⚕️Care Handbook

Post-Fall Protocol

Knowing exactly what to do when a resident falls is critical. A clear, evidence-based post-fall protocol protects the resident, ensures appropriate assessment and treatment, and meets CQC reporting requirements.

⚠ Emergency Action

If the resident has sustained a serious head injury, has lost consciousness, is unable to move a limb (suspected fracture), or is bleeding heavily: do NOT move the resident. Call 999 immediately.

Post-Fall Protocol

1

Immediate Actions (First 10 Minutes)

  1. 1Do NOT rush to move the resident — stay calm and reassure them
  2. 2Assess for injury — check for pain, deformity, bleeding, or head injury
  3. 3Check consciousness level and responsiveness
  4. 4Observe for signs of fracture — swelling, deformity, inability to move limb
  5. 5Check for signs of head injury — confusion, unequal pupils, vomiting, headache
  6. 6If a serious injury is suspected — do NOT move the resident, call 999
  7. 7If no serious injury — assist the resident up slowly using appropriate moving and handling technique (use hoist if needed)
  8. 8Stay with the resident and provide comfort
  9. 9Inform the nurse in charge immediately
2

Assessment (Within 1 Hour)

  1. 1Complete neurological observations if head injury suspected (GCS or AVPU scale)
  2. 2Record baseline observations — blood pressure, pulse, oxygen saturation
  3. 3Assess for pain and administer prescribed analgesia if needed
  4. 4Check skin for grazes, bruising, or lacerations — clean and dress wounds
  5. 5Check for signs of fracture — request X-ray if suspected
  6. 6Review medications — consider contribution to fall
  7. 7Assess for delirium (4AT or CAM tool)
  8. 8Record full details in the incident report
3

Monitoring (Next 24-48 Hours)

  1. 1Increase observation frequency for at least 48 hours post-fall
  2. 2Continue neurological observations if indicated (2-hourly initially)
  3. 3Monitor for delayed symptoms — worsening pain, swelling, confusion
  4. 4Offer food, fluids, and comfort measures
  5. 5Ensure the resident can reach the call bell
  6. 6Review and update the falls prevention care plan
  7. 7Consider referral to falls clinic or physiotherapy
4

Reporting and Review

  1. 1Complete the incident/accident report form
  2. 2Notify the registered manager and family/next of kin
  3. 3Notify CQC if the fall resulted in serious injury (Regulation 18 notification)
  4. 4Hold a post-fall review meeting — what happened and why?
  5. 5Review the falls risk assessment and update as necessary
  6. 6Review the environment — was there a hazard that needs to be addressed?
  7. 7Review medications — did any contribute to the fall?
  8. 8Share learning with the care team — update care plan and risk assessment
  9. 9Record in 24-hour log and handover

When to Call 999

Call 999 immediately if the resident has any of the following:

!Loss of consciousness (even briefly)
!Suspected fracture (swelling, deformity, cannot move limb)
!Signs of head injury (confusion, unequal pupils, vomiting, severe headache)
!Severe bleeding that cannot be controlled
!Difficulty breathing or chest pain
!Suspected spinal injury (numbness, tingling, inability to move legs)
!Seizure following the fall
!The resident is in severe pain and cannot be moved safely

Assessment Tools After a Fall

After the immediate actions are taken, use structured assessment tools to evaluate the resident thoroughly:

Glasgow Coma Scale (GCS):If head injury is suspected — assess eye, verbal, and motor responses
AVPU Scale:Quick consciousness check — Alert, Voice, Pain, Unresponsive
4AT or CAM:Delirium screening — essential after any fall in an older adult
Abbey Pain Scale:For residents who cannot self-report pain
Neurological Observations:2-hourly GCS checks for 48 hours if indicated after head injury
NEWS2 (National Early Warning Score):Baseline physiological observations to detect deterioration

Reporting Requirements

CQC Notification (Regulation 18)

Care homes must notify CQC of any incident that affects the health, safety, or welfare of a person using the service. A fall that results in serious injury (fracture, head injury, hospital admission) must be notified to CQC via the notification portal. This is a legal requirement under Regulation 18 and failure to notify is a breach of registration.

Internal Reporting

  • •Record the incident in the resident's care notes and the 24-hour log
  • •Complete the accident/incident report form in accordance with your organisation's policy
  • •Notify the registered manager and senior team
  • •Inform the resident's family / next of kin
  • •Notify the GP if any injury is sustained or if the resident's condition changes
  • •RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013): report to HSE if the fall results in a specified injury or over-7-day incapacity

Post-Fall Review

After every fall — even if no serious injury occurred — a post-fall review meeting should be held to identify lessons learned and update the care plan. This is a key requirement of C “Responsive” and “Well-led” key questions.

  • •What happened? (Review the ABC of the fall — Antecedent, Behaviour, Consequence)
  • •Were there environmental hazards that contributed?
  • •Could medication have been a factor? (Request a medication review)
  • •Are there new or worsening intrinsic risk factors?
  • •Does the care plan need updating?
  • •Has the falls risk assessment been reviewed and updated?
  • •Have lessons learned been shared with all staff?

Further Reading

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Important Notice

Care Handbook is a guidance resource only. It does not replace your organisation's policies, formal training, or current CQC standards. Always follow your employer's specific post-fall procedures. If in doubt, always seek medical advice. Call 999 for any suspected serious injury, head injury, or loss of consciousness.