Nursing Home Litigation
Nursing Home Falls
Preventable, Not Inevitable Louise A. Lock
Y
ou are contacted by a family member of a nursing home resident and advised that mom has suffered a fall and has broken her hip which necessitated
hospitalization for surgical repair and required postoperative rehabilitation. In evaluating whether a claim should be pursued, what factors should you consider in assessing liability and the merits of a potential cause of action?1 Relevant literature suggests that multi-disciplinary
interventions can be quite effective in preventing or reducing the risk for and the rate of falls in nursing homes.2
Despite
this, studies involving chart reviews and observational studies have revealed that there are significant shortcomings in this area and expose both a lack of documented plans of care for residents with a fall history and the failure to implement interventions, even when they have been documented in the resident’s plan of care.3
The Medical Record Te process should start with an evaluation of the
resident’s pre-fall condition, as documented in the facility’s and other relevant medical records (i.e., recent hospitalizations and the relevant discharge summaries, consultations), to see if there were risk factors present that may have predisposed her to suffering a fall and, if so, whether adequate, preventive measures were implemented prior to the fall. Some of the more obvious risk factors include a history of falls, gait problems or impaired mobility; visual problems (macular degeneration, glaucoma); or cognitive impairment (depression, agitation, dementia or Alzheimer’s). Identifying the number and types of medications
that the resident is taking is very important. For example, the resident may be taking medications for blood pressure control, and the circulating levels of those drugs may fluctuate
1 Te damages aspects of a fall case are not addressed in this article. In brief, the devastating consequences of a fall can include: fractures with significant functional deficits, an overall reduction in longevity, or death in the immediate period after the fall.
2 Te American Geriatrics Society, the American Academy of Orthopaedic Surgeons Panel on Falls Prevention and the National Institute for Clinical Excellence are a few of the organizations that have studied and reported on this issue.
3 Wagner, et al.,Fall Risk Care Processes in Nursing Home Facilities, JAMDA July 2011, pp. 426-430. Trial Reporter / Fall 2011 37
and potentially cause hypotension, hypertension or dizziness. Psychoactive medications can also affect functioning and their therapeutic levels may vary with diet and interaction with other medications. Generally, the more medications the resident is taking, the more likely there exists the potential for adverse reactions that affect cognition or mobility, or both, and thereby increase the risk of falling.
The Plan of Care Te Plan of Care document contains and identifies
problem areas the resident may have and sets forth the goals of the plan relative to the interventions that should be implemented to address the problems. It also establishes which discipline (i.e., nursing versus medical) is responsible for their implementation. Te care plan should be designed to meet the individual resident’s needs and preferences, and identify the services the resident needs each day to be in the best possible physical and mental condition. It should be developed by a team, including a doctor, nurses and other facility staff. Finally, it is a fluid document and should be modified as the resident’s needs change.
The Minimum Data Set (MDS) Document Te MDS is replete with information about the
resident’s physical as well as psychological well-being. It is a form document that must be completed at specific intervals during the resident’s tenure: upon the resident’s admission, and thereafter, quarterly as well as annually. Further,
if
certain triggering events occur (e.g., re-admission if there is a hospitalization or change in the resident’s condition or status), a new MDS record must be generated. If there is a change in status, or fall or accident, the records should contain
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