Taking Care of Vulnerable Patients

Vulnerable patients are those patients who, for any reason, are not able to protect or take care of himself/herself, against exploitation or harm. 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. It is the duty of the hospital to identify such patients and provide them with necessary support so that they are safe in the hospital surroundings.

Following type of patients can be identified as vulnerable

      1.       Patients who are old (above 65 or a certain age, as decided by the hospital)

      2.       Patients who are of minor age (Patients below 12 years or as decided by the hospital)

      3.       Patients with physical problems, such as limited mobility, blindness, deafness, speech limitations etc.

      4.       Patients with mental problems, such as depression, mental retardation, forgetfulness etc.

      5.       Patients who are unconscious or in semi-conscious stage

      6.       Patients who are illiterate and have difficulty in understanding written instructions

Vulnerable patients are prone to face following problems during their stay in the hospital

      1.       Fall from bed or in washroom or while transporting from one place to another. The physical and mental limitation makes it difficult for these patients to avoid falls

      2.       Harms due to medical errors such as wrong medication, wrong diet etc., as they are unable to be watchful about the care being given to them

      3.       Neglect, abuse (verbal or physical) and similar other behaviours by some staff

      4.       Infringement of their rights, such as privacy, informed consent, confidentiality, respect etc.

      5.       Acquiring of healthcare-associated infections, as these patients may not be observant about infection prevention practices

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

      

      1.       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. The senior nurse or the medical officer on duty can be given the responsibility of identifying vulnerable patients in their department. They must be given an orientation on vulnerable patients’ care. They can identify a vulnerable patient through observation, basic details of the patient and by basic assessment of physical/mental limitation.

Vulnerable patients so identified can be given a patient ID band of a separate colour, or a label can be put on their medical file for the information of healthcare staff.

      2.       Fall risk assessment -  One of the prevalent risk, all vulnerable patients face is the risk of fall. Hence, as a prevention measure, all patients identified as vulnerable must be assessed for risk of fall. ‘Morse fall scale’ can be used for this purpose, which gives a risk score. Necessary measures can be taken for a patient with high score to prevent fall.

      3.       Safety of vulnerable patient – As vulnerable patients are susceptible to certain harms, following safety practices must be followed for each vulnerable patient. While this list is generic and can apply to all types of vulnerable patients, inclusion, exclusion and modifications can be done in the list depending upon the type and level of vulnerability assessed.

a.       Hospitals must have disabled friendly environment as many patients categorized as vulnerable will be disabled.

b.       Such patients should be monitored more frequently for ensuring that they are safe (at-least twice in each shift or as decided for each patient)

c.       They shall be accompanied by an attendant while going to washroom or any other area.

d.       The washroom that they use must have grab bars, anti-skid mats and call alarm system

e.       While they are on bed safety railings should be put up in place to prevent fall from bed

f.        While being transported on wheelchairs or stretchers, safety belt shall be put up

g.       Responsibility shall be given to a senior nurse or a duty doctor to ensure that these patients are not being neglected or abused. They shall also ensure that rights of these patients are being protected

h.       The family of such patients shall be sensitized towards the risk and they shall be explained on various safety precautions needed to be taken with the patient

i.         Vulnerable patients who are determined to be at complete bed rest for prolonged periods of time shall receive proper pressure ulcer prevention and care

j.         Children shall be admitted to paediatric ward only. In case, hospital does not have any separate paediatric ward, good security arrangement shall be made. Code Pink procedure for prevention of child abduction/missing child shall be in place.

k.       Elderly patient must be assessed for conditions associated with old age, such as delirium, forget-fullness, impaired vision etc.

l.         A double check shall be done before administering any medicine or carrying out any clinical intervention on these patients

m.     Informed consent shall be taken from vulnerable patient as well. In case they cannot provide consent it must be obtained from their legal heir.
n. In case, a vulnerable patient needs to be restrained, special care must be taken for the safety of patient and proetcting their rights.

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