Dignified Throne

Angela Wade, Dignity Champion & Acting Associate Chief Nurse Emergency Carrie Tyler, Falls Clinical Nurse Specialist

At Mid Essex Hospitals Trust, Carrie Tyler, Falls CNS and Angela Wade Dignity Champion joined both their work streams to increase patient dignity and reduce falls in hospital toilet and bathrooms.

20% of falls that occur each month occur in the toilets and bathrooms. It was noticed that the patient group who fell in this location were more likely to fall during the day and did not have an underlying confusion. This patient group differ from the patient groups that fall by the bedside in the respect that, the majority of the falls are caused by loss of strength and balance, and the impact of a poor environment.

The Dignified Throne audit looked at the environment and also surveyed the patients and staff to gain insight to how safe or user friendly the bathrooms are. It was recognised that our social historical use of the bathroom had changed from communal in the medieval times to very private with a lock from the Victorian times. People value their privacy and dignity highly, but rarely complains about the lack of it in hospital, the patients are more vocal about the hospital food. However when surveyed for Dignified Throne, the patients shared concerns about lack of hooks, shelving, the height of the showers, lack of seating and their dislike of sharing the facilities. Staff felt that the bathrooms were safer for the patients during the day than at night, and that risk of falling would make them more likely to give personal care at the bedside.

Four causes of falls were identified

1. Illness and medications

Preventions:

  • Record lying and standing BP routinely
  • A medication review
  • If a patient has altered cognition consider wall mounted TABS monitors and close supervision

2. Reduced Strength & Balance

Preventions:

  • Mowbray stand, perching stool and shower stool all have hand rails to enable the patient to use their arms to assist standing
  • Physiotherapy assessment to establish strength and balance
  • Handrails
  • Declutter the environment, ensure waste bins are near the sink and not a trip hazard, or too far away from the sink

3. Dynamic Movement

Falls risks are associated with the following patient activities: dressing and undressing , washing, showering, standing up from the toilet, emptying catheter bags,  hand washing, retrieving paper towels, using pedal operated bins.

Preventions:

  • Showers have a shower chair
  • Perching stools are provided for patients to sit on and wash
  • Hand rails
  • Shelf for personal toiletries
  • Hooks for clothing
  • Call Don’t Fall Posters

4. Environment

A lack of hooks or shelves for patients to place clothing or other items forces patients to put them on the floor or a chair forcing the patient to stay standing or to bend and stretch further than usual for them.

Poor ventilation causes excessive heat and humidity causing fainting or vasovagal syncope.

Handrails need to be well placed for patients to use when standing or walking in the toilet or bathroom.

Wet floors from showering or washing are a slip hazard

Bins may be too large for the room, and therefore inappropriately placed

Preventions:

  • Audit environment for correct equipment
  • Have ward/ area risk assessments until alterations can be made
  • Wet floor signage
  • Emergency keys to access the area if a patient falls or collapses