Risk Management

Situation

A 67 yr old gentleman was admitted to the facility after suffering a fall during a relapse of Multiple Sclerosis, which he’s had since the age of 32. The patient is now wheelchair bound, and has been so for the last twenty years. The patient has had numerous hospital admissions due to his condition, and has lost function each admission; only to regain some, and then lose it again each relapse. The patient himself says s he’s not a “defeatist”, but now feels any therapy goals may be “like flogging a dead horse”. The patient prior to his latest admission was living at home independently, with services visiting regularly for meals and showers etc. He was able to stand before his last relapse, but has not been able to after numerous attempts with various physiotherapy efforts. The patient has a supportive family who visits him often, though he recently lost his wife to pancreatic cancer. The patient has some motor losses due to his MS, and has noticeable weakness in his upper limbs since being in hospital (no lower limb movement on assessment).

 

Task

My task was to assist the patient to transfer from his chair to the plinth to assess his sitting balance, in the physio gym. I wasn’t unfamiliar with wheelchair and slideboard transfers and felt relatively comfortable due to my placement at Shenton Park Spinal Unit.

 

Action

On our way to the gym, the patient informed me he was not overly optimistic in the gains he may make whilst at the facility. He has dealt with his condition for a number of years, and says he has always given 120% in his recovery, though “something was different this time”. The patient set himself up for the transfer at the plinth, using the slideboard, as he has done for a number of years. I initially attempted to correct the patient in one aspect of the transfer (only doing so as they were familiar from previous experience), but the patient quickly informed me diplomatically (and politely) that he had done this for so long now, and that he’s best left to do it on his own. I stepped back a little and did as he asked, acknowledging his own experience is greater than mine.

 

Result

The result of me taking a step back and letting the patient transfer himself was that he nearly fell onto the floor by missing the plinth due to poor slideboard positioning and execution. I was certainly close, but given his size and the wheelchair involvement, my blocking him was a hard task. Because I was half squatting/kneeling near him anyway, I got enough weight under him to stop him and help him back onto the plinth.

 

Evaluation

The result was certainly less than ideal. I juggled in my head my own preference of helping him with the transfer, and his insistence that he do it on his own. He didn’t quite end up on the floor, but it was potentially going to end that way. I know it places myself at risk of injury by attempting to stop his fall. I managed it fine in the end, but if factors had been slightly different (if his foot slipped for example), then we both may have slipped.

 

Strategies

I think some diplomatic law enforcement could have been good in this instance. If I’d said it was facility policy to assist with patient transfers on all first-time sessions with a patient, then perhaps he may have complied. I could have been slightly closer to him while transferring also. Ensuring he is as close as possible to the plinth, TED stockings pulled off his feet for more grip, plinth positioning to minimise any personal injury are all other potential risk management strategies applied would help a situation such as this. If all else fails and he does not consent to help, then I guess I ask my supervisor what should be done, because as a student, you always have than lack of uppermost seniority to enforce protocols, which can sometimes be used to nudge patients in the right direction. Trusting my own instincts about the transfer will be done next time, I’ll use my own diplomacy to navigate the transfer safely.

A bit more experience wouldn’t go astray either!