By Ishmeet Singh (PT)

Falls are one of the most common adverse events in inpatient rehabilitation, and in frail older adults they can result in catastrophic injuries, including spinal cord trauma. 

At the Cambridge Rehabilitation Unit (CRU) which is a 36-bed inpatient rehabilitation unit, most of our patients are frail older adults, often scoring 6 to 7 on the Rockwood Clinical Frailty Scale. Nine out of ten inpatients are at high risk of falls from the moment they arrive. 

For us at CRU, fall prevention is not an isolated intervention; it is part and parcel of our daily practice. With this poster, I share transferrable best practices from our multidisciplinary team- practices that show how structured fall prevention can protect spinal cord health, reduce injury, and preserve independence

Frailty, cardiovascular instability, balance deficits, vision problems, nocturia, bone fragility, and medication side-effects all converge to create a high-risk profile. Unless we intervene systematically, the likelihood of a life-changing fall is very high. Our approach embeds prevention from admission, throughout the stay, and into the community- ensuring safety at every stage of rehabilitation

On Admission

Geriatricians and pharmacists review medications linked to dizziness or hypotension and assess bone health. Physiotherapists assess moving and handling, balance, and mobility. Occupational therapists review transfers and toileting, often introducing bedside commodes from the very first night. Nurses perform the multifactorial falls risk assessment, check vision, monitor postural blood pressure, hydration, and nutrition, and screen for delirium. 

We utilise Digital tools like SystmOne to flag high-risk patients so the MDT can act quickly.”

During the Stay

The medical team continues medication reviews. Physiotherapists and assistants deliver gait and balance training, exercise programmes, and prescribe walking aids. OTs carry out functional assessments, ADL training and conduct access visits for environmental assessment

Nurses and healthcare assistants monitor vital signs daily, ensure adherence to moving and handling care plans, using anti-skid socks, and managing nocturia. Dietitians address nutritional deficits that weaken bones. Even housekeeping plays a role by keeping walking routes safe and free of trip hazards. In this way, fall prevention becomes everyone’s responsibility.

Before Discharge

Our OTs conduct home safety assessments, arrange equipment, teach safe transfers, and link patients with community falls teams. We physiotherapists provide personalised home exercise programmes. Our Nurses educate patients and families on managing nocturia and postural drops. And our medical team complete a final medication review and reconcile take-home prescriptions. Together, the MDT ensures risks are minimised before a patient leaves hospital.

Lessons & Innovations

What makes our model unique is its integration: prevention is not the job of one profession but of the entire team. From a nurse educating a patient on nocturia, to an OT teaching safe transfers, conducting environmental assessments, to a physiotherapist prescribing exercises, and a geriatrician deprescribing medications every discipline contributes. Even housekeeping staff play a major role in ensuring safe walkways.

Importantly, this model is transferable!

Frail older adults are among the most vulnerable to falls, and with every fall comes the potential for spinal trauma. 

Fall prevention is spinal cord protection. And together, we can reduce falls, and protect spinal cord health, preserving lives and independence.

The ISCoS Prevention Committee hosted a Poster Competition on the occasion of 10th World Spinal Cord Injury Day. This year’s theme was Fall Prevention- Spinal Cord protection. I presented a poster sharing best practices from our MDT.

Here is a link to the full poster

(PDF) Multidisciplinary approach to fall prevention: lessons from Cambridge Rehabilitation Unit