To make a complaint to the hospital?

[Questionablmouse]

My dad was taken into hospital last week with a suspected heart block that was causing confusion and low heart rate. They found out he'd had a minor heart attack and put him on blood thinners. I got a call last night at 7pm saying he was confused and they were worried about hospital delirium but would monitor him.

He went to the toilet by himself at 8am this morning and fell, banging his head. He's had a CT scan which shows some bleeding and he's in quite a bad way.

Aibu in thinking that considering he was confused and on blood thinners he should have has something with him he he couldn't just wander around the ward? I feel like making a complaint because he should have been safe in hospital and now there's a chance he might not come home at all.

I think this shows up a big difference in expectations on families. In the UK there is no expectation that families will take any part in care of patients whereas in many countries that is the norm.

I think what the Public expect from the NHS is often unrealistic and would require 1 to 1 care.

I don't think that's the only issue although it is a significant cultural difference. I genuinely don't know what you're expected to do in the NHS in this sort of circumstance. We do have issues with falls here when family aren't attending but ultimately as has been mentioned, 1:1 for so many people simply isn't possible. If a patient is at high risk and won't stay in the bed, what do you actually do on a practical level? I realise I'm not in the UK so there will be difference but it's only another EU country so there tends to be a certain amount of parity in these things. I did think restraint was applied in the UK when necessary. Here we know that no-one is restrained out of cruelty, it is for their own safety and only when necessary. What else do you do? Sedate them? I'd argue that's worse.

I wouldn’t go straight to a complaint but I would be asking if he was assessed as a falls risk and what was being done to prevent further falls. If he had no history of falls there wouldn’t necessarily be one.

My mum was a falls risk when admitted to hospital and after I think 2 falls and being very disruptive generally they did put her in a side room with 1:1 support. I visited daily and they were always glad of a break. I couldn’t just stay I had a 4 yo. She would forget she couldn’t walk or that she has just been to the loo and was persistently getting up. She was on a DOLS due to repeatedly trying to leave (asking anyone any everyone to direct her to the nearest bus stop) but that didn’t give them permissIon to restrain her. As has already been said, using the side rails can be more risky if people try to climb over so they are only used on a case by case basis.

When she moved a care home, they had a profiling bed on the lowest setting and a crash mat on the floor and one against the wall so she wouldn’t hurt herself if she got out of bed. She had an alarm mat in bed so staff knew if she was on the move. She had 1:1 there too for a good few weeks until they got her medication right as otherwise thet just couldn’t cope with her. She has severe vascular dementia but that wasn’t diagnosed until she had been in hospital for a while and been assessed and it came on really quickly. When she first arrived they would have assessed her on her history up to that point. At no point was she physically restrained. She remained under a DOLS for over a year until she stopped asking to leave when she had less awareness of her surroundings.

Keep advocating for your Dad, that’s the best thing you can do for him. As some have said it’s possible that a brain event caused the fall and not the other way around. Sending positive thoughts .

Op my fil was recently in hospital and due to falls risk wasn’t allowed leave his bed. No confusion. He ended up being medically fit for discharge but unable to walk and it was a massive fight to get him into a rehab facility to regain mobility.
I’m really sorry your dad had a fall and is so ill but it’s impossible to fully prevent falls and efforts to do so can have life changing consequences. I hope he makes a full recovery

I think most Brits would assume the wife wasn't allowed to stay overnight.

Definitely this as every patient should have one. Take it from there.

I agree with this. Visiting is quite strictly enforced in our local hospital but I was allowed to go outside because of her being so difficult and in a side room. I was asked to keep out of the way when the bell went so others wouldn’t ask questions. Because my son was small, I used to put him to bed and then go and visit mum. I usually arrived around the end of visiting and would stay an hour or so. She was in hospital for 3 months and on 1:1 care probably for 2 of those.

for folk based in the UK who have rellies with complex cognitive needs who are in hospital, it's worth looking up John's Campaign. Most hospitals are receptive to the idea of extended visiting for patients with additional needs these days.

It is worth remembering thought that where an elderly person is in hospital, quite often the nearest relative who can or wants to visit is equally elderly and they do need to be able to rest themselves so they don't become ill too.

Indeed but when they arrived she was shown the sofabed for her use and the sheets provided for it and she was repeatedly asked to stay so...

Anyway, clearly restraint is seen as unacceptable over there but falls risk assessments can be difficult. We don't know yet from the OP just how mobile her father is or what sort of assessment was done or what, if anything, was put in place to prevent falls. It is also possible, as someone else suggested, that the bleed precipitated the fall rather than caused it. I have seen this happen before too. How is your father now, @Questionablmouse and what has the attitude of the hospital been towards the fall?

I’m not aware of bed rails used to restrain patients. I did some fall falls training this week and bed rails are advised to be used with caution to stop people falling out of bed, but not if they are confused and can independently mobilise. This is to avoid people trying to climb over them. Agree with pp to ask to see how he was assessed re falls risk and what was put in place, eg cohort observation perhaps. I hope he gets better soon.

Well yes - rails work for those who aren't mobile enough to climg over them but could fall out of bed otherwise and who are compliant. We don't know what the case was with OP's father.

I personally wouldn’t complain,just ask questions and see how the hospital responds. My late mum would get bad hospital induced delirium and she would have 24 hour 1 to 1 care. I used to try and spend as much time with her as I could and never saw the worst behaviour which was things like taking her feeding tube out and trying to get out of bed.

Once she was home she would be back to normal within a couple of days. I think the delirium is a coping mechanism in a weird way. But once I realised it wasn’t a permanent change it was easier to cope with.

Bedrails can only be used with consent, either at a patients request or in their best interest if they cannot consent. A full bedrail, capacity, falls risk, mobility risk and safety plan have to be in place as they are a form of restraint.

I expect people quite often find your advice unwelcome, it might be worth thinking about why.

My Nan was actually dropped by staff when she was in hospital several years ago being moved from her chair back to bed. She skinned both her shins and bruised her arm badly, the staff put dressings on her legs but didn’t tell any of the family.

When my aunt went to visit the next day, she asked Nan about her bruises and was told what had happened. Nan had no cognitive issues and was only in for observation following a bad nosebleed that wouldn’t stop. When asking the staff, my aunt was told ‘oh yes, there was an accident yesterday evening’ but nobody bothered to tell the family.

When a complaint was raised via PALS, the hospital send Nan away for ‘rehabilitation’ at a centre over an hour away which was really difficult for family to visit. Said rehab consisted of 15 minutes of physio twice a week and she was there for 26 weeks!

She went in a fully mobile 85 year old who could look after herself and came out unable to walk and needing carers four times a day.

Lessons would be learned from the incident apparently 🤔

‘Sorry to hear about your dad though, OP’

Wow. I just showed that to my colleague and she snorted and said that "here we just use common sense". I raised my eyebrows because I can't fully agree with her on that statement but it does sound a bit over the top to me, a bit over officious or 'Nanny state'.

Common sense isn't enought, there are policies in place for bedrooms in all health settings.

Gov,UK produce clear guidelines on the use of bedrails

I’m really sorry to hear about your Dad. I do hope he makes a full recovery.

Unfortunately, falls in hospital are not uncommon, and they often involve fractures and bleeds. The floors are so hard and I think there should be more grab rails etc. It would be great if the magic ‘falls assessment’ delivered all the recommendations it suggests upon completion, but tbh it just doesn’t. 1 nurse and 1 HCA for 12+ patients just doesn’t cut it when they are confused. You can try and get extra staff to 1:1 patients but these days due to cuts there just is not enough staff. The budget in my hugely strapped trust doesn’t allow for ‘extra’ staff on shift. I think it will be common practice soon to ask family for more support.

I would speak to PALS. It should and must be investigated. As a nurse, I welcome fact finding investigations when things have gone wrong. These are people’s lives and questions should always be asked. Nothing will ever change if the conditions for both patients AND staff are not challenged. The nurse will be devastated.

im sorry to hear about your dads fall. I hope he makes a quick recovery. Depending on the circumstances it’s up to you if you want to complain but to give a nurses perspective and maybe some insight into how these things can happen….

most general medical/surgery wards run with a desired ratio of 1:8 nurses to patients. However this is rarely the case due to short staff. When I was working in a gen med ward it was much more like 1:10 or even 1:14. Nurses simple CAN NOT be everywhere at the same time.

most patients in hospital are elderly, we have an aging population and for obvious reasons they are the highest population group in hospitals, they are also more likely to become delirious, coupled with short staff this is a recipe for disaster.

most hospitals are old, and over the years more and more bed have been added making ward layouts awkward and most of the bays unobservable so often nurses cant physically see patients climbing out of bed or other risk taking behaviours until it’s too late and they hear a bang. Newer hospitals are even worse as they have more and more single rooms, great for younger patients and infection control, not so great for older delirious patients. I worked in a fully single room hospital and there wasn’t a single shift that went by were I wasn’t completing incident forms for falls.

lots of pp have mentioned risk assessments yes this “should” have been completed and you can absolutely ask if it was. There should also be a pressure area risk assessment, a bed rails assessment form, a nutritional assessment form, obs charts, medication forms, cannulation forms, catheter forms, care plans etc etc etc on top of the daily notes, which the nurse has to complete for ALL 10-14 of her patients while you know, actually caring for the patients and doing ward rounds, drug rounds, updating relatives, answer phones, planning discharges, cleaning rooms to welcome new patients etc so as you can see it can be easy to maybe miss a box or two to be ticked.

a few pp have mentioned bed rails and to find out if they were used to prevent him getting up. Part of the assessment is NOT to use bed rails if someone is a falls risk as they are just more likely to climb over them, making the height of the fall higher.

complaining isn’t a bad idea, people SHOULD be upset these things are happening but go easy on the staff on the ward, they will be upset by this, it’s not what they want and you can already be sure they will be dragged through the coals for it.

My comment was a direct response to someone who was suggesting the best way to improve the NHS is to complain. I quoted that comment, I wasn't talking to the OP.

Yes. It did sound like you were talking about her rather than to her:

‘But everyone, including the OP, needs to sit back, do their due diligence and work out the value of a complaint before leaping in.’

It’s not good practice to keep the sides up on beds now as it doesn’t stop people with confusion from trying to get up, it just means they are even more likely to fall and injure themselves when they do try.

Patients are NOT physically restrained. Do you really expect us to believe that they tie patients to their beds?