It’s a fact of life that as we get older we become less steady on our feet, and for many people, hearing their elderly relative has injured themselves in a fall comes as no surprise – and often is something they have expected.
So if a loved one is injured in a fall when in the care of either a residential or care home, or a hospital, should we consider it something which was to be expected and could not possibly have been avoided? Certainly not.
Of course, there are cases when elderly patients fall and the circumstances simply couldn’t have been predicted or avoided.
However, in many cases we see as specialists in handling medical negligence compensation claims at Hudgell Solicitors, falls, many of which have resulted in serious injuries and ultimately lead to earlier death, could and should have been avoided with appropriate planning and care.
Often, this is because elderly patients have not been adequately risk assessed on admission, leading to them not being supervised appropriately.
Guidelines require health providers to fully risk assess patients for falls
National Institute for Health and Care Excellence (NICE) guidelines state that older people coming contact with any healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the falls.
This information should be used in order to devise a suitable care plan aimed around reducing the risk of falling.
Those considered at risk should be observed closely and assessed, taking into account their falls history, balance, mobility, strength, muscle weakness, fear on their feet, visual impairment, and continence problems which may lead to a patient often leaving their bed.
Once all of these elements have been assessed, and the impact on balance of any medication has been taken into account, a plan should be made to ensure all staff, at all times, are doing all they can to prevent the patient from suffering a fall.
Simple steps that could and should be implemented in most cases when a patient is deemed to be at risk of falls include;
- Ensuring sufficient nursing staff are available to provide the necessary levels of supervision
- Providing nursing supervision appropriate to the risk of falling – perhaps one-to-one supervision may be needed on those prone to wandering and who are unsteady
- Communicating the “at risk” status at each nursing shift handover to ensure clear understanding of needs of all staff
- Orientating the patient to their surroundings to ensure they are not confused about where they are
- Ensuring the patient is positioned in a high visibility area of a ward (if placed in an individual room this can hamper direct supervision and observation)
- Implementing a nurse call system – which can even be placed in a patient’s hand if needed
- Regularly instructing a patient to call for help before getting out of bed or before attempting to walk
- Regularly informing a patient and their family of the fall prevention interventions
- Evaluating all medications for the potential side-effects.
- Providing a commode at the bedside if deemed appropriate to limit the need to leave the bed
- Ensuring beds are in the lowest position possible
- Removing all obstacles and clutter and other unnecessary equipment and furniture
- Using a nightlight as appropriate
- Using electronic sensor alarms which will detect and sound if the patient attempts to mobilise independently from either a bed or chair
- Ensuring the patient has correctly fitting footwear as necessary
- Considering using protection devices such as hip protectors so as to avoid an unnecessary hip fracture should the patient unfortunately fall.
As can been seen from the list above, much can be considered and implemented to reduce the possibility of falls as much as possible, and relatives would be well within their rights to ask whether such precautions and measures had been in place should their loved one suffer a fall causing injury.
Prompt care and treatment is crucial should a patient be injured in a fall
Equally important is the treatment afforded to an elderly person following a fall. Too often we see failures to fully investigate injuries after a fall, leading to injuries worsening, and longer term pain and suffering for the patient.
In a recent case of mine, an 83-year-old patient died two weeks after suffering a broken hip in hospital, after wandering from his bed and falling six times in a matter of weeks. That is simply unacceptable and a clear example of a Hospital Trust failing in its duty of care. For the family involved the cost has been the avoidable loss of a much loved father, grandfather and great-grandfather.
So, in summary, families should not simply accept that an elderly person is likely to suffer a fall at some stage when in care.
What they must do – to ensure their loved ones are not let down – is insist all is done to prevent falls happening in the first place, and that health bodies demonstrate that they could have done nothing more should falls and injuries still occur.