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TTSH: Patient fell off the bed for his own good.


Bic_cherry
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TTSH: Patient fell off the bed for his own good.

Me thinks that if TTSH is sued, it should be liable for at least 80% of damages sustained as a result of the fall to Ivy Teo's 74yr old father (Mr Teo).

References (Published ST forum: 08Feb2012):

Patient falls after wife's request goes unheeded

Patient reminded to use call bell if he needed help

Electric-Hospital-Bed.jpg[img source]

Reasons:

 

  • BOTH Family and hospital had noted the fall risk of the patient to be high.
  • The family, by their judgement had explicitly asked the hospital to raise all 4 cot sides of the bed to prevent against the patient falling.
  • The hospital refused/ ignored their request thinking that they knew better and insisted upon keeping the 4th cot side lowered.
  • The fact that TTSH was aware of Ms Teo's father's multiple strokes meant that there would be a level of uncertainty regarding his behavior. The hospital was thus presumptuous to assume that since "Mr Teo had consistently demonstrated the ability to call for nurses' assistance via the call bell at his bedside" that there would be little chance of Mr Teo attempting to get up without sounding the call button- a repeat stroke/ delirium being of increased probability.
  • Whilst "raising only three of the four cot sides of the bed as this has been shown to help them feel less anxious or 'trapped', and also reduces the chance of a serious injury should they attempt to get down from the bed unassisted", another key feature of falls prevention should be the direct observation of patients; and it was this important feature that the TTSH high fall-risk ward lacked.
  • It might be argued that but for the lowering of the 4th cot side, Mr Teo would not have fallen since the time taken for a patient to fall from a bed with all sides up would obviously have been longer and the attempt much more visible than the same scenario but from a bed with one cot side down; the severity of injures resultantly sustained not withstanding. Given the explained short duration in which Mr Teo sustained his fall, the nurse would have easily heard/ noticed Mr Teo's actions and taken immediate remedial action to prevent such a fall/ assist him as necessary. Keeping in mind that most of the ward patients would have been stroke patients of poor eyesight/ senior age and possibly disorientated due to the dim light of night, more hospital staff should have been in attendance so that someone would always have a constant eye on the patients, most of whom would have had 1 cot side down by hospital policy, and especially so in a 'high fall risk' cubical/ ward; an adequate staffing system should have been in place so that when one nurse attends to a patient, an assistant is present to watch over the patients, especially in a 'high fall risk' cubical/ ward.
  • Notwithstanding the fact that the 4th cot side was down due to hospital policy, Mr Teo sustained his fall whilst in a 'high fall-risk' cubicle at TTSH. It would be the duty of the hospital as part of its care of the patient to ensure the safety and treatment of patients within its care. Mr Teo fell due to a lapse in the provision of care by the hospital and as a result of this lapse in care compounded by inflexible hospital policy and lack of interest in the concerns, reservations/ suggestions of immediate relatives; other accessory comfort/ fall prevention measures notwithstanding.
  • As a result of his fall that night, Mr Teo "sustained a cervical injury, which led to further weakness in his limbs" " He suffered further weakness to his limbs and could no longer sit up or stand. He also could not eat or relieve himself unaided. He had to be fed blended food and had a catheter inserted.

    For days after the incident, he was stressed and often delirious. A few days later, he had another stroke."

 

Given the trend of events, I feel that TTSH should compensate Mr Teo at least 80% of his assessable damages sustained as a result of the fall in TTSH's 'high fall risk' cubical/ ward which no doubt was due to TTSH's lapse in it fall prevention precautions as a result of a possible staff shortage in the attendance of patients and blatant ignorance to the concerns of patient's relatives, most of whom would have known the patient's nature, character and personality change post illness for the most part of their lives.

 

PS: As a side note, the Medical Board Chairman (TTSH) said "raising only three of the four cot sides of the bed as this has been shown to help them (patients) feel less anxious or 'trapped'": if the mindset of patients is so compromised such that they even feel 'trapped' in such a bed, then wouldn't more nursing staff be needed deployed to care for these patients rather than excuses and high lofty ideas about patient welfare be bandied around by professors? The fact remains: the patient fell, hurt his spine and became paralyzed. Stressed by his condition, he suffered another stroke and is now totally disabled and bed-bound.

"An old man falling while in the care of a hospital shows lack of care." ~ how true is this statement.

Sometimes, in Singapore, its just not economically productive to say, yes we're sorry.

ST23Mar2007-%20Why%20pay%20must%20go%20up.JPG

 

The Straits Times; Published on Feb 8, 2012

Patient falls after wife's request goes unheeded

MY 74-YEAR-OLD father was admitted to Tan Tock Seng Hospital after suffering an acute stroke last October. While he needed help to walk to the toilet, he could sit and eat by himself. However, he was placed in a 'high fall-risk' cubicle.

Subsequently, the ward doctor informed me that my father was in a stable condition and the hospital was planning to transfer him to Ren Ci Hospital for rehabilitation.

My mother visited him in the evening, and before leaving, she saw that one cot side was down. She reminded the nurse about it as she was afraid my father might attempt to leave the bed unassisted.

That night, my father fell from the cot. Apparently, the nurse on duty found him lying on the floor. The fall injured his spine. He suffered further weakness to his limbs and could no longer sit up or stand. He also could not eat or relieve himself unaided. He had to be fed blended food and had a catheter inserted.

For days after the incident, he was stressed and often delirious. A few days later, he had another stroke.

My father was in a high fall-risk ward. That meant the nurses on duty had to keep a close watch on all the patients there. Why was it that my father could attempt to leave the bed without anyone noticing it?

My mother reminded the nurse to raise the cot side before she left. But that was not done. If the staff had done as instructed, the accident would not have happened.

My father stayed in the hospital for 70 days. Today, he is totally disabled and bedridden as a result of the fall and consequent stroke. The fall should not have happened.

I am disheartened by the entire incident. An old man falling while in the care of a hospital shows lack of care.

Ivy Teo (Ms)

http://www.straitstimes.com/STForum/Story/...ory_764139.html

The Straits Times; Published on Feb 8, 2012

Patient reminded to use call bell if he needed help

WE EMPATHISE with the condition of Ms Ivy Teo's father and the stress it creates for the family.

Her father has a history of multiple strokes. He was admitted to a ward with a designated 'high fall-risk' cubicle following an acute stroke.

There, our nurses keep vigil and provide frequent assistance to patients when they wish to move around, and render aid promptly whenever alarm devices such as the call bell are activated.

During his stay, Mr Teo had consistently demonstrated the ability to call for nurses' assistance via the call bell at his bedside.

On Oct 24, our nurses had, during their ward rounds, reminded Mr Teo to use the call bell if he needed assistance. Unfortunately, when our nurse was attending to an adjacent patient and had her back to him, Mr Teo fell. He was seen to immediately but sustained a cervical injury, which led to further weakness in his limbs. We understand Ms Teo's mother had earlier requested that the fourth cot side of the patient's bed be raised.

However, for the comfort and safety of patients who are able to call for assistance, our hospital practises raising only three of the four cot sides of the bed as this has been shown to help them feel less anxious or 'trapped', and also reduces the chance of a serious injury should they attempt to get down from the bed unassisted.

We apologise that our staff may not have conveyed the practice clearly to Mrs Teo.

Mr Teo's subsequent development of another stroke during his hospitalisation was clinically unrelated to his fall.

The family's distress over the sudden turn of events is understandable. We deeply regret Mr Teo's fall while in our care, despite our best efforts to watch over him.

Clinical Associate Professor Thomas Lew

Chairman, Medical Board

Tan Tock Seng Hospital

http://www.straitstimes.com/STForum/Story/...ory_764146.html

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to show his pro-active approach to problem solving, lhl is donating 1000 mattresses to put on the floor on both sides of hospital beds..... just in case and 'safe landing' still can be achieved by the falling patients :D

 

joke aside, to keep patients in a safe conditions is fundamental in hospitals [:)]

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Frankly what does patient got to do with increase pay??

 

totally no link...

 

Hospital already shortage of staff you still dont allow hospital to pay raised..

 

BTW, last year adjustment for nurse is a joke.. 3% which is equal to their yearly increment.

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I'm not sympathetic to the family's view...

 

If the hospital raised all 4 sides of the bed, IMHO it's even more dangerous and create more risk for the patient.

 

The patient's family member has said that the patient might try to get out of the bed unassisted. In this case, raise all 4 sides... the patient might try to get out, face this extra obstacle, try to get over it, and then fall down!

 

It'll be worse, right??

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Uncontrollable patient even raise 4 side, they will still climb. And this will be even more dangerous. Sometimes the nurse has to tie the patient down.

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Uncontrollable patient even raise 4 side, they will still climb. And this will be even more dangerous. Sometimes the nurse has to tie the patient down.

Actually they consider that to be inhumane to strap a patient down but the way you put it reminded me of something S&M.

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Mr Teo's subsequent development of another stroke during his hospitalisation was clinically unrelated to his fall.

The family's distress over the sudden turn of events is understandable. We deeply regret Mr Teo's fall while in our care, despite our best efforts to watch over him.

Clinical Associate Professor Thomas Lew

Chairman, Medical Board

Tan Tock Seng Hospital

http://www.straitstimes.com/STForum/Story/...ory_764146.html

 

Maybe true but I think an old man suddenly with another acute problem will definitely be under great stress. In my opinion, it's related to his injury sustained during the fall from the bed.

 

It's scary to grow old in Singapore (FIRST world) isn't it.

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Actually they consider that to be inhumane to strap a patient down but the way you put it reminded me of something S&M.

I was staying in a 4 bedded, and witness how the nurse tie one patient down. But no choice, the patient is simply uncontrollable.

Edited by Ender
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Frankly what does patient got to do with increase pay??

totally no link...

Hospital already shortage of staff you still dont allow hospital to pay raised..

BTW, last year adjustment for nurse is a joke.. 3% which is equal to their yearly increment.

Sorry for misunderstanding.

The increase in pay refers to political title holders, not to the layman on street, was included because PM Lee keeps harping how good the civil service is when all the civil service seems to be doing is staff cutting and welfare curtailing.

 

In any case, the pay of political title holders is expected to increase in future as we follow capitalistic USA where politicians are heavily sponsored by corporates: U scratch my back and I yours... corporates donate $ to politicians to promote more corporatism. Politicians besides getting donations also get higher salaries since political salaries are tagged to top 32 earners in Singapore, or is it the top 1000 now: then again, what difference does it make, they really don't care about median population salary cos it really doesn't concern them: cost cutting and fee increases is the game of the day to make corporate CEOs immediately rich.

 

I am all for the increase in staff number &/or their salary where the need arises such as in this case where the hospital failed to provide adequate medical care to its patient resulting in severe disability arising.

 

Perhaps tagging Ministerial salary to median pay of ALL Singaporeans would be a better idea since that would truly promote employment and mutual trust and understanding between government and the proletariat. Nurses would then be happy to work for a fair wage and not under the threat by politician's take it or leave it attitude in their hegemonic leadership methods, hyper inflated GRCs and slanted PA grassroots political advisers schemes being their tools of political hegemony. but that topic is one other for yet another day.

 

For the time being however, guess we all have to get used to this:

6850389757_4bc1c65385.jpg[elitist leadership/ pict link]

 

More coat-tail MPs:

TinPeiLing_SMGoh.jpg[pict.source]

Edited by Bic_cherry
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dont know how true. but as a MP, TPL seems to be doing a lot better than a lot of other previous regime or so i heard.

 

Sorry for misunderstanding.

The increase in pay refers to political title holders, not to the layman on street, was included because PM Lee keeps harping how good the civil service is when all the civil service seems to be doing is staff cutting and welfare curtailing.

 

In any case, the pay of political title holders is expected to increase in future as we follow capitalistic USA where politicians are heavily sponsored by corporates: U scratch my back and I yours... corporates donate $ to politicians to promote more corporatism. Politicians besides getting donations also get higher salaries since political salaries are tagged to top 32 earners in Singapore, or is it the top 1000 now: then again, what difference does it make, they really don't care about median population salary cos it really doesn't concern them: cost cutting and fee increases is the game of the day to make corporate CEOs immediately rich.

 

I am all for the increase in staff number &/or their salary where the need arises such as in this case where the hospital failed to provide adequate medical care to its patient resulting in severe disability arising.

 

Perhaps tagging Ministerial salary to median pay of ALL Singaporeans would be a better idea since that would truly promote employment and mutual trust and understanding between government and the proletariat. Nurses would then be happy to work for a fair wage and not under the threat by politician's take it or leave it attitude in their leadership methods. but that topic is one other for yet another day.

 

For the time being however, guess we all have to get used to this:

[elitist leadership/ pict link]

 

More coat-tail MPs:

[pict.source]

 

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The real reason the hospital was at fault was..

 

Their need to make more profit....in a shorter time.... that makes them accord less care to patient and in his case, it showed in the way that they were in a hurry to transfer the patient out of their ward...

 

Let's don't deviate from this and start discussing Mini Star pay...

 

The whole God damn system is clogged with faults...with more to come..

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dont know how true. but as a MP, TPL seems to be doing a lot better than a lot of other previous regime or so i heard.

 

This ought to be the case, at least for another year or so, if not, heavy critics will come down hard on her. <_<

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I'm not sympathetic to the family's view...

If the hospital raised all 4 sides of the bed, IMHO it's even more dangerous and create more risk for the patient.

The patient's family member has said that the patient might try to get out of the bed unassisted. In this case, raise all 4 sides... the patient might try to get out, face this extra obstacle, try to get over it, and then fall down!

It'll be worse, right??

Hi Sosaria, I think that you have either very low expectations of the Singapore medical healthcare system or have been successfully hoodwinked by the over defensive professor.

 

Please note that the issue of 3 or 4 cot sides is just a side topic and not the main issue.

 

The main issue is that the patient had a high fall risk and this was duly noted by both hospital and patient's wife.

 

According to singaporemedicalguide.com: 'Hospitals - Ward Classes' [link], "There are essentially five ward classes; A, B1, B2+, B2 and C.. In all instances, there is no difference in medical care of the patient. The difference is in the comfort factor while hospitalized."[webshot]

 

It is thus the primary role of public hospitals, regardless of ward class or size, to provide adequate medical staff for the medical care of patients, comfort being of secondary concern and proportionate to ward choice.

 

The Chairman Professor of the medical board in fact stated that "He was admitted to a ward with a designated 'high fall-risk' cubicle following an acute stroke."

 

The statement "Unfortunately, when our nurse was attending to an adjacent patient and had her back to him, Mr Teo fell." suggests that there is only one staff attending to multiple patients. Where such a staff attends to one patient, it is understood that the rest of the patients under care of such staff are left totally unobserved: thus allowing the fall by Mr Teo- not an unexpected consequence considering that these were "high risk" patients who'd just suffered a stroke, and in the case of Mr Teo, "multiple strokes".

 

Did the nurse mismanage her priorities? Was the nurse aware of the speed in which a disorientated stroke patient might get up in the darkness of the night especially when a cot side was intentionally left down? Were protocols in place so that where a nurse attends to the concerns of one patient, another (even a non-medically trained ah-mah might be present/ be called) to observed the patients whom by hospital protocol had one cot side down?

 

The hospital failed in its core medical duty, and for this, the hospital must compensate.

 

[Disclaimer: I DO NOT know Mr Teo NOR his family personally]

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