Catch-22: Managing the falling patient…catalyst for consensus
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Louise Whitby Director, Louise Whitby and Associates P/L, workedWELL P/L (P54, Thursday, Lower NZI Room, 2-3)
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Catch-22: Managing the falling patient…catalyst for consensus
- 1. Catch 22 Managing the falling patient … catalyst for consensus Louise Whitby
- 2. Overview evidence case law panel discussion opportunity
- 3. Our panel Pat Alexander Sue Alexander Dilly de Silva Mike Fray Håkan Skenhede Angela Stevenson Melanie Sturman-Floyd Laurette Wright Pippa Wright
- 4. Definition A fall is an event which results in a person coming to rest inadvertently on the ground or floor or on a lower level Australian Commission on Safety and Quality in Healthcare
- 5. Evidence Falls are the most commonly reported adverse event among hospital patients. In sub-acute and rehabilitation hospital settings, more than 40% of patients experience one or more falls during their admission. Patient injury results in approximately 30% of such falls, and death in approximately 0.3 %. Falls are more common amongst residents of aged care facilities – up to half of whom fall at least once a year. The majority of falls are not witnessed. Australian data, Best practice guidelines for hospitals (2009), ACSQH
- 6. Evidence Injury to staff is most likely to occur when the patient falls during transfer between two seated surfaces e.g. bed to chair, chair to toilet. Betts 2006 Sturman 2008 Hignett and Sands 2009
- 7. Evidence Risk assessment of the patient is the most appropriate and effective means of preventing falls and preventing injury from falls.
- 8. Biomechanics Forces acting on the spine (L5/SI) when catching a person are estimated to exceed safe levels e.g. for 53 kg patient, force at L5/S1 estimated to be 5250 N Fray (2003), reported in HOP 6, Smith J(ed), 2011
- 9. Case law Bayley v Bloombury Brown v East Midlothian Health Authority, 1983 NHS Trust, 1992 student nurse, patient auxiliary nurse, failed to fell while walk assist intervene inadequate training – insufficient practice to early, resulted in overcome the nurse’s patient fall instinct to catch or try adequate training to save the falling patient employer not negligent employer negligent
- 10. Case law Hadfield v Manchester Fleming v Stirling Health Authority, 1976 Council, 1992 auxiliary care assistant nurse, patient’s legs employer tried to link fall buckled while walk to emergency assist situation, therefore not inadequate training subject to OHS legislation employer negligent (MHOR, 1992) – rejected no falls assessment unsafe system of work
- 11. Case law Dockerty v Stockton-on- References Tees Borough Council, 2006 Manual handling in care assistant injured health and social policy stated that care, Mandelstam, 2002 employees should allow a person to fall HOP 6, Smith J (ed) 2011 inadequate policy and training employer negligent
- 12. Case law Dempsey v Home Care Smith v Sydney West Area Service of NSW, 2001 Health Service, 2008 care assistant RN, assisting with chair transfer, co-worker let assisting client in go when pt collapsed bathroom when lost Court of Appeal – balance but did not fall foreseeable event compensation awarded employer vicariously liable Source: AustLII
- 13. In summary It is not appropriate for organisations to adopt a no-intervention policy and to advise employees to do nothing. Training essential – how to assist a falling patient as safely as possible. HOP 6, 2011