Catch-22: Managing the falling patient…catalyst for consensus
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Catch-22: Managing the falling patient…catalyst for consensus



Louise Whitby

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 Catch-22: Managing the falling patient…catalyst for consensus Presentation Transcript

  • Catch 22Managing the falling patient … catalyst for consensus Louise Whitby
  • Overview evidence case law panel discussion opportunity
  • Our panelPat AlexanderSue AlexanderDilly de SilvaMike FrayHåkan SkenhedeAngela StevensonMelanie Sturman-FloydLaurette WrightPippa Wright
  • DefinitionA fall is an event which results in a personcoming to rest inadvertently on the groundor floor or on a lower levelAustralian 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 tooccur when the patient fallsduring transfer betweentwo seated surfaces e.g.bed to chair, chair to toilet.Betts 2006Sturman 2008Hignett and Sands 2009
  • EvidenceRisk assessment ofthe patient is themost appropriateand effective meansof preventing fallsand preventing injuryfrom falls.
  • BiomechanicsForces acting on the spine (L5/SI) whencatching a person are estimated to exceedsafe levelse.g. for 53 kg patient, force at L5/S1 estimated to be 5250 NFray (2003), reported in HOP 6, Smith J(ed), 2011
  • Case lawBayley v Bloombury Brown v East MidlothianHealth 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
  • Case lawHadfield v Manchester Fleming v StirlingHealth 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
  • Case lawDockerty v Stockton-on- ReferencesTees BoroughCouncil, 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
  • Case lawDempsey v Home Care Smith v Sydney West AreaService 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
  • In summaryIt is not appropriate fororganisations to adopt ano-intervention policy andto advise employees to donothing.Training essential – how toassist a falling patient assafely as possible.HOP 6, 2011