Discharge Instructions: Nurse Can Be Responsible For What Happens At Home

Request a complimentary copy of this month's newsletter.

Discharge Instructions: Nurse Can Be Responsible For What Happens At Home

Legal Eagle Eye Newsletter for the Nursing Profession

February 1999

Quick Summary: When hospital nurses know a patient will be using a medical appliance at home, the hospital can be ruled at fault if the patient is injured at home due to inadequate discharge instructions for the use of the appliance. It is advisable to document carefully the specific discharge instructions that were given to the patient. COURT OF APPEAL OF LOUISIANA, 1998.

The Court of Appeal of Louisiana let stand the jury’s verdict of no liability in favor of the hospital. The case could have gone for or against the hospital. The court said it had no clear grounds to reverse the jury.

The patient was discharged from the hospital using a walker after hip surgery. Before discharge her physician also prescribed an elevated toilet seat to use at home, the same make and model she was using in the hospital. Seventy days after discharge she fell off the seat at home and re-injured her hip.

The patient sued the hospital, claiming hospital staff were responsible for her fall at home. She claimed the hospital’s nurses and physical therapists failed to provide adequate discharge instructions for using a raised toilet seat in conjunction with a walker.

In court the orthopedic unit nursing director and several orthopedic specialist staff nurses were permitted to testify it was their routine practice to instruct patients how to use a walker when getting on and off a raised toilet seat, as an activity of daily living while in the hospital, as well as in anticipation of independent living at home.

However, the court was concerned because there was no charting about patient instruction, although in this case it felt sub-standard documentation did not necessarily reflect a deficit in basic care. The jury apparently believed the patient was given proper instruction, even though it was not specifically documented in the nursing or physical therapy progress notes.

The court noted that much of the patient’s direct care and direct coaching in techniques to use a walker with a raised toilet seat came from nursing assistants who were not allowed or expected to chart what they did. The resulting lack of documentation of patient instruction could have been a problem defending the case before a different jury, the court pointed out.

The patient also claimed she should have been prescribed a seat extension that locked down to the seat of her home toilet. The court agreed with her that would have been better, but said the standard of care at the time of her discharge (1984) did not mandate a locking seat extension.

The court also said the longer a patient has been living independently, with limitations, but without problems, the more responsibility the patient has for his or her own safety, and the less an accident ought to be blamed on the hospital’s discharge instructions. Moore v. Medical Center, 720 So.2d 425 (La. App., 1998).