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The National Institute for Health and Care Excellence (NICE) has warned that the NHS needs to re-focus on preventing falls in hospitals.
In hospitals throughout England it is reported that thousands of patients suffer falls in hospital every year. These can be falls from beds or falls while mobilising and can occur for a variety of reasons, for example because no guard rails are used or no nursing assistance is available or offered to elderly or otherwise unstable patients. The additional costs of claims arising from the falls or additional costs of extended treatment are avoidable with appropriate care.
NICE has recently updated Clinical Guideline 21, which was published in 2004, with a new CG161 Pathway published in June 2013. The guidance makes clear that each patient is different and has different needs and should be assessed in terms of their risk of falls accordingly. The guidance also specifically refers to vulnerable groups, particularly the elderly, or sufferers from dementia, stroke, vision or hearing problems, who are at higher risk of falls. These patients should be carefully assessed and a plan prepared to protect them as far as possible from falling. Patients should also be encouraged to call for any assistance that is needed.
Our experience is that it is not only such recognisably high risk patients who are injured in hospital falls, and it is therefore vital that an adequate history is taken on admission from every patient which will identify any risks that need to be addressed.
It is also vital that doctors and nurses respond to requests for assistance and make patients feel free to request this assistance without being worried about being a nuisance. This is a common complaint that we hear from our clients that they feel unable to request assistance, and this must be addressed.
We have also seen cases where nursing staff have determined that a patient’s difficulties necessitate the use of cot sides/bedrails, but then because the patient is not situated near the nurses’ station patients may not be observed trying to get out of bed during the night and can then actually suffer a more serious injury because of the precautions instituted to protect them. The use of bedrails, and the risks, therefore needs to be carefully assessed for each individual patient.
The issue of falls in hospitals is also exacerbated by the lack of continuity of care on hospital wards due to reduced staff numbers and increasing reliance on bank and agency nurses and rushed handovers, meaning that details of a patient’s condition and their risk of falling is not fully understood by everyone caring for them.
Falls can also occur outside the wards. In one case a patient with a prosthetic knee from a previous procedure, merely attending the hospital for a routine scan, slipped on the wet surface of a covered walkway between hospital buildings leading to a fracture of the tibia and fibula in the affected leg, another complex and expensive operation and delaying her recovery from her original surgery by over 12 months. This highlights the need not only to protect patients, but also employees and visitors, which require adequate risk assessment and preventative measures.
In addition to reducing the risks of someone falling in hospital it is vital that, when a fall does occur, a proper assessment of the patient is undertaken and post-fall care plan implemented. We have seen cases where, even when a patient’s fall is documented, a doctor may not be called to physically examine the patient and serious injuries, such as closed head injuries, go unrecognised which can lead to serious brain injury and even sadly death, which may have been avoided with a full assessment after the fall. Patients in hospital are often more vulnerable to more serious injuries from seemingly minor falls, due to their present illness, and therefore a higher threshold of assessment after a fall can be required.
As clinical negligence solicitors we see our clients after they have suffered a fall in hospital due to negligent hospital treatment. These falls can have devastating consequences. Our clients were already in hospital and the additional injuries they suffer due to an avoidable fall can delay their recovery from their original illness significantly, which in turn has significant emotional and financial consequences. The numbers of hospital falls reported are staggering and must be reduced. We fully support the new guidelines and hope that they will be widely adopted as standard practice to reduce the number of patients who suffer injury after an avoidable fall in hospital.