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Preventing falls in hospitals

I wrote last year about warnings from NICE (National Institute for Health and Care Excellence) about the need for the NHS to do more to prevent falls in NHS hospitals due to the high numbers of falls occurring every day and the resulting high cost to the NHS.  I have read stories since about steps that are being taken at some hospitals to do more to reduce the number of falls, which is encouraging, but is more action still required?

Guidelines and recommendations:

All patients admitted to hospital should be assessed promptly on admission for their risk of falling.  The NICE recommendations include:

1.    Patients aged over 65 should be regarded as being at risk of falls and their care managed accordingly.

2.    Assessment of a patient’s individual risk factors for falling including cognitive impairment, continence problems, falls history, footwear, specific health problems which may increase the risk of falling, medication, balance problems and visual impairment.

3.    Good communication with the patient and their family about their risk of falling, measures put in place to reduce the risk, and how the patient can call for assistance.

Steps to prevent falls in hospitals:

If a patient is at risk of falling in hospital, steps can and should then be taken to reduce the risk of falling in hospital. These steps can include:

1.    Close/frequent observation – the patient should be in clear view of nursing staff.

2.    Movement alarms to alert staff when patients are mobilising.

3.    Wearing hip protectors to reduce the impact of a fall.

4.    The use of height adjustable beds which can be adjusted to a low level if a patient is at risk of falling from their bed to reduce the risk of suffering significant injury.

5.    The use of bed rails.

6.    Ensuring the patient has easy access to a call bell and knows how to use it

7.    Ensuring the patient has appropriate footwear.

8.    Ensuring the patient has easy reach of a walking aid if required.

9.    Ensuring floors are free from water and obstacles.

Steps implemented must be specific to the patient and their own particular needs and risk factors. There is no “one size fits all” approach and not all measures will be appropriate for every patient.

Improvements

Examples of positive steps in this area that have been taken around the UK include:

–    South Warwickshire NHS Foundation Trust have purchased some beds which are specifically designed to be lower than regular beds and also using sensors which alert staff if patients get out of bed.

–    Royal United Hospitals Bath NHS Foundation Trust have implanted a colour coded label system for walking frames, with different colours representing what level of assistance the patient requires.  So if a patient is mobilising the staff can immediately see the colour of the label and identify if that patient should have assistance of 1 or 2 carers when walking and whether that is being complied with.

Our experience

Whilst it is encouraging that some hospitals are taking specific steps to reduce the risk of their patients suffering falls while under their care, there is still more that needs to be done particularly to prevent falls in hospitals due to negligence.  Suffering a fall in hospital can lead to further injury (on top of the injury for which the patient is already in hospital) and an extended recovery time and this can be devastating for a patient, particularly an older patient as falls can lead to fractures.

The NICE guidelines need ongoing and consistent implementation across all hospitals ensuring that all patients are appropriately assessed for their risk of falling, re-assessed at appropriate times (particularly if their condition changes) and any recommendations as a result of patients being deemed at risk of falling are implemented robustly.

We acted recently in a case where a male patient in his 60s had been assessed on admission as being at low risk of falls.  During his admission his condition deteriorated due to the treatment he was receiving but his risk of falls was not reassessed as a result.  His family reported that he became more confused and disoriented and one day when he was unattended he suffered a fall after getting out of bed and banged his head, suffering a bleed on his brain, and he sadly died within days.  A compounding problem was that, even after he had fallen, the staff did not take appropriate steps to monitor his condition and notice that he was deteriorating at an early stage where he could have been treated, and therefore another opportunity to prevent his death was missed.

If you or a member of your family have suffered a fall in hospital and have suffered injury as a result, please contact me or one of my colleagues to investigate whether appropriate steps were taken to prevent the fall and if you may be able to bring a claim to compensate you for the injuries you have suffered.

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