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Patient’s Fall: Fall Care Plan Not Yet In Chart, Court Sees No Nursing Negligence.
Legal Eagle Eye Newsletter for the Nursing Profession
One of the patient’s estate’s experts acknowledged that the standard of care requires a written fall care plan for patients who are at risk for falls, and there was as yet no written fall care plan for this patient before her first fall. However, the nurses had performed a fall risk assessment when the patient first came to the facility for rehab, a plan did exist to prevent falls and the measures required by the plan were being implemented.
There was a notice on the door to the room and on the patient’s wrist band to alert staff to her fall risk, she had been instructed in the use of her call bell to summon assistance and her call bell was within reach and the floor had been cleared to prevent clutter. After her first fall a written fall care plan was included in the chart. Nevertheless the patient fell two more times before she was readmitted to the hospital for further acute care.
The jury was correct to find no negligence by the facility’s nursing staff, despite a technical violation of the standard of care. SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION May 1, 2018
The elderly patient was admitted to a sub-acute rehab facility following a hospital admission for surgical correction of an abdominal aortic aneurism. In the hospital after that surgery she also had to have an angioplasty on her right leg to circumvent an arterial plaque blockage and restore adequate blood flow. The angioplasty necessitated a large surgical incision on the left leg to obtain a vein graft to place in the right leg.
The patient came to the rehab facility with diagnoses of emphysema, COPD, hypertension, diabetes and atrial fibrillation. When the patient first arrived a nurse performed a standard fall risk assessment that produced a score of fourteen. A score of ten or more on this instrument was considered high fall risk. The nurses starred her wristband and the door to her room to alert caregivers to her fall risk, instructed her about her call bell and kept it within her reach and cleared the floor of clutter. Because of her breathing difficulties from COPD the patient preferred to sleep at night sitting up in her wheelchair.
Five days into her stay in rehab her roommate rang for assistance because the patient had slid out of her chair down to the floor while she was asleep. The nurses talked to her and examined her, found no injuries and helped her back into her chair. After the fall a written fall care plan was placed in the chart. It included basically the same interventions the nurses were already implementing before the fall.
The patient slid down out of her chair twice more. Then due to her worsening medical condition she was sent back to the hospital. At the hospital the physicians could find no injuries to her surgical sites from her falls. Nevertheless more surgeries were needed for a new problem with deep vein thrombosis in her right leg. The Superior Court of New Jersey, Appellate Division, upheld the jury’s determination of no negligence by the nurses at the rehab facility. Karanasos v. Rehab, 2018 WL 2012114 (N.J. App., May 1, 2018).
More references from nursinglaw.com
http://www.nursinglaw.com/nursing-home-fall-standard-of-care.htm
http://www.nursinglaw.com/patient-fall-nursing-home.pdf