Patients awaiting triage assessment at hospital, transfers, or ‘parked’ on a trolley waiting for a bed to become available contribute to the majority of falls at hospital.
Most of these falls are unwitnessed – primarily due to the lack of staffing and close supervision.
Staff may become distracted perhaps whilst attending to other patients or emergencies, leaving vulnerable, elderly or cognitively impaired patients at risk of falling.
Patients can be left for long periods of time on their own and may try to mobilise themselves, but without the necessary strength, awareness or cognitive function to be able to do so safely.
Patients experiencing a fall at hospital usually result in spinal, hip, shoulder, arm or wrist injuries.
With closer supervision and monitoring, these incidents could and should have been avoided.
Hospitals should carry out risk assessments and to ensure that all patients are safe.
A number of other incidents causing injury arise from patients falling out of their hospital bed. We believe that this is one of those events which is completely unacceptable and entirely avoidable if proper supervision and risk assessments are in place.
Often patients will return to their hospital bed following surgery under general anaesthetic. Patients are usually groggy from the sedative effects of anaesthesia and strong painkillers administered whilst undergoing recuperation. Unfortunately, many hospitals and intensive wards are understaffed. Although some patients may need one-to-one close supervision, we suspect that in practicality, that is a difficult goal to achieve. This provides an opportunity for vulnerable, disorientated or impatient patients to try and get out of bed themselves unaided, placing themselves in danger and 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 the policy is in place, nursing staff attending to a patient in bed may lower the sides, for example, to administer treatment, examine or turn a patient, but then inadvertently forget to raise the side rails again – putting them 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 appears to be that there is more risk of serious injury (and possibly death) by a patient being trapped between or by the bed rails, than would be caused by rolling out of bed (or over the top of bed rails if on a higher mattress). However, we take the view that there is more likelihood, and therefore, a greater risk to elderly or vulnerable patients falling out of bed if there are no bed rails in place to prevent them from falling.
The NHS tried to defend one of our previous cases on the basis that the bed rails were left down because they thought that our 82 year old client was likely to try and climb over the bed rails to get out of bed! Our client was recuperating from major surgery, and even if she was 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 entirely prevented! Her accident was a 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, 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 there were 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 have been 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.
