Catch 22Managing the falling patient

… catalyst for consensus

Louise Whitby

Overview evidence case law panel discussion opportunity

Pat AlexanderSue AlexanderDilly de SilvaMike FrayHåkan SkenhedeAngela StevensonMelanie Sturman-FloydLaurette WrightPippa Wright

Our panel

DefinitionA 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

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

EvidenceInjury 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 2006Sturman 2008Hignett and Sands 2009

EvidenceRisk assessment of the patient is the most appropriate and effective means of preventing falls and preventing injury from falls.

BiomechanicsForces 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

Case lawBayley v Bloombury Health Authority, 1983 student nurse, patient

fell while walk assist inadequate training –

insufficient practice to overcome the nurse’s instinct to catch or try to save the falling patient

employer negligent

Brown v East Midlothian NHS Trust, 1992 auxiliary nurse, failed

to intervene early, resulted in patient fall

adequate training employer not

negligent

Case lawHadfield v Manchester Health Authority, 1976 auxiliary nurse,

patient’s legs buckled while walk assist

inadequate training employer negligent

Fleming v Stirling Council, 1992 care assistant employer tried to link fall

to emergency situation, therefore not subject to OHS legislation (MHOR, 1992) – rejected

no falls assessment unsafe system of work

Case lawDockerty v Stockton-on-Tees Borough Council, 2006 care assistant injured policy stated that

employees should allow a person to fall

inadequate policy and training

employer negligent

References

Manual handling in health and social care, Mandelstam, 2002

HOP 6, Smith J (ed) 2011

Case lawSmith v Sydney West Area Health Service, 2008 RN, assisting with chair

transfer, co-worker let go when pt collapsed

Court of Appeal – foreseeable event

employer vicariously liable

Source: AustLII

Dempsey v Home Care Service of NSW, 2001 care assistant assisting client in

bathroom when lost balance but did not fall

compensation awarded

In summaryIt 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