Falls in Hospital
Patients awaiting triage, transfer or assessment, or ‘parked’ on a trolley waiting for a bed on a ward, contribute to the majority of falls in hospitals. Most of these falls are unwitnessed – primarily due to the lack of staffing and supervision. Staff are often busy attending to other duties, leaving vulnerable, elderly or cognitively impaired patients at risk of falling. Those who are left for long periods of time on their own may try to mobilise themselves, but without the necessary strength, awareness or cognitive function to be able to do so safely.
With closer supervision and monitoring, these incidents could and should have been avoided. Hospitals should carry out risk assessments to ensure that all patients are safe.
Many more people are injured due to falling out of their hospital bed – an incident that is completely unacceptable and entirely avoidable if proper supervision, risk assessments and mitigation measures are in place.
Often, patients will return to their hospital bed following surgery, groggy from the effects of anaesthesia and strong analgesics. Unfortunately, many hospital wards are understaffed, meaning patients do not receive adequate supervision. This provides an opportunity for vulnerable, disorientated or distressed patients to try and get out of bed unaided, putting themselves at risk of falling.
NHS statistics have previously shown that 1 in 200 patients fall out of a hospital bed, which is quite incredible, considering that the situation could easily be avoided.
All hospitals should have a bed rails policy. However, even when such a policy is in place, nursing staff may lower the bedrails to administer treatment, examine or reposition a patient, and forget to raise the bedrails once complete, leaving the patient at risk of falling.
We understand that some hospitals have a policy not to put the bed rails up for fear of causing worse injuries – asphyxiation or entrapment of the head or neck. The rationale being that the risk of serious injury (and possibly death) due to a patient being trapped between or by the bed rails is greater than would be caused by rolling out of bed. However, it is impossible to make such generalisations: these decisions should be made on an individual basis, guided by an accurate – and patient specific – risk assessment.
The NHS tried to defend one of our previous cases on the basis that the bed rails were left down because they thought our 82-year-old client was likely to try and climb over the bed rails. Our client was recuperating from major surgery and, even if she were fully fit, she said that her climbing days were over! The NHS rationale for leaving the bed rails down was clearly flawed, and had they remained in place, her injuries would have been easily prevented! Her accident was totally avoidable.
Bed rails and bed safety equipment should be assessed to balance the risks and benefits to each patient. According to MHRA (Medicines and Healthcare Products Regulatory Agency) ‘Safe use of bed rails’ (December 2013), “Risk assessments should be carried out before use and then reviewed and recorded after each significant change in the bed occupant’s condition, replacement of any part of the equipment combination and regularly during its period of use, according to local policy.” The risk assessment should include whether the patient is likely to fall from their bed and whether bed rails are an appropriate solution. Consideration should be given as to whether any alternative methods could be used instead. Could the use of a bed rail increase the risk to the patient’s condition, for example, “if an active but disorientated bed occupant tried to climb over it?”.
Certain categories of patient are considered at greater risk of entrapment in bed rails, including the elderly, adults or children with communication problems or confusion, and those with dementia, repetitive or involuntary movements, and impaired or restricted mobility. Entrapment is defined as “entrapment of a patient’s chest or neck within bed rails, between bed rails, bed frame or mattress, where the bed rail dimensions or the combined bed rail, bed frame and mattress dimensions do not comply with Medicines and Healthcare products Regulatory Agency (MHRA) Guidance”.
According to the NHS, Never Events, reported between 1st April 2017 and March 2018 (published April 2019), there were 418 reported Serious Incidents, but only 2 recorded incidents of chest or neck entrapment in bed rails.
For further information, read our webpage: Fall out of a hospital bed, and our previous blog on Negligence claims for falling out of a hospital bed.
In summary, most falls from a hospital bed could have been avoided with adequate risk assessments, monitoring, and appropriate risk management.
These ‘never events’ “should not occur if the available preventative measures are implemented by healthcare providers”.
If you or someone you know has experienced a fall from a hospital bed, call us on 0161 272 5222 or 0800 011 4136 for a free consultation, as you may be entitled to compensation for injuries sustained.