You find a patient on the bathroom floor. Your first action is:

Assess without moving them: responsiveness, A-E, pain, obvious injury including head and hips

Help them straight back to bed to preserve dignity

Fetch a hoist before speaking to them

Complete the incident form immediately

The patient's left leg lies shortened with the foot rotated outward, and the hip is too painful to move. You suspect:

A fractured neck of femur: keep them still, analgesia per prescription, urgent medical review and likely X-ray

Nothing significant if they can wiggle their toes

An unwitnessed fall; the patient takes apixaban and has a small scalp graze. You:

Start neurological observations per head-injury policy and inform the medical team promptly, because anticoagulation raises intracranial bleed risk

Note the graze and take no further action

Stop the apixaban yourself as a precaution

During neuro obs, which change matters most urgently?

A falling GCS or a newly unequal pupil

A preference for tea over coffee

Tiredness at their usual bedtime

Complaining about the observations themselves

The Planning phase after this fall should include:

An updated falls risk assessment and prevention plan: causes reviewed, environment, footwear, call bell reach, mobility referral

Restricting the patient to bed indefinitely

Only treating the current injury

Removing their walking aid as punishment for using stairs

Part B of 3 The 12 APIE Scenarios Chapter 25 of 35

OSCE APIE Scenario: Fall and Fracture

The NMC OSCE fall scenario through APIE: post-fall assessment before moving, hip fracture signs, neuro obs after head strike, and 5 questions.

Start reading ← OSCE practice hub ~5 min read

By JobLabs Editorial · UK healthcare reference editorial team

· July 18, 2026 · 2 min read

The fall scenario starts where real falls do: on the floor, with the strong urge to help someone up immediately. The exam’s first mark is resisting that urge, because assessment before movement is the whole safety logic of post-fall care.

Assessment. On the floor: responsiveness, then A to E. The injury sweep has two headline checks. Hips: a shortened, externally rotated leg with groin pain is the neck-of-femur picture, and it means the patient stays put. Head: any strike, or an unwitnessed fall where one can’t be excluded, starts the head-injury pathway, with the threshold dropping further for anyone anticoagulated. Add the “why” history while you work: dizziness before the fall, chest pain, palpitations, new weakness; a fall is often a symptom wearing an accident’s clothes.

Planning. Two plans in parallel: the injury plan (immobilisation, analgesia, imaging, pressure care while immobile, and floor-time matters: long lies cause pressure damage, hypothermia and rhabdomyolysis in the frail) and the prevention plan, because every fall re-opens the falls risk assessment: medication review, postural blood pressures, environment, footwear, call bell within reach.

Implementation. Safe moving only after assessment clears it, with enough people and the right equipment; analgesia before movement, not after; neuro observations at head-injury-policy frequency, scored with GCS done properly; and the communication set: the medical team informed, the family per the patient’s wishes, and the incident report, which is a patient-safety tool and not an admission of blame; the exam wants you to say so without prompting.

Evaluation. For the injury: pain controlled, obs stable, neuro obs unchanged, skin intact. The neuro red flags that convert evaluation into emergency: falling GCS, new pupil inequality, repeated vomiting, seizure. For prevention: has the plan actually changed anything measurable: fewer near-misses, safer transfers, appropriate aid in use? And for the record: falls documentation is among the most-audited and most-litigated in nursing, so the notes carry the circumstances, findings, actions and notifications in full.

Five questions below, then the scenario that changes the goals entirely: end of life care.

Sources & further reading

Key takeaway from OSCE APIE Scenario: Fall and Fracture

Frequently asked questions

What does a fractured hip look like on the floor?

The classic triad: the affected leg shortened, externally rotated (foot pointing outward), with pain in the hip or groin and inability to weight-bear. The patient stays where they are; moving them is for adequate help with proper technique after assessment.

When does a fall trigger neurological observations?

Any known or suspected head strike, any unwitnessed fall where a head strike can't be excluded, and lower thresholds for patients on anticoagulants, where a slow intracranial bleed is the feared complication.

What belongs in the post-fall documentation?

The circumstances (witnessed or not, before-and-after symptoms), the injury assessment, observations and neuro obs if indicated, who was informed, the incident report, and the updated falls prevention plan. Falls documentation is heavily audited and often legally read.

Check your understanding

Quick quiz: OSCE APIE Scenario: Fall and Fracture

5questions. Click an answer to see the explanation. Your score is saved on this device only.

1
You find a patient on the bathroom floor. Your first action is:
Assessment precedes movement, always: lifting a person with an unstabilised fracture or spinal injury converts an accident into an injury you caused. Dignity is managed with a blanket and calm words while the assessment happens, not by a fast lift.
2
The patient's left leg lies shortened with the foot rotated outward, and the hip is too painful to move. You suspect:
Shortened and externally rotated is the neck-of-femur picture, common after low-impact falls in older people. Toe movement doesn't exclude it. The plan is immobility, pain relief, pressure care on the floor if the wait is long, and urgent imaging.
3
An unwitnessed fall; the patient takes apixaban and has a small scalp graze. You:
Head strike (or unexcludable head strike) plus an anticoagulant is the highest-alert combination this scenario carries: slow bleeds present hours later. Observations start now, and the prescriber decides anything about the drug. Waiting for vomiting waits for deterioration.
4
During neuro obs, which change matters most urgently?
Falling conscious level and pupil asymmetry are the classic signs of rising intracranial pressure: an emergency call, not the end-of-round note. Distinguishing ordinary sleepiness from unrousable drowsiness is exactly what serial GCS scoring is for.
5
The Planning phase after this fall should include:
Every fall re-opens the falls assessment: why now (postural drop, sedation, infection, environment), and what changes. Bed-rest 'protection' increases deconditioning and future falls; the plan is safer movement, not less movement.

OSCE APIE Scenario: Fall and Fracture

Sources & further reading

Frequently asked questions

Quick quiz: OSCE APIE Scenario: Fall and Fracture

Keep reading

Pressure Area Assessment: OSCE Station Checklist

Pain Assessment: OSCE Station Checklist

OSCE APIE Scenario: Hernia