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Background The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents, facilitating learning and improving patient safety (NHS England. Patient Safety Incident Response Framework [internet]).Our organisation promotes a patient safety culture through compassionate engagement and support, promoting a just approach to patient safety events, open and transparent reporting with focus on system-wide improvement. Falls and medication errors are the most common causes of harm in our inpatient setting.Aim To reflect/compare two incidents resulting in significant harm – fractured neck of femur. One investigated using PSIRF framework.Method Case note review and application of PSIRF methodology.Results Both cases highlighted areas of good practice. After falling, they were both reviewed promptly by the overnight co-ordinator who liaised with the duty medical team. There was evidence of good support for the patient and families in negotiating a treatment plan and escalation to hospital. There was evidence of risk confidence, allowing patient autonomy to make choices regarding their care. Both patients had been reminded to use call bells for assistance when attempting to mobilise and were known to rehabilitation teams. The patients had capacity to make decisions regarding their mobility; the team on duty could not have prevented the falls occurring. Areas for learning included timely completion of falls risk assessments, updating assessments to allow clear documentation of clinical reasoning, promoting falls champions on each ward, installation of low-level patient movement activated lighting, ongoing use and review of safe staffing quality initiative and upskilling all staff in PSIRF methodology. Application of PSIRF methodology facilitated more learning and engaged wider numbers of healthcare professionals, promoting open communication.Conclusion PSIRF methodology can be applied in a specialist palliative care setting and promotes system-based approaches for learning from patient safety incidents.