Louise Whitby Director, Louise Whitby and Associates P/L, workedWELL P/L (P54, Thursday, Lower NZI Room, 2-3)

1. Catch 22
Managing the falling patient
… catalyst for consensus
Louise Whitby

2. Overview
 evidence
 case law
 panel
 discussion
 opportunity

3. Our panel
Pat Alexander
Sue Alexander
Dilly de Silva
Mike Fray
Håkan Skenhede
Angela Stevenson
Melanie Sturman-Floyd
Laurette Wright
Pippa Wright

4. Definition
A fall is an event which results in a person
coming to rest inadvertently on the ground
or floor or on a lower level
Australian Commission on Safety and Quality in Healthcare

5. Evidence
 Falls are the most commonly reported adverse
event among hospital patients.
 In sub-acute and rehabilitation hospital
settings, more than 40% of patients experience
one or more falls during their admission.
 Patient injury results in approximately 30% of such
falls, and death in approximately 0.3 %.
 Falls are more common amongst residents of aged
care facilities – up to half of whom fall at least
once a year.
 The majority of falls are not witnessed.
Australian data, Best practice guidelines for hospitals (2009), ACSQH

6. Evidence
Injury to staff is most likely to
occur when the patient falls
during transfer between
two seated surfaces e.g.
bed to chair, chair to toilet.
Betts 2006
Sturman 2008
Hignett and Sands 2009

7. Evidence
Risk assessment of
the patient is the
most appropriate
and effective means
of preventing falls
and preventing injury
from falls.

8. Biomechanics
Forces acting on the spine (L5/SI) when
catching a person are estimated to exceed
safe levels
e.g. for 53 kg patient, force at L5/S1 estimated to be 5250 N
Fray (2003), reported in HOP 6, Smith J(ed), 2011

9. Case law
Bayley v Bloombury Brown v East Midlothian
Health Authority, 1983 NHS Trust, 1992
 student nurse, patient  auxiliary nurse, failed to
fell while walk assist
intervene
 inadequate training –
insufficient practice to
early, resulted in
overcome the nurse’s patient fall
instinct to catch or try  adequate training
to save the falling
patient  employer not negligent
 employer negligent

10. Case law
Hadfield v Manchester Fleming v Stirling
Health Authority, 1976 Council, 1992
 auxiliary  care assistant
nurse, patient’s legs  employer tried to link fall
buckled while walk to emergency
assist situation, therefore not
 inadequate training subject to OHS legislation
 employer negligent (MHOR, 1992) – rejected
 no falls assessment
 unsafe system of work

11. Case law
Dockerty v Stockton-on- References
Tees Borough
Council, 2006 Manual handling in
 care assistant injured health and social
 policy stated that care, Mandelstam, 2002
employees should
allow a person to fall HOP 6, Smith J (ed) 2011
 inadequate policy and
training
 employer negligent

12. Case law
Dempsey v Home Care Smith v Sydney West Area
Service of NSW, 2001 Health Service, 2008
 care assistant  RN, assisting with chair
transfer, co-worker let
 assisting client in go when pt collapsed
bathroom when lost  Court of Appeal –
balance but did not fall foreseeable event
 compensation awarded  employer vicariously
liable
Source: AustLII

13. In summary
It is not appropriate for
organisations to adopt a
no-intervention policy and
to advise employees to do
nothing.
Training essential – how to
assist a falling patient as
safely as possible.
HOP 6, 2011