January 2015

  A nurse familiar with the safety needs of a total knee replacement surgery patient should have been the one to conduct an assessment of all the factors involved in moving this patient.  COURT OF APPEALS OF TEXAS November 21, 2014

  An obese patient was recuperating in the hospital after right-side total knee replacement surgery.  The first day after surgery she called for assistance to transfer from her recliner chair to the bedside commode.   A lone nurse attempted to help her up with a walker.   However, the recliner was not locked and the patient slid down to the floor and twisted her newly-operated right knee.  A Hoyer lift was brought in to get her back into bed and the surgeon was notified.

  Four days later she was transferred to a rehab facility and soon was discharged.  Two months after that her orthopedist diagnosed a patellar dislocation which he related to the incident in the hospital.

  The Court of Appeals of Texas ac-cepted the conclusions of the patient’s nursing expert as to the standard of care for a nurse caring for a post total knee replacement patient. Expert medical testimony was necessary beyond that to relate the patient’s orthopedic diagnosis months after the fact to the incident in the hospital.   The patient’s nursing expert noted the admission care plan called for the patient to be instructed to call for assistance before transferring, which the patient did.  

  However, the nurse who came to the room should have known that safely moving an obese patient the day after total knee replacement surgery presents special challenges.  She simply could have asked the patient how much assistance had just been needed to move her from her bed to her chair, and would have learned that it took six or seven people.  At that point the nurse surely would have known, if she did not know already, that more help was needed.