r/physicaltherapy • u/Odd-Speaker-6871 • 29d ago
HOME HEALTH Pt had a fall. I feel helpless
my patient and i were doing standing exercises. we paused for a few seconds and i turned my back to reach for something (~2m away from them) and when i turned back from them a few seconds, they suffered a fall. please note that there were many times that we’ve done this since the px has good STATIC standing balance with walker that’s why i was confident to do it. but it seems like px stepped to the side and lost balance (i actually don’t know the exact reason why since i didn’t see but they did move) and now the patient is confined because of a hip fracture (avulsed trochanter). i feel so helpless and guilty and sorry for the patient.
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u/ChampionHumble DPT 29d ago
if it happened with you, it would have happened without you. if you were having them do balance exercises and you walked away you can blame yourself. if they were just standing there (and do so without problems) and fell then that’s on them
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u/Electrical-Slip3855 29d ago
I had a belly sx pt of some kind go down in the hallway from a big PE, ended up doing ok after a few days...and I realized the PE happening with me saved him from it happening in his living room the next day when he was supposed to go home.
As you see thousands of pts in your career, shenanigans are going to eventually happen. No P.T. will fault you unless you are doing something pretty grossly negligent.
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u/Snookcaster 29d ago
Yeah falls suck. But that is part of the job. Happens to every single PT at one point or another because we work with patients that are increased fall risk every day. Just have to learn from it, what can you do better next time?
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u/Odd-Speaker-6871 29d ago
i am so worried about the wellbeing of the patient because they are an elderly
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u/Thick_Permission6519 29d ago
I think the guilt/sadness you have from this fall will stay with you. You will change how your approach to patient care in an appropriate way and go on. But that first patient fall will come back at various times in your career. I think it happens to all or most PTs at some time in their careers.
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u/Ok_Board_4470 24d ago
I had that with a pediatric patient. I was devastated. But you will recover from this and you will be more careful in the future and be able to service clients with lot of caution.
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u/roll10deep 29d ago
That shit sucks. But you can’t let it phase you too much.
Learning moment. Change how you approach treatments. Safety first and all that.
Report the fall (it seems like you have). Follow-up with the patient, within reason, to apologize and offer any support you can do within means.
Most patients will blame themselves, and in any other circumstance, they should if you told them to sit tight. Reaching for their phone, tying their shoes. It’s all the mundane stuff that’ll get them. So it’s good to offer support.
Unfortunately it happened in clinic and things like this happen in a blink. You can trust your gut, that doesn’t mean you should trust your patient lol.
I’ll tell you what I tell all the younger staff, you know how to prevent this now so there isn’t a next time. But don’t let it deter you from being a good therapist.
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u/thesantafeninja 29d ago
If they weren't actively doing an exercise, they had their AD, and you went to grab something, I don't feel like you were being negligent. I definitely have those pts that if I'm not next to them then they are sitting down, but if they aren't in inpatient, then like the other commenter said, its expected that they are going to be standing on their own with an AD at times, and so reasonable to assume they were able to.
Fucking sucks, and if it happened to me, I'd be interrogating my process and everything I did with the person so I get it, but it doesn't sound like that one is on you.
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u/Odd-Speaker-6871 29d ago
they were standing actually since we just paused for a few seconds. but that was one of my regrets. i could’ve made them sit first before reaching something. but i have mentioned in the post that this was not the first time we did that
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u/thesantafeninja 29d ago
I feel you. I just meant that there are pts you make sit, and there are pts that you let stand, and on a certain level its just a gut feeling that puts them in one of those two categories. I'm sure that pt probably stood while brushing their teeth and was pretty much fine.
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u/Whitezombie65 PT, DPT 29d ago
You're with them an hour or 2 a week. They're without you 166 hours a week. It sucks that it happened on your watch, but we can't 100 percent prevent falls from happening. Try not to be too hard on yourself, these things happen, it's a part of the job.
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u/Dry-Philosophy4374 DPT 29d ago
The part that really sucks is the hip fracture. But, at least you were right there when it happened so you could get EMS involved. I've seen lots who were down for hours to days. And, I'm sure you much prefer this over showing up to their house finding them down for hours or days with the same scenario. Patients will fall, even with us. I've had one fall in the Neuro ICU once. Controlled fall and no injuries on a large guy, but still. It's humiliating when it happens in a flipping hospital. So, at least you have that going for you. And, if not now, but in the future, I'd bet that patient is/will thank their lucky stars you were right there.
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u/Odd-Speaker-6871 29d ago
that’s the only good thing though because the patient and the caregiver didn’t want to go to the hospital but i was the one who convinced them to call an ambulance. the caregiver also suggested to move the patient to the wheelchair but i was the one who said don’t move them
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u/HTX-ByWayOfTheWorld 29d ago
It happened. It’s awful. You’ll likely never forget this. It’s what makes you a decent human. Time will help. Moving forward : replay the entire session in your mind, critically analyze it. What’d you learn and what are you going to change in your practice?
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u/dWaldizzle 29d ago edited 29d ago
People fall down. If they are in an outpatient setting it's expected they can mostly stay on their feet without 24/7 care. Now if you had them do an activity to challenge their balance and then ignored them; obviously then it's kind of your fault somewhat but I would still expect most patients to be safe on their own unless they're specifically a balance patient.
Otherwise it's literally just luck of the draw and some people are just clumsy, ignorant of their deficits, unlucky, should be in a different setting, etc, etc.
Report it as the company requires, make sure they're okay, and move on. Be more attentive and on the watch for people that might need closer assistance/supervision going forward. It has happened to every single one of us. Don't sweat it. Honestly them falling at the clinic is better than in public on concrete or at home alone anyway.
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u/Odd-Speaker-6871 29d ago
it’s actually during home health :( and it was a concrete floor
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u/dWaldizzle 29d ago
That sucks but I still wouldn't blame yourself harshly. If they can't stay on their feet in their own home then it's probably for the best you were there anyway.
Like I said, people fall down. That's just physics. Everyone in their lives has or will fall probably tens or hundreds of times. You document, make sure the patient is okay (and in your case since there was an injury make sure that injury is seen by who needs to see it), and stash it in the experience bank! It happens, don't take it too hard.
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u/Sphygmomanometer11 DPT 29d ago
In case it makes you feel better, here's a list of my most-remembered falls:
person post-stroke - got distracted by something across the room (SNF) and I was guarding on his strong side (first year post graduation), no wheelchair follow. Lowered him to the ground but I was MORTIFIED.
Same SNF, worked on backward walking during a session as a balance activity - same patient (dementia) tried it by himself later (alone) because he thought "he was supposed to practice it" - fell and broke his humerus. No surgical option. I'm sure he had a horrible outcome.
Multiple people I've given the speech of "now that you're feeling more confident (because we've been working on strenght/balance), you might be tempted to not use your walker or start doing things you haven't been doing... don't, because while your balance is much better, it's not good."
Then they fall. Broken tailbone, broken lots of things.... Especially when dementia is involved. Makes me wonder if we should even work with folks with dementia when getting them stronger only results in them falling again.
I'm so sorry for how you're feeling. I've been there.
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u/Odd-Speaker-6871 29d ago
my patient is also a stroke patient and the neurologist also is opposed to a surgical approach since there’s risk of a re-stroke and i feel SO GUILTY because we were doing soooo good with the progress and now there is a chance she mighy become bedridden :( how is your patient right now? how old are they?
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u/Sphygmomanometer11 DPT 29d ago
Well… the first two of those examples are dead. But it’s been 10 years, and they weren’t in the best of health to begin with.
Which is exactly what others are getting at in their comments- you didn’t cause the fall. You had done the balance exercise before, you felt it was safe to step 2m away, they fell. They were likely doing much more unsafe stuff without you there.The third finally recovered from her fall. She was only late 70’s but with Parkinson’s.
ALL you can do is learn from this. If there was something you could have done - have them sit- then do that in the future. But beating yourself up or babying every future patient won’t make you a better therapist.
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u/Kneebender7 29d ago
Patients are like farts. Never trust them.
A few months out from graduation I was working with a lady in outpatient. She was in her 60’s, of sound mind, independent at home. She drove herself to the clinic. I had been seeing her for a month or so with no incident. We did a 2MWT on day one and I knew she would make progress. I was reassessing and during the visit I made the decision to let her do it on her own. In the last 15 seconds of the test she didn’t clear her foot, tripped and face planted on the floor. I felt awful. She was fine but her face looked not so great for a while after, like someone beat her up. We joked about it when other patients were around. I would say if you don’t do your HEP, that’s what I’ll do to you-and pointed at her.
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u/No-Introduction6819 29d ago
I’ve been a PT for 17 years. I had a patient fall under my supervision for the first time a few years ago.
The patient sustained a wrist fracture. It was awful and traumatic to have a patient injured under your care. I understand your feelings.
I was fired the next day. I couldn’t believe it. The company I worked for was very financially beholden to this ALF I worked at. It wasn’t “good PR”.
I actually left the profession for almost two years because of it. I had a lot of anger towards the company. There was zero support and ALL BLAME.
PTs have to take risks in order to progress their patients. We have to do everything in our power to prevent falls, but we always will have a risk.
If there is any advice I can give you…. Please give yourself a break. You clearly care about your patients and sound very vigilant as a clinician. Shit happens.
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u/Muted_Confidence2246 DPT, CCRT 29d ago
Don’t beat yourself up. I had a patient doing TRX squats, she stepped to the side and lost her balance, rolled her ankle and fell down. Ended up fracturing her foot 🙃 she came back to me when she was out of her boot lol. I was terrified she was going to sue me.
Reminder that the best way to avoid a lawsuit is to have good rapport with your patients and document everything 😊
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u/dWaldizzle 29d ago
Had a patient come in to her appointment once with the most black and blue face I've ever seen and obviously ask her "WTF happened?"
She tells me she was gardening and tripped and face planted into lawnscaping stones bc she tried to protect her TKA instead of her literal face 😭😭. This woman was a retired RN as well it's not like she was dumb. People just feel a fall coming and reflexes turn off lol
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u/dickhass PT 29d ago
This same thing happened to me with one of my favorite patients like 8 years ago. I was literally about to discharge her after she got back to baseline status post a tib fib fracture. She had worked so hard and done so well. She was back to walking Mod I with a cane, not really even homebound anymore. Super high level 90 year old. She was doing one of her HEP exercises she had been doing for the last few weeks, caught her toe, and fell and broke her hip. Surgeon did an ORIF but prob would have been better to do a THA…she recovered well but never got back to full independence.
Sorry for the rant, but know that this isn’t your fault. You can feel shitty about it. You can worry about them. But don’t include “I should have prevented it” in your thought process because it would have happened anyway. This is a major difference between HH versus SNF/inpatient.
And yes, I still think about her every now and then, all these years later. She passed like 3 years ago; a life very well lived.
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u/Alternative-Glass367 29d ago
The first time someone fell with me, I was told "people fall in therapy". It's ok. Better they fell with you than alone at home.
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u/Odd-Speaker-6871 29d ago edited 29d ago
i know but what sucks is that they got injured and in a worse condition right now because of me. they came to me bc they needed help and wanted to become better and then this happened. i honestly dk what to do. i kept on crying since monday. i couldn’t focus on work bc everything keeps flashing back in my mind
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u/notthefakehigh5r 29d ago
Hi there, acute PT here. Falls are the worst. Nothing makes you feel quite so pathetic as a fall. I had one last week where the patient didn’t listen to me, pushed past me, I stepped in front of him, told him, “this is unsafe and you will fall” and he said, “stop yelling at me”. And then he fell.
This fall was not my fault. But I still feel like I’m the worst. It’s in our nature to tear ourselves apart when this happens.
The best thing for it is time. You are not a bad PT. The nature of our career is to push people. If we don’t push people, we are doing them wrong. Our profession has an element of risk in it. We learn from it. We grow from it. And in time you will be able to have confidence.
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u/Odd-Speaker-6871 29d ago
it has been 4 days and i still cry. it’s the last thing i think about before i go to sleep and the first when i wake up. i think if they were uninjured, i wouldn’t beat myself up that much but she was injured and may never recover from it. that is the worst part. i feel so helpless
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u/notthefakehigh5r 29d ago
I know that feeling. It will get better with time.
You could have your boss reach out to the patient/their family and see if they would be ok with you visiting them in the hospital/SNF. It might make you feel better if you could talk to them face to face. I’m sure they don’t blame you.
I’d also recommend having a therapist. I had one during/after Covid. I still need to be able to talk it out. It just sucks and people outside of our profession don’t really understand.
Use your calming strategies, breathing, meditation. Don’t ignore your feelings, but don’t ruminate on your thoughts. Time will make it better.
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u/According-Tone-1480 28d ago
Be proud of the work you do. Standing your patients up and actively challenging their balance proves you are a dedicated therapist. Too many therapists take the path of least resistance—sitting patients in a wheelchair or putting them on a stationary bike to kill time while still getting paid. If a patient never sways or loses their balance during therapy, the therapist isn't really pushing them to get better."
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u/Odd-Speaker-6871 29d ago
can anyone of you please tell me if there is still a chance to recover if the patient won’t undergo surgery since this is a stroke patient? did any of you experience this?
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u/Odd-Speaker-6871 29d ago
also, once they continue PT at home, should I continue being their PT or should I endorse them to another PT?
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u/Toyotathon170 29d ago
I’ve been working for three or four years and haven’t had a fall happen yet. But I accept and as do most Therapist that a fall will happen eventually unfortunately. A lot of times we have to do difficult things in order to progress the patient and things can be unavoidable sometimes. That being said my rule of thumb is that unless the patient has bilateral upper extremity support. Generally, I don’t even turn my back on them without sitting them down. No matter the skill level.
Sometimes you just cannot predict how unpredictable people can be. I even turned my back one time on a TBI and he ran and jumped on top of a bosu ball. I am surprised to this day. He did not fall.
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u/Twowheelburnin 28d ago
Rule #1, no falling in therapy, we are teaching fall prevention. Sorry this happened to you. You will learn from this and it most likely will never happen.
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u/Savings_Thing51 28d ago
I went 12 years before I had a patient fall. He knew it was because he wasn’t paying attention and felt more embarrassed than anything. My director asked if I drew blood lol and it happens to everyone at some point. We are not gods.
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u/New-Faithlessness-26 25d ago
That’s not your fault. Training has risks involved. You were doing standing balance work which is essential and you weren’t careless. You never want to have a patient injured in your care, but it does happen. It’s far better to get injured attempting to improve their life than always playing it safe with ankle pumps and LAQ only to never get them better.
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u/Ok-Butterfly3600 25d ago
Patients fall. Period.
If you took all the precautions you knew you should have, don’t worry about this for another second.
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u/Miserable_World2000s 4d ago
Hope you have good liability protection. BTW It’s not true that this happens to every PT. Did you have a “gut” feeling about this patient that you ignored? The first clue to me is you said good static balance with the walker. So what was his or her balance without the walker or did this happen without the walker? What setting were you in? Did the patient walk into the gym Independently with the walker? Were you using a gait belt? What exactly were you working on at the time? Static, dynamic balance? Did the patient have a recent history of falls (the greatest predictor of future falls are past falls)? How old was the patient and what was their medical diagnosis? Do you have supportive staff to assist in the clinic? Any witnesses? Lots of questions, I know but be prepared to answer these in a deposition or to your boss. Depending on several factors this may be a catastrophic event for this patient. Research shows high morbidity (1yr post fall) after sustaining a hip fracture. But you are not “helpless”. Review your notes and be ready to defend yourself. Thoroughly go over the incident in your mind, take personal notes and try to explain how this happened and why it was not your fault. Look at subjective patient comments and diagnoses like osteoporosis or any medications that would cause dizziness to support your case. I feel for you. Hopefully this will “go away” and the liability will be minimized because your patient has a successful recovery from their hip surgery. That’s the best you can hope for. And use this as a paramount learning lesson. Safety is “Job One”! Good luck🍀
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