Whitby et al. Ergonomics Australia. 2014. 1:3
Research Article
Inconsistent approach to providing care worker assistance to the falling patient Louise Whitby1, 2 and Craig S McLachlan2 1
Louise Whitby and Associates PL.
2.
Rural Clinical School, Faculty of Medicine, University of New South Wales, Australia.
Abstract Background: Inpatient falls are commonly reported as adverse events. While health care providers have implemented strategies within their individual organisations to minimise or prevent patients falling, falls do persist and for some falls care workers are present. We hypothesise that current practice and guidance are ad hoc and inconsistent across Australian hospitals, aged care and community organisations. This presents care workers with a significant dilemma, to assist or not assist, the consequence of either action is likely to be an injury. Aim: To survey patient handling advisors to understand current practice in hospital, aged care and community settings with respect to care workers providing assistance to a falling patient. Method: The Moving and Handling Association of New Zealand /Australian Association for the Manual Handing of People conference on patient handling was held in New Zealand in 2012. Delegates, all patient handling advisors, were invited to complete a written survey on assisting the falling patient. Separate questions were presented to distinguish between employed (internal) and consultant (external) advisors. Eighty-three delegates completed the survey, a response rate of 43%. Results: Ninety-three percent of respondents were internal advisors, of which 47 (61%) reported that the organisation for which they worked had a procedure to address the falling patient and 22 (29%) did not. Thirty percent reported that the procedure recommended care workers assist where possible and 62% reported a procedure instructing no assistance be provided to a falling patient. Sixty-four percent of respondents indicated that care workers at their facility were provided with training to support the procedure, i.e. to assist/not assist. For external advisors, 44% of respondents teach care workers to assist a falling patient and 44% teach that a falling patient should never be assisted. Analysis confirmed that external consultant advisors are more likely than employed internal advisors to include specific skills/ techniques when training care workers how to deal with a falling patient (p-value = 0.02). Conclusion: Patient handling advisors are divided in their advice and the training they promote in respect to intervening to assist a falling patient. The results highlight opportunities for further research to explore worker practice with respect to the falling patient as well as the risks and outcomes associated with intervening or not to assist the falling patient. ©Whitby: Licensee HFESA Inc.
Background In Australia and internationally, falls amongst inpatients are the most common reported adverse events in both hospitals and in aged care facilities [1, 2]. Due to falls contributing significantly to the cost of health services and poor patient outcomes [3], health care providers have implemented strategies within their organisations to minimise the risk of patients falling. Nevertheless, patients do still fall and in some cases care workers (nursing, medical, allied health, and patient support personnel) are present to witness the fall. If care workers do not intervene, the patient is potentially exposed to a range of injuries from the fall. Where care workers do intervene to assist the falling patient, the patient can suffer contact injuries, such as shoulder dislocation or skin tears. Care workers can also sustain injury through contact with a falling patient, such as a musculoskeletal disorder including back, shoulder or neck injury. Whatever the outcome, care workers may find themselves involved in litigation associated with a falling patient [4].
There is significant evidence relating to falls prevention [5] and for the management of patients following a fall [6]. However, there is a gap in evidence for how care workers who witness an assist-able fall should deal with the circumstances of this event, which places them in a ‘dilemma’ whether or not to intervene to manually assist to rescue a falling patient. The purpose of this study was to survey patient handling advisors to understand what is being taught to hospital, aged care and community care workers with respect to providing assistance to a falling patient.
Method Sample population The Manual Handling Association of New Zealand (MHANZ) and the Australian Association for Manual Handling of People (AAMHP) represent health professionals involved in the handling of people in hospitals, aged care and in the community. Delegates attending the MHANZ/ AAMHP joint conference in Auckland, New Zealand in March 2012 were invited to complete a survey regarding the direction or
Corresponding author: Louise Whitby. Email –
[email protected] [ 1 ]
Whitby et al. Ergonomics Australia. 2014. 1:3 instruction promoted to care workers with respect to assisting a falling patient. Delegates included patient handling advisors, employed in-house by health, aged care or community care providers, who provide education to staff working in these organisations on patient handling – hereafter referred to as internal advisors. Delegates also included patient handling consultants, such as OHS consultants, ergonomists, physiotherapists, nurses or occupational therapists, who consult to a range of organisations on patient handling – hereafter referred to as external consultant advisors. While the majority of delegates came from Australia and New Zealand, there were several delegates from Europe, North America and Asia who responded to the survey, so the survey does not reflect the Australian and New Zealand experience exclusively.
Survey For the internal advisors, the focus of the survey was to determine two key issues: whether their employer had a policy or practice directive on care workers intervening to assist a falling patient, and if so, what training was provided to those workers with respect to that policy. For the external consultant advisors, the focus of the survey was on what they advocate in the training they provide with respect to the falling patient. The questions of interest for the survey are depicted in Table 1. Table 1: Number and percent of responses regarding policies and training for assisting falling patients n
%
Internal patient handling advisors
77
Does the healthcare organisation you work for have a patient handling policy that includes direction on managing the falling patient?
Yes
47
61.0
No
22
28.6
Don’t know
8
10.4
If yes, what is the direction?
Assist
14
29.8
Never assist
29
61.7
Other
2
4.3
No response
2
4.3
Yes
30
63.8
No
11
23.4
No response
6
12.8
Does the patient handling training provided at your organisation include specific skills/techniques for how to manage a falling patient?
External (consultant) patient handling advisors
27
Does the patient handling training you present include specific skills / techniques for nurses/carers on how to manage a falling patient?
Yes
19
70.4
Yes, conditional
7
25.9
No
1
3.7
If yes, what do you teach?
Assist
12
44.4
Never assist
12
44.4
No response
3
11.1
Analysis Descriptive data is displayed as percentages. Fisher’s exact test was used to test statistical significance of categorical data in GraphPad (Prism 6 for Windows, V 6.01). A p-value of p
