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Do falls and falls-injuries in hospital indicate negligent care-and how big is the risk?

A
retrospective analysis of the NHS Litigation Authority Database of clinical negligence
claims, resulting from falls in hospitals in England 1995 to 2006
Authors: D Oliver, S Killick, T Even, M Willmott
Accepted 16 January 2008
Abstract
Background:
Accidental falls are very common in older hospital patientsaccounting for 32% of
reported adult patient safety incidents in UK National Health Service (NHS) hospitals
and occurring with similar frequency in settings internationally. In countries where the
population is aging, and care is provided in inpatient settings, falls prevention is therefore
a significant and growing risk-management issue. Falls may lead to a variety of harms
and costs, are cited in formal complaints and can lead to claims of clinical negligence.
The NHS Litigation Authority (NHSLA) negligence claims database provides a novel
opportunity to systematically analyze such (falls-related) claims made against NHS
organizations in England and to learn lessons for risk-management systems and claims
recording.
Objectives:
To describe the circumstances and injuries most frequently cited in falls-related claims; to
investigate any association between the financial impact (total cost), and the
circumstances of or injuries resulting from falls in closed claims; to draw lessons for
falls risk management and for future data capture on falls incidents and resulting claims
analysis; to identify priorities for future research.
Methods:
A keyword search was run on the NHSLA claims database for April 1995 to February
2006, to identify all claims apparently relating to falls. Claims were excluded from
further analysis if, on scrutiny, they had not resulted from falls, or if they were still
open (ie, unresolved). From the narrative descriptions of closed claims (ie, those for
which the financial outcome was known), we developed categories of principal and
secondary injury/harm and principal and contributory circumstance of falls. For
each category, it was determined whether cases had resulted in payment and what total
payments (damages and costs) were awarded. The proportions of contribution-specific
injuries or circumstances to the number of cases and to the overall costs incurred were
compared in order to identify circumstances that tend to be more costly. Means were
compared and tested through analysis of variance (ANOVA). The association between
categorical variables was tested using the chi-square test.
Results:
Of 668 claims identified by word search, 646 met inclusion criteria. The results presented
are for the 479 of these that were closed at the time of the census. Of these, 290
(60.5%) had resulted in payment of costs or damages, with the overall total payment
being 6 200 737 (mean payment 12 945).
All claims were settled out of court, so no legal rulings on establishing liability or
causation of injury are available. Falls whilst walking; from beds or trolleys (with
and without bedrails applied) or transferring/from a chair were the most frequent
source of these claims (n=308, 64.2%). Clear secondary contributory circumstances were
identified in 190 (39.7%) of closed claims. The most common circumstances cited were
perioperative/procedural incidents (60, 12.5%) and requests for bedrails being
ignored (54, 11.3%). For primary injuries, hip/femoral/pelvic fracture accounted for
203 (42.4%) of closed claims with total payments of 3 228 781 (52.1% of all payments),
with a mean payment 15 905 per closed case. A secondary contributory circumstance
could be attributed in 133 (27.8%) of cases. Of these, delay in diagnosis of injury,
recurrent falls during admission and fatalities relating to falls were the commonest
circumstances (n=59, 12.2%).

Discussion:
Although falls are the highest volume patient safety incident reported in hospital trusts in
England, they result in a relatively small number of negligence claims and receive a
relatively low total payment (0.019% in both cases). The mean payment in closed claims
is also relatively small. This may reflect the high average age of the people who fall and
difficulty in establishing causation, especially where individuals are already frail when
they fall. The patterns of claims and the narrative descriptions provide wider lessons for
improving risk-management strategies. However, the inherent limitations and biases in
the data routinely recorded for legal purposes suggest that for more informative research
or actuarial claims analysis, more comprehensive and systematic data to be recorded for
each incident claim are needed.

Reaction:
As one of the 11 key areas of responsibilities, Nurses must ensure the safety of their
patients, as merely as the smallest details that may harm their patients should be avoided.
Patient deserves to have quality health care that should be provided by the healthcare
team members; hence they are entitled to have this. We, as a student nurse should
practice as early as their novice stage. As stated on the article that falls remains the
highest volume patient safety incident reported in hospital trusts in England. These cases
are present also in the Philippines especially that the country is experiencing shortage of
healthcare team members. Where the ratio of a nurse in a hospital per patients were not
sufficient. Negligence is not impossible to occur. Just to consider the latest incident
happened at Delivery room CRMC, Cotabato City, where the nurse failed to give safety
to her laboring patient. The patient was already in her 1
st
stage of labor but the nurse
failed to notice it. The newborn died due to falling to the floorings of the room. The
family wants to sue the nurse and requesting to remove the said nurse to the institution to
prevent further incidence of negligence in the said institution. Safety should always be
observed through the novice stage down to the Expert stage.

Reference:
http://scholar.google.com.ph/scholar?start=30&q=critical+issues+in+hospital+negligence
+articles&hl=en&as_sdt=0,5
http://qualitysafety.bmj.com/content/17/6/431.short


Ebus, Raya Jane K.
BSN-4C

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