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Improving Post-Fall Assessment Documentation in Older Inpatients Using a Structured Falls Proforma: A Retrospective
Ella V Brockwell-Mole1, Dujinthan Jayabalan1,2, Su Kitchen1
1Geriatric, Acute and Rehabilitation Medicine Sir Charles Gairdner Osborne Park Health Care Group Nedlands Western Australia Australia.
Objective:
Falls among hospital inpatients are a major cause of morbidity, mortality, and healthcare burden. The aim of this study was to evaluate the association between the use of a structured Falls Proforma and the completeness of post-fall assessment documentation in an Australian hospital.
Methods:
A retrospective cohort study was conducted on patients who experienced inpatient falls between January 2022 and December 2024. Fall events were stratified by 6-month audit intervals, and cases were randomly selected within each stratum using computer-generated sampling. All falls within this time frame were eligible for inclusion; only a patient's first fall among those aged > 65 years was counted, and data with missing details were excluded from analysis. Falls were categorized into "proforma" or "non-proforma" groups. Documentation across 12 assessment domains was compared, and demographic and clinical characteristics associated with proforma use were evaluated.
Results:
A stratified random sample of 202 inpatient falls was reviewed, with 167 eligible for analysis. Of these, 125 (75%) were assessed using the proforma. Documentation was significantly higher in the proforma group across examination domains: cervical spine (96.8% vs. 47.6%), hip (98.4% vs. 40.5%), cranial nerve (92.8% vs. 40.5%), upper limb neurology (93.6% vs. 45.2%), lower limb neurology (95.2% vs. 42.9%), external head (97.6% vs. 35.7%), cognition (95.2% vs. 19.0%), coagulopathy (98.4% vs. 16.7%), musculoskeletal (95.2% vs. 35.7%), mobility (92.0% vs. 7.1%), and contributing factors (87.2% vs. 59.5%) (all p < 0.001). Scenario documentation was high in both groups (85.6% vs. 95.2%, p = 0.100). In multivariable analysis, preexisting cognitive impairment was associated with lower odds of proforma use, however this association did not reach statistical significance after adjustment (OR = 0.450, 95% CI 0.190-1.030, p = 0.062).
Conclusions:
Use of a structured Falls Proforma was associated with significantly greater completeness of post-fall documentation. However, lower uptake among patients with cognitive impairment may represent a disparity in documentation within a high-risk population. Embedding structured tools into routine practice may standardize documentation and support adherence to recommended post fall assessment frameworks.
