someone who has had a brain bleed allowed to fall in hospital toilet smashing his head AIBU

[tallulah07]

I just visited a relative in hospital. He had a brain bleed 24 hours ago and is extremely unsteady on his feet. When I arrived he said he needed the toilet and asked me to pass him his walking stick. I did this and watched with concern as he shuffled one inch at a time. A nurse came in and told him he must ask to be helped if he needs to go to the loo. She took his arm and led him to the toilet which was opposite the ward. I sit on his chair. About 5 minutes later I head an almighty crash and a cry of pain. DH saw that my relative had been left in the toilet and he had fallen and smashed his head very hard against the door! AIBU to think that he should have been placed on the loo and helped back up. When I left he was in pain in his head and waiting for the doctor who had been called. I feel so upset and angry as somebody who has had a brain bleed should be lying still and not left unattended anywhere.

It sounds like your relative has a lot of pride and is struggling to ask for help/ wait for help. It is a very difficult thing to do. I think the nurses will be more aware of this now and hopefully manage accordingly. However speak to them if you have concerns.
How close are you?
Speak to him, ask him questions, try to understand.

@tallulah07 are you saying you think the nurse should have been in the toilet with him?

I’m a nurse. I had this exact scenario happen to me two weeks ago (patient had not had a bleed but fell in the toilet after I excepted them out). I had left them to run to the trolley to get fresh incontinence wear. I reminded not to move whilst I was gone or to ring the buzzer when finished. They didn’t and ended falling. They were not confused, just felt they could manage themselves. It’s awful for the patient and family but also for the nurse. There is only so much that can be done, we don’t have eyes on the backs of our heads or enough staff to ensure everyone is watched all the time. I’m sorry for your relative but as someone up thread said, no one wants an audience either and a fall can happen even when assisting.

Agree

It's a tough call though isn't it. Clearly your relative was trying to be independent but needed help. Every day they have to make judgements on how much independence to encourage and when to step in. I understand why you would be angry. I assume they were following procedure/protocol.

You could contact PALS and ask what his falls risk assessment said and whether this was followed. Sadly not all falls can be prevented though. I hope he wasn't too badly hurt.

The only time ‘duty of care’ can override consent as you put is when a patient lacks capacity. If the patient has capacity (which is always assumed they do until proven they don’t) the you can’t do whatever you want without their consent. That’s called abuse…

Yes exactly. The relative still has capacity to understand what they want.

i feel so upset and angry as somebody who has had a brain bleed should be lying still and not left unattended anywhere.
Just re-read your op.
Is it yourself that you're angriest at then? Given you were the one who helped them out of the bed and off to the loo? The nurse intervened only once you'd done this.
She made have had to abandon another patient or task to do this as well

Duty of care can override consent if it is deemed as a safeguarding issue. As you can see I wrote that at nearly midnight. There was a recent situation were a man jumped off a roof, still under the influence of the ketamine used during surgery. There's also been a different few instances were the patient had capacity. So new safeguarding policies have been put in place to cover temporary/not yet diagnosed lack of capacity. Which is why you need to start by asking questions.

The nurse immediately came through - the nurses station was directly the other side of the window and the toilet was directly opposite that. My relative is very hard of hearing and seemed sightly confused as would be expected after a brain haemorrhage or stroke.

But still you who helped them out of bed?

People fall all the time and nurses generally don’t have time to be 1 to 1 with every patient using the loo . The nurse likely sat them on the toilet and said ring the bell it’s hardly their fault if the patient stood up rather than ringing . I was a nurse for 30 yrs , it happens exactly as I’ve described . No nurse wants a patient to fall as invariably it means a shed load of form filling .

Im a hospital director. Every patient will have a falls risk assessment. Ask what his falls risk assessment needs were at the time of the fall and ask if it was adhered to.

Just to second this.
Also, OP, had the nurse not been there to intervene when you gave him his stick to shuffle to the toilet, he’d not have had any assistance at all. If a nurse had to stand in the bathroom with every patient that was at risk of falls they would never get anything else done. It is very unfortunate and I’m sorry it happened and has caused you distress, but most patients need and deserve a degree of autonomy and dignity.

I would presume that anybody who had had a brain bleed (and who was on blood thinning drugs) should have been treated with extreme caution and told to lie flat for several days incase of a further bleed.

Had a nurse not have come I would have walked him - the nurse took over so I assumed he was safe.

He got out of bed himself. I had no idea of his mobility but it quickly because obvious he was only able to move an inch at a time. He had taken about 5 'steps' right next to me when the nurse came and took over (which I was glad about and presumed he would be safe).

I have suffered several brain haemorrhages myself and, yes, at the very least, I would have expected somebody to stand the other side of the curtain. When I have bled I have had to stay flat on my back for up to two weeks afterwards and I have never had blood thinners, aspirin or anything..

What do you want OP? Are you looking for people to agree with you and shout for the nurse to be disciplined, to encourage you to sue?

Once he was up (after you helped) I can imagine if he'd been put back or told to get back in bed, you'd be complaining about that?

I would be very concerned about upsetting his dignity. I would be mortified at having a stranger (or anyone else for that matter) watch me on the toilet.
Apparently the Romans had communal toilets so I suppose it was the norm at one time. (Not the point, I know).

I have suffered several brain haemorrhages myself and, yes, at the very least, I would have expected somebody to stand the other side of the curtain

Someone standing at the other side of a curtain wouldn't have prevented the fall.

It's sad, but I cannot WAIT to go on mat leave and have time away from NHS. I'm also looking at what else I can do when due to return been about 15 years in AHP post and can't do it anymore.

And if you're so knowledgeable re protocols, why help him up op?