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)

Published in: Health & Medicine
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Catch-22: Managing the falling patient…catalyst for consensus

  1. 1. Catch 22Managing the falling patient … catalyst for consensus Louise Whitby
  2. 2. Overview evidence case law panel discussion opportunity
  3. 3. Our panelPat AlexanderSue AlexanderDilly de SilvaMike FrayHåkan SkenhedeAngela StevensonMelanie Sturman-FloydLaurette WrightPippa Wright
  4. 4. 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
  5. 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. 6. 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
  7. 7. EvidenceRisk assessment ofthe patient is themost appropriateand effective meansof preventing fallsand preventing injuryfrom falls.
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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