Falls with injury are a persistent patient safety challenge in the acute care setting. This article describes the creation and implementation of a Certified Falls Prevention Advocate (CFPA) program on a medical-surgical unit. The program created standardization of nursing support staff involvement in falls prevention and engaged them as members of the interdisciplinary team. The CFPA program was an important element in the unit's improvement in falls with injury rates. The mean falls with injury rate decreased from 1.115 to 0.178 per 1000 patient-days over a 1-year period.

SUMMARY'Self-cutting' is a specific type of emergency presenting to accident and emergency departments. All cases presenting in Sheffield in a 6-month period were studied. The self-cutter is most often a young, unemployed man: this is the group most likely to cut repeatedly. At least 45% of all cutters had a past psychiatric history, and a quarter of them were judged a high suicidal risk. The seriousness of the physical injury and the suicidal risk cannot be simply correlated.The crucial part of acute management is the decision about psychiatric referral. As with a complex physical injury, formal assessment must be performed and specialist referral made on that basis.