Nursing

Complacent staff may be opening you up to fall risks

Nurse Leader Weekly, October 18, 2004

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Complacent staff are your toughest obstacle when complying with the JCAHO's new 2005 Patient Safety Goal to reduce the risk of patient harm from falls. It takes effect January 1.

No doubt your staff are well trained to identify patients who are at high risk for falling, and they know what to do to prevent falls from happening. But how often do they actually follow your organization's fall prevention policy?

The answer may surprise you, as managers at one New York hospital can confirm. Nurses had received training about how to identify, document, and minimize fall risks-and then disregarded their training and the hospital's policies when their shifts grew busy.

What happened: A 62-year-old patient at the hospital decided to go to the bathroom by herself after nurses failed to answer her call bell. On the way, she became dizzy, fell, and smashed her head on the sink. The patient later died due to injuries she suffered from the accident.

Their fatal error: Nurses and physical therapists had identified the patient as high-risk because she was taking medication that increased her urine output and was unsteady on her feet, recalls Yolanda Smith, RN, MSN, CCRN, a cardiothoracic staff nurse who analyzes nursing standards of care for plaintiff malpractice attorneys. Smith reviewed nursing notes for the case, which resulted in an out-of-court settlement.

"The patient's risk for falling was clearly documented in the medical record," says Smith, who is also president of YGS Medical Legal Consulting in Brooklyn, NY. "Nursing staff should have checked in with her more frequently."

Because all staff had received special training on patient falls, managers at the hospital assumed that nurses were carefully monitoring high-risk patients. Avoid taking the same gamble, Smith warns.

One of the most common errors that Smith uncovers when reviewing nursing notes for plaintiff attorneys is that clinicians don't properly follow hospital policies and procedures. These mistakes help plaintiff attorneys build a stronger case against a hospital once a deadly or near-deadly error has occurred, she says.

"It's pretty basic," says Smith. "Once staff identify a patient's fall risk, they need to plan to prevent that patient from falling. They may write on the assessment that the patient has fallen twice in the past month, or that the patient is taking four different medications that may cause dizziness. But then they don't plan or document how they're going to prevent that patient from falling," she says.

- Adapted from Briefings on Patient Safety newsletter (October 2004), published by HCPro, Inc.



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