Stepwise Falls Guide

How to reduce harm, improve quality and save costs - A practical step-by-step guide for ward staff and frontline healthcare teams


In-patient falls are the most common causes of patient harm in the NHS. In England & Wales, 283,438 incidents were reported to the National Patient Safety Agency (NPSA) between October 2008 and September 2009.

A significant number of these falls resulted in death (83 deaths). Others resulted in severe or moderate injury - including around 840 fractured hips, 550 other types of fracture and 30 intracranial injuries.

The financial cost of falling is high and the human cost is significant. Even less serious falls cause distress, pain, injury, loss of confidence and loss of independence, as well as anxiety for relatives, carers and hospital staff.

Dr Mahmood Adil, National QIPP Advisor at the Department of Health (England), who led the work to develop this guide during his fellowship at the NHS Institute, says;

“Reducing human suffering motivates us to improve safety in our hospitals. Already, some good resources have been developed to help NHS organisations understand and prevent falls - including the Patient Safety FIRST ‘How to’ guide for reducing harm from falls (2009). Yet, there is a gap when it comes to helping frontline NHS staff find answers to three fundamental questions underlying falls, or indeed other forms of patient harm which could result in a business case to improve quality and decrease cost together:

1. How big is the problem?

2. What is the solution and what will it cost?

3. What is the harm costing us and how much can we save by implementing the improvements?

The Stepwise approach is a response to that gap and I hope it would further motivate and help the healthcare professionals to develop a business case for quality and safety with their joined-up efforts.”

Download the guide

The Stepwise Falls Guide is available to download from our catalogue, click here.
Additional resources
Slips, trips and falls in hospital, The National Patient Safety Agency (NPSA), the third report from the Patient Safety Observatory

How to guide for reducing harm from falls (2009)