Cross-specialty safety

This page is part of the wider ‘enduring standards that remain valid from previous patient safety alerts‘ set of webpages.


Patient falls are a significant patient safety issue within the NHS. While the mainstay of improvement work is national resources – National Institute for Health and Clinical Excellence (NICE) guidelines, national clinical audits, improvement resources and eLearning – a previously issued alert outlined several enduring standards that remain valid for care after an inpatient fall:

  • Providers with inpatient services should have a post-fall protocol that includes:
    1. checks by nursing staff for signs or symptoms of fracture or potential for spinal injury before the patient is moved
    2. safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury
    3. frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (eg unwitnessed falls) based on current NICE clinical guidelines for head injury
    4. timescales for medical examination following a fall (including fast track assessment for patients with signs of serious injury, or high vulnerability to injury, or who have been immobilised).
  • Their post-fall protocol is easily accessible (eg laminated versions at nursing stations).
  • Their staff have access to clear guidance and formats for recording neurological observations using a 15-point version of the Glasgow Coma Scale (GCS) and that changes in the GCS that should trigger urgent medical review are highlighted.
  • Their staff have access to special equipment (eg hard collars, flat-lifting equipment, scoops) and colleagues with the expertise to use it, for patients with suspected fracture or potential for spinal injury.

Note: community hospitals and some mental health inpatient units may be able to make arrangements with ambulance services to supply special equipment and expertise for patients with suspected fractures or spinal injury.

Acute kidney injury (AKI)

A previously issued alert set out the requirement to ensure the NHS Acute Kidney Injury algorithm is integrated into organisations’ local laboratory information systems and test results are sent to local patient management systems. These requirements remain as an enduring standard that organisations should adhere to.

Emergency calls

While technology brings new communication solutions that may not involve a specific number being dialled, where an internal telephone number is dialled to summon an emergency team for cardiac or respiratory arrest or peri-arrest, this should be standardised to 2222.

Identity bands

The following standards from previously issued alerts, relating to identity bands that display a patient’s core identifiers (and may be applied to the wrist or ankle), continue to apply. Note the term ‘identity bands’ has replaced the term wristbands used in the original alert, as other types of wristband have come into use in clinical settings and because identity bands may be worn on other limbs.

  • All inpatients in acute hospitals should wear identity bands unless there are clinical reasons that make this impossible or they refuse to do so.

Note this is the minimum standard established by the past alert, but current best practice is to use identity bands in wider cohorts of patients.

  • NHS Digital Information Standard ISB 0099 now establishes the core patient identifiers (last name, first name, date of birth, verified NHS number) and should always be referred to for current requirements and detail of font size, etc.
  • Information standards for the use of bar coding in identification have since been produced. No information other than the core identifiers and barcodes should be included on the identity band.
  • Only use a white identity band with black text or (to identify a known risk) a red identity band with black text in a white text box background.

The standard relating to a single identity band continues to apply because;

  • systems that used a white identity band, with a second red wristband for patients with allergies, created an inherent error trap as staff will assume if there is no second wristband the patient has no allergies,
  • it does not preclude the use of an additional wristband (giving details of allergies or other special considerations) alongside a red identity band; but the risks and benefits of this, including when space is insufficient to identify all allergies, needs careful local assessment.
  • this standard does not preclude the use of other wristbands, bracelets or sleeves that are clearly distinct from the single identity band and do not hide it (e.g. a sleeve warning that blood pressure and blood samples should not be taken on an arm with an arteriovenous fistula or target saturation wristbands).



Go back to the main  ‘enduring standards that remain valid from previous patient safety alerts‘ webpage.