In Indian culture the family takes care of the patients and the attendants (close relatives and friends) who accompany the patients.
‘Vulnerability’ is operationally defined as the potential risks associated with the physical and mental status of an individual, which might reasonably be anticipated irrespective of the context in which care is provided.
Such patients are prone to various risks within the hospital, such as fall, injury, neglect, abuse, medical errors and acquiring of infections. Vulnerability of a patient may be due to his/her age, physical or mental condition.
Following type of patients can be identified as vulnerable:
⦁ Patients who are old (above 65 or a certain age, as decided by the hospital)
⦁ Patients who are of minor age (Patients below 12 years)
⦁ Patients in ICU
⦁ Patients with limited mobility, blindness, deafness, speech limitations etc.
⦁ Patients with no family support are vulnerable to fall
⦁ Patients who are on high medications and more than 8 or 10 medications
⦁ Patients who are on blood transfusion
⦁ Patients receiving chemotherapy
⦁ Patients on dialysis
⦁ Terminally ill patients
Vulnerable patients are prone to face following problems during their stay in hospital:
⦁ Fall from bed or in washroom or while transporting from one place to another.
⦁ Harms due to medical errors such as wrong medication, wrong diet etc.,
⦁ Infringement of their rights, such as privacy, informed consent, confidentiality, respect etc.
⦁ Acquiring of healthcare associated infections.
How to take appropriate care of vulnerable patients:
It is evident that vulnerable patients require special care and attention to prevent them from likely harms. Following things can be done in this regard:
⦁ Identifying vulnerable patients – The first step is to identify the vulnerable patient who may require special attention. The list of conditions under which a patient should be considered ‘Vulnerable’ (as the one given above) can be used for quick identification of such patients and” Safety First “ sticker at the head end side of the end and orange patient tag for their identification
⦁ CAPS risk assessment Tool – all vulnerable patients face the risk of fall. Hence, as a prevention measure, all patients identified as vulnerable must be assessed for risk of fall. Apollo hospitals uses CAPS Risk assessment tool for vulnerable patients.
CAPS tool assessment is done on admission and at every shift if the initial score is 45 or more and once every third day if the initial score is less than 45. The purpose of repeated scoring is to take any additional measures for patient safety.
Safety of vulnerable patient – As vulnerable patients need more safety measures, following safety practices are followed:
⦁ Safety first sticker on the head end of the patient bed.
⦁ Side rails up.
⦁ Patient beds are on brake mode.
⦁ Provide adequate lightning.
⦁ Place call bell devices within reach.
⦁ Instruct patient and family members to call for help before getting out of bed.
⦁ Develop a schedule for turning and positioning.
⦁ Increase frequency of patient rounds.
⦁ Instruct the patient on side effects of drugs that are being administered.
⦁ Instruct housekeeping staff to keep path way clear from obstacles and keep toilet floor dry at all times.
⦁ Teach patient to use grab bars in the rest room.
⦁ Instruct the patient and family about the significance of fall prevention program and get fall risk consent form.
At Apollo Shashedripuram, we have introduced Fall Acknowledgement Form as an additional measure to engage patient and patient relative.