Thousands of patients in NHS hospitals are at risk of serious falls as they cannot safely reach call bells or walking aids, a report has warned.
A fifth of falls recorded are from bed, and yet only half of NHS trusts had carried out a recent bed rail audit.
And while hospitals had policies in place for dealing with falls, there was "no association" between them and the care patients actually received on wards.
The study, published by the Royal College of Physicians, found the trust with the highest number of falls was Northern Devon Healthcare NHS Trust.
This was followed by Aintree University Hospitals NHS Foundation Trust and the Airedale NHS Foundation Trust.
Dr Shelagh O'Riordan, who led the study, said: "This is the first time there has been a national audit of falls prevention in hospitals across England and Wales.
"Our results show that although there are pockets of really good care, many hospitals are not doing everything they can to prevent falls."
Research has shown that falls in hospitals can be cut by 20%-30% through careful planning and identifying patients at risk.