Ward Care & Clinical Governance

Falls Prevention, Risk Assessment & Post-Fall Protocols

Balancing evidence-based safety, local trust policy, and the truth: not every fall can be stopped — but every response can be excellent.

Falls are the most common safety incident in UK hospitals. For you as a student nurse, they can feel like a personal failure. The reality is more nuanced — and more compassionate. This guide walks you through what NICE says, what your trust will expect, how to protect patients without stripping away their dignity, and exactly what to do when someone does fall.

1. National Guidance — NICE NG249

Good practice follows the evidence. NICE Guideline NG249 (April 2025) is the current UK standard — replacing the older CG161. It shifts the focus in three important ways:

• Don’t rely only on scores: Numerical risk tools alone are not enough. They flag risk but don’t tell you what to do. You need a full, individualised assessment instead.
• Assess what can actually change: Look at risks that can be improved during the admission — medication side effects, mobility, confusion, footwear, environment.
• Keep people moving: Bed rest causes weakness, confusion, and worse outcomes. Encourage dressing, sitting out, and walking — safely — whenever possible.

2. Trust Policy vs Clinical Basics

Every hospital does the paperwork differently. One trust uses electronic forms; another paper charts. One observes hourly; another follows a sliding scale. But underneath the forms, the core nursing work is identical everywhere:

3. The Hard Truth — Not Every Fall Can Be Prevented

You walk into the room. They’re on the floor. Your first thought: “Did I fail?”

Let me say this plainly, because few people will tell you: Some falls cannot be stopped. A sudden drop in blood pressure. A momentary blackout. A split-second decision to get up alone. If a patient has capacity and can physically stand, they can — and sometimes will — fall. To “prevent” every fall would mean restraining people, sedating them, stripping away their choices. That is not safety. That is imprisonment.

Your job is not to achieve an impossible zero-fall statistic. It is to prevent the falls that can be prevented — the ones caused by clutter, by unreachable call bells, by unaddressed confusion, by unmonitored medication side effects — and to respond with skill and compassion when the rest happen anyway.

4. Dignity vs Safety — The Balance

Here is a situation you will face again and again:

He wasn’t being difficult. He was protecting his dignity. And he had the legal right to make that choice — even with the risk attached. So how do you manage this defensively and compassionately?

• Check capacity: Does he understand the risk? If yes, you cannot force bed rest — that’s false imprisonment.
• Meet needs proactively: Scheduled toileting. Check on him overnight. Make sure he never feels he has to choose between dignity and safety.
• Talk openly: “I respect you want to do things yourself — that’s who you are. But falling could take your independence away completely. Let’s find a way that keeps you safe and dignified.”
• Write it all down: The conversation, his wishes, the plan you agreed. Good notes prove you respected his rights while keeping him as safe as you could.

5. When a Fall Happens — Step by Step

Stay calm. Follow the sequence. Don’t rush.

Phase 1 — Assess Before Moving

• Do NOT pull them up straight away. If they’ve fractured a hip or injured their spine, moving them incorrectly causes permanent harm.
• Ask: “What happened? Where does it hurt?” Check they’re awake, breathing, oriented.
• Look for: deformity, severe pain, head strike, loss of consciousness, bleeding. Any of these = keep them down and call for medical help.

Phase 2 — Get Them Up Safely

• If they’re alert, pain-free, and able to weight-bear → use a hoist, Raizer cushion, or enough staff to assist. Never lift alone.
• If they hit their head, have pain, or seem unwell → leave them comfortable on the floor. Call the doctor. Warmth, reassurance, observations while waiting.

Phase 3 — Check & Monitor

• Full NEWS2 observations — including lying and standing BP to check for postural drop
• If head was involved → neurological observations (GCS, pupils, limb strength) hourly initially, scaling down if stable
• Document exactly what happened — witnessed or unwitnessed, time, activity, injuries found, who was informed
• Submit incident report (Datix or local system) — this is how the trust learns and prevents future falls

6. Looking After Yourself Too

When a fall happens, it’s easy to replay it in your head: “If I’d checked sooner… if I’d been there…” Be kind to yourself. You are learning. You are doing your best in an environment where perfection is impossible. What matters is that you responded well, learned from it, and will keep showing up with care.