Page 4 | Falls in Hospital

FlipFlopVibe · 2023-11-23T23:44:57+00:00

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?

FlipFlop1987 · 26/11/2023 22:07

That may be what they are, all I know is the DoLs form was in there and the DNR. It’s a red file if that makes any difference

HappyHamsters · 26/11/2023 22:13

There will be discussions about privacy and permission as its covered by data protection and the staff and hospital have a legal duty to keep medical notes safe, secure and confidential . Dgm will have been seen by a doctor every day, apart from the weekends unless there are concerns, they will always check its OK to share information, it doesn't matter how close they are.

Missingthegore · 27/11/2023 00:35

Your DM needs to talk with the medical team and nurse manager and not rifling through folders.

HesterLee · 27/11/2023 01:03

Where I work, if a patient has a fall we must always contact the named next of kin to inform them.

The use of bedrails is dependent on the patients condition, constantly being reviewed. I care for post-op hip and knee replacement patients (elective not trauma). The OP states that her GM was fully lucid between op and fall and during that time I would discuss with the patient if they felt safer with the rails to be up or down. Hospital beds are narrow and often patients are used to double beds and are worried they will roll out. They are up on the condition that patients ring for help to remove them before trying to get out of bed. If a patient is confused and trying to get out of bed, then bed rails should be down.

We are no longer authorised to get an HCA to sit with patients.

The DoL suggests the GM was confused and trying to leave the ward. This absolutely should have been discussed with next of kin. As she is now completely lucid again, it should be lifted.

The DNAR order is the Consultants decision and next of kin are not required to be consulted. But the conversation should have been had with the GM. I find orthopaedic doctors are extremely skilled in bones, not so much in communication.

Original poster

FlipFlopVibe · 27/11/2023 10:54

Missingthegore · 27/11/2023 00:35

Your DM needs to talk with the medical team and nurse manager and not rifling through folders.

They constantly say there's no one available it's 'change over time'. The visiting times are 3:30-4:30 and 6:30-7:30 so they just say the doctors are finishing!

OP posts:

Original poster

FlipFlopVibe · 27/11/2023 10:57

HappyHamsters · 26/11/2023 22:13

There will be discussions about privacy and permission as its covered by data protection and the staff and hospital have a legal duty to keep medical notes safe, secure and confidential . Dgm will have been seen by a doctor every day, apart from the weekends unless there are concerns, they will always check its OK to share information, it doesn't matter how close they are.

I don't really know why this has become a thread about privacy and data protection, my DGM has given my DM permission to view anything she needs to and take decisions on her care where required. The nurses are fully aware of this now she's been there 2 weeks.

OP posts:

Original poster

FlipFlopVibe · 27/11/2023 10:59

HesterLee · 27/11/2023 01:03

Where I work, if a patient has a fall we must always contact the named next of kin to inform them.

The use of bedrails is dependent on the patients condition, constantly being reviewed. I care for post-op hip and knee replacement patients (elective not trauma). The OP states that her GM was fully lucid between op and fall and during that time I would discuss with the patient if they felt safer with the rails to be up or down. Hospital beds are narrow and often patients are used to double beds and are worried they will roll out. They are up on the condition that patients ring for help to remove them before trying to get out of bed. If a patient is confused and trying to get out of bed, then bed rails should be down.

We are no longer authorised to get an HCA to sit with patients.

The DoL suggests the GM was confused and trying to leave the ward. This absolutely should have been discussed with next of kin. As she is now completely lucid again, it should be lifted.

The DNAR order is the Consultants decision and next of kin are not required to be consulted. But the conversation should have been had with the GM. I find orthopaedic doctors are extremely skilled in bones, not so much in communication.

There is a page in the DoL that says who is the person to contact regarding the decision and it has DM's name and then her contact number, the line underneath says to check this box and sign to say contact has been made. The box is ticked and signed but they absolutely did not contact DM.

OP posts:

Redburnett · 27/11/2023 11:00

Bed rails definitely are used for patients who cannot move much. They are not used where there is a danger of a patient trying to get out of bed and getting limbs caught up in them. Did your GM have a yellow wristband (or whatever the hospital uses) to indicate falls risk. If so, ask what the plan was to prevent her falling, and if not ask why not. In some hospitals it is necessary to have a staff member located in the bay at all times to prevent falls (not foolproof, but risk is recognised and it reduces the chance of it happening).

shellyleppard · 27/11/2023 11:07

OP......ask for a meeting with the ward manager. They tend to use bed sides now. My mum had a bad fall whilst in hospital and we had to get an investigation started. I hope your dgm recovers x

HappyHamsters · 27/11/2023 11:29

Your mum can speak to PALS and they will liaise with the staff and help you set up a meeting with a doctor and the senior ward nurse. There is more to a DOL than a piece of paper, the medical notes should state all the staff involved in making that decision and ime its unusual for the social worker to do this in the evening, it's something a nurse can do during the day.

HesterLee · 27/11/2023 13:33

The hospital is not being open with your GM or DM (as nok). They are not having open or honest conversations about what has happened. It may be that your previously independent GM got out of bed unaided and unwitnessed and, without using a frame / crutches / stick, fell due to her surgery. I have seen this happen before.

No-one is at fault. People fall and many falls cannot be prevented.
Lack of money is preventing us being able to have one member of staff specialing in a bay however as your GM was not confused pre fall, there would have been no reason to have this in place.

But the after care of a patient who has fallen is very much a protocol of actions to be followed. Duty of candour is a big part of this and the staff caring for your GM are not adhering to this.

I would contact the ward manager and request a meeting with them and a doctor from your GM's team. Don't rely on trying to speak to staff when you visit - at those times of day it won't happen.

Original poster

FlipFlopVibe · 27/11/2023 16:06

HappyHamsters · 27/11/2023 11:29

Your mum can speak to PALS and they will liaise with the staff and help you set up a meeting with a doctor and the senior ward nurse. There is more to a DOL than a piece of paper, the medical notes should state all the staff involved in making that decision and ime its unusual for the social worker to do this in the evening, it's something a nurse can do during the day.

It signed, dated and timed at 2044hrs, just over an hour after my DM left the hospital. Instead of liaising with her whilst there, they waited till she had left

OP posts:

Original poster

FlipFlopVibe · 27/11/2023 16:09

HesterLee · 27/11/2023 13:33

The hospital is not being open with your GM or DM (as nok). They are not having open or honest conversations about what has happened. It may be that your previously independent GM got out of bed unaided and unwitnessed and, without using a frame / crutches / stick, fell due to her surgery. I have seen this happen before.

No-one is at fault. People fall and many falls cannot be prevented.
Lack of money is preventing us being able to have one member of staff specialing in a bay however as your GM was not confused pre fall, there would have been no reason to have this in place.

But the after care of a patient who has fallen is very much a protocol of actions to be followed. Duty of candour is a big part of this and the staff caring for your GM are not adhering to this.

I would contact the ward manager and request a meeting with them and a doctor from your GM's team. Don't rely on trying to speak to staff when you visit - at those times of day it won't happen.

This is what we mean, we don't want to blame anyone, she's obviously been confused. We want to know she's safe and the risk is being minimised. If we don't know the policy, we can't help manage it.

DM was told by the lady in the next bed that she heard/saw DGM fall and hit her head and it was her who rung the buzzer to alert staff. She then said 'please don't tell them I told you'

OP posts:

HesterLee · 27/11/2023 16:21

Is she on an elderly care ward or a surgical ward?

Oblomov23 · 27/11/2023 17:57

I can't believe most of the above posts. Posters saying OP shouldn't be bothered by this. Yes, she should be. It's not ok.

MissLucyEyelesbarrow · 27/11/2023 20:04

FlipFlop1987 · 26/11/2023 22:05

In nearly 2 weeks they haven’t had chance to speak to her? There was one day after the hospital fall she was very drowsy but the other 11 days no one has made any attempt to discuss anything with her

That's the least surprising thing in this whole thread. I've been a carer for both parents and their complex medical problems and multiple admissions. It was a frigging nightmare, trying to get any information, ever. And I'm a doctor.

Original poster

FlipFlopVibe · 27/11/2023 21:02

Oblomov23 · 27/11/2023 17:57

I can't believe most of the above posts. Posters saying OP shouldn't be bothered by this. Yes, she should be. It's not ok.

Thank you. I think on paper she's just another very elderly person who people assume should be on end of life care now. One day we will be that age and it must be such a frightening time. No one should go into hospital and end up worse off nor should they be lied to about it

OP posts:

FlipFlop1987 · 27/11/2023 21:05

I think it’s sort of a combination of the two, a surgical ward specifically for elderly who have had orthopaedic surgery. All on the ward have had some sort of joint replacement

FlipFlop1987 · 27/11/2023 21:06

HesterLee · 27/11/2023 16:21

Is she on an elderly care ward or a surgical ward?

Sorry last update was to yourself

FlipFlop1987 · 27/11/2023 21:09

MissLucyEyelesbarrow · 27/11/2023 20:04

That's the least surprising thing in this whole thread. I've been a carer for both parents and their complex medical problems and multiple admissions. It was a frigging nightmare, trying to get any information, ever. And I'm a doctor.

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That’s really sad isn’t it, that elderly care is such hard work. It’s exhausting! I understand how busy they are but it seems like compassion has gone out the window

HesterLee · 27/11/2023 21:39

Not telling any family members what has happened is so bad. If you are unable to sort a meeting via the ward manager then try the matron and then PALS.