TORBAY Hospital has changed its procedures after an 84-year-old Holcombe widow died as a result of falling out of one of their beds, an inquest at Teignmouth heard.
Margaret Sim, of Hall Lane, was found on the floor in the middle of the night, despite the bed rails on her electronic bed being raised to their fullest extent. The grandmother, who suffered from osteoporosis, fractured her right femur and spine and died the following day. . Mrs Sim was admitted to Torbay Hospital on April 13 after falling at her daughter's home, where she lived. She was suffering from a respiratory infection and was drowsy and confused.
She suffered from osteo – and rheumatoid – arthritis. A risk assessment was carried out, putting her at high risk of falling and of developing bed sores. To provide extra comfort, a pressure relieving mattress was placed on top of the normal one.
Matron Catharine Bessent said: 'The overlay mattress did reduce the clearance between the mattress and the top of the rails.' Since Mrs Sim's death, she said the hospital had stopped using overlay mattresses with that type of bed. It had also contacted the manufacturer about getting higher bed rails.
'We always act when we have an incident. We realise there is a greater risk of using overlay mattress with a static mattress,' she told the inquest.
Earlier, daughter, Carol Betts, told the inquest that since Mrs Sim moved in 17 years previously, her health had declined. Her mother did not break any bones after falling at home, but two days later was unresponsive when Mrs Betts went to wake her in the morning.
An ambulance took Mrs Sim to Torbay Hospital and, after a week of treatment, she showed signs of improvement. Mrs Betts claimed that the cot sides were too low and that the night-time staffing levels in Simpson Ward were inadequate.
On the night of Mrs Sims' fall there were two trained nurses and two untrained nursing assistant on duty in mixed ward of 24. At 1.30am on April 19, a nurse investigating a noise, found Mrs Sim on the floor three feet from her bed.
In a written statement, Sally Highgate-Betts, Mrs Sim's grand-daughter in-law said that shortly before she died, Mrs Sim told her she had been dropped.
Mrs Bessent said that nothing in the medical notes suggested that was the case. 'Unfortunately we couldn't identify the cause of the fall.'
Cause of death was given as cardio-respiratory failure due to a fracture of the femur and spine and heart disease.
Recording a verdict of accidental death, Torbay coroner Ian Arrow said he was satisfied that Mrs Sim fell from her bed.