Falls in Hospital

[FlipFlopVibe]

I may have posted in the wrong place...

Can anyone advise on the correct procedure and questions we should be asking regarding a fall in an NHS hospital?

My DGM is 94 and fell on her stairs last week and broke her hip. She had a hip replacement the next day and was recovering well. My DM went to visit her today and she was totally out of it and couldn't wake her up. My DM on leaving asked the nurses about it and it turns out she fell getting out of bed during the night, hit her head and needed a CT scan. This came back clear.

No one informed my DM about the fall and we would be non the wiser had she not mentioned it. On visiting again tonight my DGM is still not conscious which the nurse said is not good and she needs to be awake more by tomorrow. Although the initial scan was clear there can be a delay in any bleed showing.

I think their care has been substandard, the guard rails on the bed can't have been on otherwise she couldn't have got out. She is very vulnerable due to age/strong painkillers and they should have taken more care to ensure her safety. What questions do we ask of the hospital to ensure this isn't just passed off?

If the person from the council (likely a social worker with mental health act assessment training) attended that quickly the hospital will have asked for an urgent DoLS assessment in order to keep her in hospital. As for PoA, yes, the law says that they should be contacted, but safeguarding overrides this. The two questions are:
Do you think she lacks capacity?
Why does the hospital think there’s a safeguarding risk?
I really think you need to have a chat with her consultant and quickly. These things can move fast and you need a better overview of the situation.

People without dementia can get confused when in hospital / on pain killers/ have infections etc . It happens at night because of the dark and strange location and then the person is exhausted the next day but far more with it. Don’t underestimate how often ‘acute delerium’ happens . Even simple things like constipation in the elderly cause it. Bed rails can be a nightmare in this situation as the fall is far more likely to cause an injury . The solution is one to one health care assistant to sit and watch them overnight. If this was the first time it happened then perhaps a surprise .
Ask to speak to the nurse in charge and if a datix was done. Ask about the DOLS too - sounds very odd.

Sounds to me like some sort of cover up. Contact that persons boss at the authority and make sure they understand the gravity of the situation!

Honestly the things that go
on in our hospitals are appalling! You can’t even guarantee an ambulance anymore in a life/death situation

Why would a DoL be needed? She wasn't trying to leave, she can't walk and no one was trying to assist her in leaving. She was unconscious after the fall.

My DS is a social worker, she's children's services but obviously is qualified in understanding these orders and works alongside those in adult care so we will have lots of advice we can access. My parents neighbour is also the deputy chief executive of the hospital!

Based on what you've said about her being fit and healthy, no other health conditions and on no medications then she wouldn't be deemed to be at risk of falls and given she's not got dementia or any other cognitive impairment then bed rails wouldn't be used as they'd be trapping her in bed. From the information you've provided I don't think it's the hospital's fault that she fell but they absolutely should have called NOK and let them know what had happened.

The DoLS sounds strange and very unusual for someone as you have described her to have that in place. I would echo what someone else said about contacting PALs for more support with your concerns.

Agree with PPs that the DOLS sounds really odd. You don't need a DOLS assessment to keep someone with delirium in hospital - you can use common law and/or the Mental Capacity Act (DOLS is part of the MCA, as amended, but a specialist part - the MCA also gives more general powers to act in a patient's best interests if they cannot make decisions for themselves).

@MissLucyEyelesbarrow you do actually need a DoLS in place if you're going to keep someone with delirium or other cognitive impairment in hospital and they're not free to leave. Mental capacity assessment and best interest decision wouldn't cover this as patient could then still get up and leave if a DoLS isn't in place to stop them

A few points a DOLS is normally completed by hospital staff normally nurses and will be reviewed by the council as they are the ones authorising it. You can complete one for immediate authorisation so will not have been reviewed at that point by the council.
A DOLS is really where we believe capacity is lacking it is not just as simple as 'they were trying to leave' so we applied a DOLS.
It is to do with decision making and asking does the person understand why they are here? What would be the outcome if the person left hospital?
Both the fall and the DOLS should have been discussed with your mum as NOK.
I believe every hospital has a similar falls policy so after the initial safety assessment and Dr review, the next action is to call NOK as soon as is feasible and, discuss what happened, how it can be prevented and what action the ward will take.
Falls are very difficult to prevent due to reduced staffing and infrastructure problems. Did you see how many pages the falls document was. Preventing falls is complex.
It sounds like your dgm has a post op delirium.
I suggest your mum contacts the ward and asks to speak to the nurse in charge, as they should be able to answer all of your questions. There have definitely been some lapses.

Hi, NHS director here. Go via PALS and request a copy of the hospital's Falls Policy and/or procedure. Take a look through that and pull out all the relevant sections to your grandmother. That's where you start by knowing what the hospitals standards are.

The policy/procedure will refer to a falls risk assessment that has to be completed for each patient and kept under review.

You can then request a copy of your grandmother's falls risk assessment and compare what was documented against what the policy/procedure says to see if there have been shortfalls in care.

We don't have an issue with the DoL as such, I understand they have a function in specific cases, we're just really confused why it was needed in this case. DGM was 8 days post op so completely lucid, she can hold a perfect conversation. Then had the fall and within an hour the DoL was completed, it seems like a total over reaction. She was an inpatient for over a week and was happy to remain there for her recovery, why the leap to this and not informing us of the fall or that this order was now in place. Like someone else said above, it's like a cover up of their lax care.
We don't want to find someone to blame, it's about making sure it doesn't happen again as it might because different outcome next time

What you need to find out is why they think there’s a safeguarding risk. Safeguarding, as you probably know, can escalate fast and does override pretty much everything else.

Also I think there’s some confusion about who filled out the DoLS form. As PP said, they can be filled out on the ward by ward staff, but you said in a previous post that it was filled out by ‘someone from the council’ ie a duty social worker. Either is able to do so, it’s just the difference between urgent/standard DoLS and the slightly different implications that they have at this point iyswim.

Is your Grandmother in a single room, or in a room with other patients?

She was put in a single room for a couple of days because those in her ward suffered dementia and were very noisy during the night so she wasn't getting any sleep. Then moved to a much quieter ward which is where the fall was.

I was a nurse for many years. Retired, let my Registration lapse - then went on to the Staff Bank as a H.C.A.. Did 1:1 shifts, where, often, the patients were in a single room and the bed was on the floor.
Having been both nurse and patient have seen both sides. Brilliant, excellent care ranging right through to appalling and neglectful.
The staffing levels are dreadful - just downright dangerous. Staff Nurses are going on to every shift with the potential of risking losing their Registration - due to completely unrealistic expectations.
Completely retired now, and I feel so sorry for the patients and staff.
I hope your Grandmother makes a full recovery💐

Not at the moment, with the current condition (sadly) of the OP's grandmother - that's my point. It doesn't make sense that the DOLS was done suddenly after she fell (see OP's update yesterday 2147), and sounds really odd & suspicious.

A hip replacement recovery is quite major and takes several months... especially at 94. When patients are admitted to hospital we don't necessarily put bed rails up for various reasons. Some people don't want them up .... maybe you should find out from the nurse in charge what actually happened and why nobody called you initially?

Are you sure it was a DOLS? It doesn't sound right to me.

Poor gran, she must be frightened after her falls. That DOL form states Enduring POA, do you know what type of POA you have? The DOL would be signed and is there a possibility that they are concerned she is not safe at home so do not want her to leave without full assessments, home visit and a best interest meeting if she lacks capacity. You need Lasting POA to make health and welfare decisions for someone who lacks capacity. They should have contacted family about her fall if they have contact details and like pp say a full mobility and falls risk on admission and after her fall.

Definitely, I can't obviously show the full form for privacy reasons but it's very clear what it is

Yes my DM and my sister and I (in DM's absence) are all lasting POA and have been since start of Covid. It's both financial and welfare.

They have ample opportunity to speak to DM as she goes twice a day. When DM asks about medication, physio, etc. no one ever knows what's going on and they blame it on shift changes which coincide with visiting time. I haven't been myself as I've just had a baby however I will be going in this week for support to DM so we can request all the things pp's have suggested.

I had my baby at the same hospital just a few weeks ago and my care was excellent, I can't believe we are dealing with the same hospital

A further update, DM has just found a DNR in DGM's file. Given her age, it would be what she would want but it's awful that she hasn't been asked about this nor my DM. DGM is back to being totally compos mentis, yet not even consulted.

It makes me so sad that after 94 years on Earth, she's just written off without any thought to her wishes or that of her dearest. Everyone should have their final wishes fulfilled and this just feels like she's a statistic. I hate the thought of growing old 😞

@FlipFlopVibe good practice is to discuss with patients what their priorities are using a ReSPECT form, but ultimately it is the Consultant's decision whether a patient should have attempts at resuscitation made. It hasn't been 'Do Not Resuscitate' for a long time. It is 'Do Not Attempt Resuscitation' because even in a hospital setting, most cardiac arrests are terminal events.

I'm so sorry you found out as you did, though. It sounds like they are communicating very poorly. However, bear in mind that if your DGM is fully alert and aware, the medical staff have no right to tell you confidential information without the express permission of your GM, PoA or no PoA. The PoA only comes into play if your DGM lacks capacity.

How has your DM managed to get access to your DGMs file? I thought records were now kept locked up in a trolley!
It may well be the case that a DNR has been discussed with her already. It should have been completed on admission to the ward - its usual practice for older people. The doctor likely wouldnt have asked her for permission as such, rather just explained it to her.

My mum went through something very similar recently. Try to check her medication to see if they are giving her risperidone