Scott Harding-Lister
Scott is a qualified nurse and solicitor. He was a senior nurse within the NHS before leaving to pursue a career as a solicitor in City practices. In 2013 he set up Apex Health Associates and the expert witness practice has gone from strength to strength. Scott is a medico-legal expert, a nursing expert, and head of practice at Apex.
Introduction
Falls are a significant concern within healthcare facilities, particularly in hospitals where patients are vulnerable due to various health conditions. These incidents not only impact patient safety but also result in prolonged hospital stays, distress to families and health care staff, increased healthcare costs, and potential medico-legal implications. Therefore, implementing effective falls prevention strategies is paramount.
It is our duty to ensure that those in our care are safe and any risks are effectively mitigated and managed.
1. National Institute for Health and Care Excellence (NICE) Guidance and Local NHS Policies
The National Institute for Health and Care Excellence provides evidence-based guidelines (CG161) for falls prevention in hospitals. These guidelines offer a structured approach to identifying, assessing, and managing the risk of falls among patients. Local NHS policies complement NICE guidance by tailoring interventions to the specific needs and resources of individual hospitals or healthcare settings. It's crucial for hospitals to align their falls prevention protocols with both NICE guidance and local policies to ensure comprehensive and standardised care.
Local policies need to be robust, simple, and clear clinical guideline documents. As nursing and medico-legal experts we often review policies which we have found to be poor, lacking detail and do not provide clear guidance to clinical staff. Local policies should set out the problem and simply and clearly describe the interventions which the organisation has decided to put in place to mitigate any identified falls risk with their patient population.
2. Identifying Those at Risk of Falling
Risk identification is the cornerstone of falls prevention. NICE guidance provides that all patients over the age of 65 years should automatically be considered as at risk of falls. But, of course, there will be many patients under the age of 65 years who will also be at risk. Clinical sound judgement and experience is needed to spot and identify at risk patients. Patients with a history of falls, mobility issues, cognitive impairments, medication usage, and certain health conditions are more prone to falling.
3. Multi-factorial Risk Assessment
A comprehensive falls prevention programme involves conducting multi-factorial risk assessments. These evaluations consider various factors such as medication review, environmental modifications, mobility limitations, vision impairments, and cognitive status. Assessing a wide range of elements allows for a more tailored and effective approach to mitigating the risk of falls.
4. Detailed Care Plans
Once the risk factors are identified, individualised care plans must be developed. As nursing and medico-legal experts we stress here the importance of ensuring that care plans are individualised focusing on the issues and strategies for the particular patient. Pre-printed or pre-populated templates are helpful but they only should act as an aide memoire. These plans should include specific interventions tailored to the patient's needs and risks. This might involve physical therapy, medication adjustments, mobility aids, environmental modifications and staff supervision. Clear documentation of these care plans is essential, providing a roadmap for healthcare providers and ensuring continuity of care.
5. Collaboration with Patients and Family
Involving patients and their families in falls prevention efforts is crucial. Educating them about the risks and preventive measures empowers patients to take an active role in their safety. Encouraging open communication, addressing concerns, and providing educational materials can significantly contribute to a supportive and informed environment.
6. Education and Information Dissemination
Continuous education is key to falls prevention. Healthcare providers should offer literature and information about fall risks, prevention strategies, and resources available to patients and their families. Visual aids, brochures, and interactive sessions can enhance the understanding and adherence to safety measures.
7. Supervision and Continuous Review
Adequate supervision is essential for high-risk patients. Nursing staff should provide appropriate levels of supervision based on individual needs. Regular reassessment of risk factors and care plans is vital to adapt interventions as patients' conditions and needs change. Continuously reviewing and updating care plans ensures the relevance and effectiveness of the implemented measures. Reviews should occur (minimum) when a patient is moved between clinical areas and if there is any change in their clinical condition. The local policy will also have mandatory time limits prescribed as to when reviews should occur (e.g. once per week).
Supervision may be regular contact and checking in with the patient right up to one-to-one nursing where the patient remains in constant eye sight and within arms reach.
As medico-legal experts a significant amount of our work concerns falls and provided advice as to whether the care was reasonable or whether it fell to such a level that it was a breach of duty. One of the key areas we look at is the level of supervision that was afforded, whether this was in line with the policy and adequate to maintain the patient’s safety.
8. Referral to Specialist Falls Team
In cases where patients require specialised intervention, such as those with complex medical conditions or recurrent falls, referral to a specialist falls team is essential. These teams, comprising professionals like nurses, physiotherapists, occupational therapists, and geriatricians, offer more targeted and advanced interventions for mitigating fall risks.
Conclusion
Falls prevention in hospitals demands a multifaceted approach that integrates guidelines, local policies, risk identification, multi-factorial assessments, comprehensive care plans, collaboration with patients and families, education, adequate supervision, regular review, and access to specialist teams. By adopting these strategies, healthcare facilities can significantly reduce the incidence of falls, ensuring patient safety, improved outcomes, and reducing the risk of medico-legal implications.
Apex Health Associates has a dedicated team of medico-legal experts that can provide evidence in falls cases (Claimant and Defendant).