Pat AlexanderSue AlexanderDilly de SilvaMike FrayHåkan SkenhedeAngela StevensonMelanie Sturman-FloydLaurette WrightPippa Wright
Our panel
DefinitionA 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
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
EvidenceInjury 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 2006Sturman 2008Hignett and Sands 2009
EvidenceRisk assessment of the patient is the most appropriate and effective means of preventing falls and preventing injury from falls.
BiomechanicsForces 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
Case lawBayley v Bloombury Health Authority, 1983 student nurse, patient
fell while walk assist inadequate training –
insufficient practice to overcome the nurse’s instinct to catch or try to save the falling patient
employer negligent
Brown v East Midlothian NHS Trust, 1992 auxiliary nurse, failed
to intervene early, resulted in patient fall
adequate training employer not
negligent
Case lawHadfield v Manchester Health Authority, 1976 auxiliary nurse,
patient’s legs buckled while walk assist
inadequate training employer negligent
Fleming v Stirling Council, 1992 care assistant employer tried to link fall
to emergency situation, therefore not subject to OHS legislation (MHOR, 1992) – rejected
no falls assessment unsafe system of work
Case lawDockerty v Stockton-on-Tees Borough Council, 2006 care assistant injured policy stated that
employees should allow a person to fall
inadequate policy and training
employer negligent
References
Manual handling in health and social care, Mandelstam, 2002
HOP 6, Smith J (ed) 2011
Case lawSmith v Sydney West Area Health Service, 2008 RN, assisting with chair
transfer, co-worker let go when pt collapsed
Court of Appeal – foreseeable event
employer vicariously liable
Source: AustLII
Dempsey v Home Care Service of NSW, 2001 care assistant assisting client in
bathroom when lost balance but did not fall
compensation awarded