HOSPITAL FALLS – NEGLIGENCE
Nurse from PennsylvaniaIn a world of highly publicized malpractice trials, where spectacular sums are awarded by juries for severe damage or loss of life incurred by relatively young complainants, we may tend to overlook the cases of elderly clients with terminal diseases, who sustain injury or loss of life directly attributable to negligence.
Every year, thousands of these potential cases against hospitals, physicians, and particularly against nursing personnel go unnoticed. On of the most common sources of inadequate nursing care contributing to complications and death of older patients is the failure to minimize the risk of patient falls during a hospital stay.
While it is the physician’s responsibility to order proper restraints once alerted to a patient’s predisposition to fall, the hospital has an obligation to prevent falls and to deal with the problem in its policy and procedure manual. The hospital or medical center’s stated goal should be to alert the nursing staff of their responsibility in the minimization of falls through identification of “PFT” (prone to fall) patients, while undertaking immediate treatment if preventive action fails.
A publication of the American Nurses Association, Gerontonlogical Nursing Practice, states that it is the duty of nursing personnel to collect data on the health status of the older adult, including the patient’s ability to perform the activities of everyday living, such as getting out of bed and walking unassisted. The health status data are collected from medical records, the patient, those close to the patient; and other’s responsible for the patient’s care. The typical nursing problem list should enumerate a patient’s strengths and weaknesses and evaluate them by comparison with the norm. Nursing goals should then be defined and specific approaches stated in order to reach these goals.
How do these standards of care fit into the real world of caring for the elderly patient? Nursing personnel are clearly responsible for insuring that a patient’s risk of injury from hospital falls is minimal. Developing a nursing diagnosis that takes into account a patient’s neurological status, debilitating diseases, drug status, mental state, sensory deficits and age is the key to minimizing that risk. Ideally documentation of nursing care history includes the patient’s level of alertness, physical or mental disabilities, previous falls, sleep habits (e.g., the need to get up at night) and current medications. Standard procedure should include orientation of patients to the location of bathrooms, checking brakes on bed coaster, answer patient calls promptly, leaving the frame of the bed in the low position whenever the nurse is not in attendance, raising at least two side rails on every patient at bedtime, and reporting wet floors or hazardous conditions immediately.
When a patient is “at risk”, further precautions are recommended: escorting ambulatory patients to the bathroom or offering a bedpan at least every four hours, use of a Geri chair or wheelchair with wheels in the locked position, and the use of a jacket or sheet restraint when necessary. For example, if an elderly patient is admitted to the hospital with a neurological deficit or an unsteady gait, consider this patient at high risk of falling, and evaluate him accordingly. If a patient also has a history of falls or stronger case exists for more extreme measures in preventing falls during a hospital stay.
Everyone who enters a health care facility, including the terminally ill or quite elderly patient, is entitled to scrupulously attentive care. Nursing standards exist so that care is optimized for every patient. The professional nurse has a duty to uphold these standards for all patients, thus minimizing the risk to the elderly and terminally ill.
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