities for patient safety in surgery Top 10 patient safety tips for surgical trainees

Patient falls are a significant concern in healthcare settings, often leading to severe injuries, prolonged hospital stays and increased healthcare costs. The importance of fall prevention extends beyond patient safety—it reduces hospital liability, enhances patient outcomes and improves overall healthcare efficiency. By proactively assessing and addressing fall risks, healthcare providers can significantly lower the incidence of falls, ensuring a safer environment for patients. Given the aging population and increasing chronic disease burden, fall prevention remains a top priority in improving patient care and quality of life. This blog from Augustine Kumah, Deputy Quality Manager at The Bank Hospital, Accra, Ghana, explores the significance of fall risk assessment, its implementation and its role in reducing fall-related incidents in healthcare settings. Introduction Falls among patients, particularly in healthcare facilities, remain a pressing concern worldwide. These incidents not only lead to injuries, prolonged hospital stays and increased healthcare costs, but can also have lasting psychological impacts on patients. Preventing patient falls necessitates a multifaceted approach, with fall risk assessment at its core.[1] Understanding the impact of patient falls Patient falls are defined as unintentional descents to the ground that occur in healthcare facilities, including hospitals, nursing homes and rehabilitation centres. According to the World Health Organization (WHO), falls are the second leading cause of unintentional injury deaths globally, with older adults being most at risk.[2] In healthcare facilities, the consequences of falls extend beyond physical injuries; they also affect a patient’s confidence, independence, and quality of life. The financial burden of falls on healthcare systems is substantial. Costs include direct expenses such as treatment for fall-related injuries and indirect costs like litigation, reputation damage and loss of trust. Additionally, healthcare providers experience emotional distress and professional repercussions when preventable falls occur under their watch. Hence, fall prevention is not just a patient safety priority but also an ethical obligation and a cost-saving measure. The role of fall risk assessment Fall risk assessment is a systematic process to identify patients at risk of falling. Healthcare providers can implement targeted interventions to mitigate these risks by evaluating intrinsic and extrinsic factors. Intrinsic factors include age, medical history, mobility impairments and cognitive status, while extrinsic factors encompass environmental hazards, medication side effects and inadequate assistive devices. Risk assessment tools, such as the Morse Fall Scale, Hendrich II Fall Risk Model and STRATIFY Risk Assessment Tool have been widely used. These tools provide a structured approach to assess risk levels and guide preventative measures. However, their effectiveness depends on accurate application and regular updates based on patient conditions. Implementing effective fall risk assessments To maximise the efficacy of fall risk assessments, healthcare facilities must adopt evidence-based strategies and integrate them into their workflows. Key steps include: Standardised assessment protocols: Developing and adhering to standardised protocols ensures consistency in evaluating fall risks across different departments and shifts. Protocols should specify the frequency of assessments, criteria for reassessment and documentation requirements. Staff training: Comprehensive training programme for healthcare workers are essential to enhance their competency in conducting fall risk assessments. Training should cover assessment tools, recognition of risk factors and communication of findings to the care team. Patient and family education: Involving patients and their families in fall prevention efforts fosters a collaborative approach. Educating them about potential risks and preventive measures empowers them to contribute to safety. Technology integration: Advanced technologies such as wearable sensors, predictive analytics and electronic health records (EHRs) can augment traditional fall risk assessments. For instance, sensors can monitor patient movements and alert staff to potential falls, while EHRs can flag high-risk patients for closer observation. Challenges in implementing fall risk assessments Despite its benefits, implementing fall risk assessments is not without challenges. Common barriers include: Resource constraints: Limited staffing, time pressures and inadequate funding can hinder comprehensive risk assessments. Overburdened staff may struggle to prioritise fall prevention alongside other responsibilities. Inconsistent application: Variability in applying risk assessment tools can lead to inaccurate results. Subjective judgment, incomplete data collection and lack of protocol adherence contribute to inconsistencies. Resistance to change: Resistance from staff and administrators to adopt new practices or technologies can impede the integration of fall risk assessments into routine care. Patient non-compliance: Some patients may resist interventions such as bed alarms, mobility aids or supervision, increasing their risk of falling. Strategies to overcome the challenges To address these challenges, healthcare facilities can adopt the following strategies: Leadership support: Strong leadership commitment is crucial to allocating resources, establishing accountability and creating a safety culture. Interdisciplinary collaboration: Engaging multidisciplinary teams, including nurses, physicians, physical therapists and pharmacists, ensures a holistic approach to fall risk assessment and prevention. Continuous Quality Improvement: Regular audits, feedback sessions and performance evaluations help identify gaps in fall prevention efforts and drive improvements. Tailored interventions: Personalising interventions based on individual patient needs and preferences increases their acceptability and effectiveness. Conclusion Preventing patient falls requires a proactive and comprehensive approach, with fall risk assessment as a foundational element. Healthcare facilities can significantly reduce fall-related incidents and their associated consequences by identifying at-risk individuals and implementing tailored interventions. However, the success of fall prevention efforts hinges on overcoming implementation challenges through leadership support, interdisciplinary collaboration and continuous improvement. As healthcare systems evolve, leveraging technology and prioritising patient-centred care will be instrumental in advancing fall risk assessments. By embracing these advancements, healthcare providers can create safer environments that uphold all patients' dignity, independence, and well-being. References The Joint Commission. Fall Reduction Program - Definition and Resources, 28 August 2017 WHO. Falls Factsheet. World Health Organization, 26 April 2021.

This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Gordon talks to us about how bureaucracy in the health service can compromise patient safety, the vital importance of agreed quality standards and what hillwalking has taught him about healthcare safety.

Dr Gordon Caldwell believes that patient safety should be an active process of checking for avoidable errors. In this blog for the hub, he describes how he developed a checklist for his ward rounds and how this became incorporated into the daily clinical review notes to ensure that all the important aspects of care on a team’s routine ward rounds are actively addressed. On a ward round in 2005 I was about to send home a man who had been successfully treated for pneumonia with intravenous antibiotics. He asked me what was wrong with his left arm. When I looked he had an obvious infection around the intravenous cannula with signs of the infection spreading up the vein. He had been treated with intravenous antibiotics which had been changed to oral 3 days earlier. At that point the cannula should have been removed. It turned out that the infection was caused by MRSA and he required a further 2 weeks of intravenous antibiotics to eradicate the infection. I promised the patient that I would do everything I could to make sure that no one else suffered in the same avoidable way that he had. This led me to think about the process of clinical review on ward rounds. I wondered if we could develop a list of check points that we could routinely go through to protect patients from avoidable harm. During this period, I started to supervise a junior doctor on the team on a ward round and afterwards she said it had been an excellent experience but she did not know if “I had done everything?” This made me think that no one had considered what “Doing everything” was on a ward round. I asked my team to come back 2 days later to discuss what “Doing Everything” was and by the end of that week we had designed our first checklist for ward rounds. The first checklist was a one-sided piece of A4 paper with, as I recall, a table with 15 columns for 15 patients and about 25 rows of points that we thought were essential during a case review. These ranged from items such as organising the notes, filing the results, reading the notes, discussing the case, through to aspects such as does the patient have an intravenous cannula or urinary catheter? Some of the rows were marked in yellow and applied to all patients and others were white, such as the capillary blood glucose which only applied to patients with diabetes. I asked a medical student on our team to watch us working and to tick off the boxes if the appropriate action or an active decision had been considered. I asked that before we moved on to the next patient that the observer highlight any omissions so that these could be corrected. Once the ward round was completed, I kept the checklist forms as well as noting the duration of the ward round. In the early weeks we were surprised to find how much we missed out on ward round reviews. We thought we were very good at hydration and nutrition, spotting cannulas and catheters and making do not attempt cardiopulmonary resuscitation (DNACPR) decisions, but we were not. I found that we were creating a process for clinical review of the patient and a checklist to ensure completion. There were problems. Sometimes the person doing the checking did not call out on omitted items. I can recall one occasion when we had put onto the checklist “Did the consultant read today’s clinical note?” I had forgotten this was now on the checklist until about the fifth patient. I asked the medical student why he had not called me out on this and he said that he was going to tell me at the end of the round! If any team is going to use the checklist process they have to create an atmosphere within the team where it is expected that omissions or errors will be called out. Our work was published in Clinical Medicine.[1] We heard that a whole surgical unit in Melbourne, Australia, picked up on our ward round checklist concept. They similarly found that senior doctors frequently made omissions during ward round processes. They built the checklist into a daily review template. Initially they found that the junior doctors did not complete the checklist. Eventually they found that if the registrars in the team at induction told the junior doctors “This is the way we work here” then they completed the checklist. The checklist then remained in the patient’s notes as evidence of a complete review. For a long time I wanted to find a way to incorporate the checklist into the daily clinical review notes rather than have a separate checklist for the cohort of patients. In 2015 we managed to achieve this by combining the checklist into the daily review template. At Worthing Hospital, Dr Richard Venn and his IT colleagues had pioneered electronic vital signs and nursing assessments. Tim Short[, one of the IT development team, came on one of my ward rounds and saw an opportunity to create a ward round patient review template. One side of this listed the patient’s demographics, clinical problems, vital signs and common blood test results. On the other side was our checklist. I did not want to force teams to use the checklist so this was optional as they created the ward round documentation. We called this process Ward Round Report (WRR). WRR could be run on the desktop computer, laptop, tablet or even smart phone. After the ward round, the sheets could be printed out and filed into the paper notes. With WRR there was plenty of space on side two for adding comments. For example, by this stage there was a question “Did you make any changes in the prescription today? Y/N?” This was the first time in my career that I was regularly making short notes about the reasons for changes in medications – for example, “Ramipril stopped today because systolic blood pressure only 80 mmHg”. What I have learned from this is that there is a process to patient review and being organised and consistent in following this process makes the ward round more effective, efficient and improves patient safety. By being consistent in the process we have released time which can be used for further conversation with the patient or for thinking through complicated cases or for teaching. I have also learned that “safety is no accident”. I like this phrase because of its double meaning that safety is no avoidable harm or accident to the patient and also that safety does not arrive accidentally. Patient safety should be an active process of checking for avoidable errors. With WRR errors still occur but are much less frequent. One point on my ward round form that seems idiosyncratic is asking for something memorable about the patient, such as what is or was their work, or what are their current interests and enjoyments. This creates some personal connection with the patient and certainly helps me to remember all of the patient’s clinical problems. I believe that this personal connection also engenders more commitment to patient safety. If clinical staff take away only one idea from my process, I recommend that it is this: seeking something memorable about each patient. Reference 1. Herring R, Desai T, Caldwell G. Quality and safety at the point of care: how long should a ward round take? Clin Med 2011; DOI: https://doi.org/10.7861/clinmedicine.11-1-20.