The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [126]
Scenario Two
You hear a loud commotion in the ward and on investigation find that Mr S, an 80-year-old patient who is 2 days post abdominal surgery, appears to have fallen out of bed and is lying on the floor next to his bed. He is in considerable pain, though there are no obvious signs of injury or haemorrhage.
Risk management stages Action
Remain calm and breathe deeply. The patient will become more anxious if you are not calm, which may result in further harm.
Call for immediate help from both the senior nurse and the medical team. The immediate priority is to prevent further harm to the patient.
1/2 Establish the context/Risk identification Undertake an initial assessment of the patient without moving him and commence any first aid procedures required, for example securing peripheral lines and abdominal wounds, whilst awaiting the medical team.
Offer the patient reassurance throughout by explaining exactly what is happening. The patient will be confused and alarmed. An understanding of exactly what is happening will reduce this anxiety.
2 Risk identification Assist the medical team in their initial assessment.
2 Risk identification and 3/4 Risk analysis and evaluation Once the patient is safe to be lifted back into bed, transfer the patient back to bed whilst following the trust’s manual handling procedures. There is the potential for a second incident in relation to manual handling so even during patient safety incidents, it is important to prevent further incidents.
2 Risk identification, 3/4 Risk analysis and evaluation and 5 Risk treatment Depending on the level of injuries sustained, undertake any further nursing observations or care required and adjust the patient’s plan of care to include extra care needs.
2–7 Explain to the patient exactly what has happened and what is going to happen to prevent reoccurrence of the incident. If appropriate, explain the situation to the patient’s next of kin. Risk monitoring and communication: communication is essential, ensuring that the patient and their family know the staff are being open and transparent regarding the incident.
3/4 Risk analysis and evaluation
If there is serious injury to the patient then a formal root cause analysis is likely to be undertaken, led by the risk co-ordinator. The nurse can do an immediate assessment of obvious causes of the fall Evaluate the root cause of the fall, for example bed guard not in place, patient confused, restless.
5 Risk treatment
The risk plan should mitigate the future risks of reoccurrence of the incident Undertake a risk assessment regarding the patient’s risk of falling again and formulate a risk treatment plan. This may include the use of bed safety sides, or one-to-one nursing care.
3/4 Risk analysis and evaluation
This scoring assessment should be undertaken in line with the organization’s incident reporting policy and in collaboration with senior staff if appropriate Complete an incident form, outlining the action which is being taken to mitigate the reoccurrence of such an incident. Include a risk score, for example if the patient fell because his bed guard was not correctly in place but this is now included in the risk treatment plan, together with extra nursing observation.
What is the likelihood of the patient falling out of bed again?
What are the potential consequences if the patient were to fall out of bed again?
7 Communication and consultation
Communicating the action needed to prevent the reoccurrence of incidents and any lessons learned is key in the management of risk within wards, departments and organizations Discuss the incident and the risk score with the senior nurse/risk co-ordinator and plan how lessons learned from the incident can be shared with the whole team. Consider whether any of the staff require further training on the management of falls prevention.
Legal and professional issues
However well intentioned healthcare organizations may be, the nature of healthcare means that at times things do not go to plan. Nurses from novice to expert can find patient safety incidents