A sixty-six-year-old male patient was admitted to the cardiac telemetry unit from the intensive care unit where he had been placed for shortness of breath, congestive heart failure and hypertension.

   On transfer to telemetry, the patient was assessed by the nursing staff as awake, alert and oriented. Although the physician’s orders included unassisted bathroom privileges, the admitting telemetry nurse instructed the patient and his family that she was to be summoned to render assistance in the event the patient wanted to get out of bed for any reason, as the nurse herself had not yet assessed the patient as capable of independent ambulation.

   The patient, however, took it upon himself to remove his nasal cannula and go to the bathroom without using the buzzer to call a nurse for assistance as he had been instructed. When he fell, a family member ran for help, but could not find a nurse for four minutes. There was no proof the hospital or nurse could have prevented the stroke, the fall or the patient's death, even though there was a four-minute delay after he fell before a nurse was found to come to his assistance on the bathroom floor.