Shrewsbury and Telford Hospital NHS Trust has admitted failing to ensure the safety of five patients following a prosecution brought by the Heath and Safety Executive.
Stafford Crown Court heard yesterday that there was a series of failings at the trust including inadequate assessments of patients and information shared by staff at the point of a shift change was insufficient.
The court was told there was also poor record keeping and failure to provide one-to-one care for the most vulnerable patients.
The trust is being prosecuted after five patients died following falls at Telford's Princess Royal Hospital or Royal Shrewsbury Hospital in 2011 and 2012.
Mr Bernard Thorogood, prosecuting, argued falls at the hospitals contributed to the death of at least four of the patients.
He said falls and fall related injuries are a very serious problem in the NHS when treating older patients.
He told the court it was important to assess the risks but one of the problems at the trust was a form used when assessing patients was "inappropriately used" and could not always document all risk factors.
Mr Thorogood said since the falls the trust had changed some of its procedures.
He said in one case, 74-year-old Mohan Singh suffered a fall at Princess Royal Hospital.
He died after suffering a head injury.
But Mr Thorogood said the fall could have been prevented if one-on-one care had been provided, as requested by a staff nurse.
But the court heard that the nurse was told there was nobody available to give that care.
Mr Thorogood said: "In relation to Mr Singh the staff on the ward did what they could but they could not provide what he needed, one to one supervision.
"If he had been given the enhanced care he clearly needed this fall would not have taken place."
He said a post-mortem report showed the fall had contributed to his death.
It is not the first time the trust has been in court for breaching health and safety rules.
The court heard that the trust was fined £50,000 at Shrewsbury Crown Court in 2010 after an 89-year-old man fell out of bed at Princess Royal Hospital and later died.
The Health and Safety Executive said it prosecuted the trust after an investigation found the hospital had failed to provide the man with a bed rail that would have prevented the fall.
Justice Charles Haddon-Cave adjourned the case until a later date when mitigating factors for the trust are expected to be outlined ahead of a sentence being handed down.
The case is expected to resume before the end of the year, with full details yet to be announced.
Justice Haddon-Cave said it was a complicated case, adding: "It's important that due attention is given to every aspect of it."
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