Improper Fall Prevention Measures Result in Injury to Elderly Patient

Nursing Expert WitnessThis case involves an elderly male patient with a past medical history of Stage 4 Myeloma. He was admitted to the hospital in Mississippi due to deterioration of his condition as well as general confusion. As a result of his age and confusion, the patient was assessed as a fall risk. Fall precautions included appropriate lighting, appropriate sized clothing at time of ambulation, assessment of elimination needs, assistance when needed, bed alert on, bed low and locked, night light, non-slip footwear, call light within reach, and the floor allegedly free of obstacles. Three weeks later, the patient got up out of his bed in the hospital to go to the restroom. On his way to the restroom, he tripped over a bedside commode and fell to the floor, sustaining fractures to his clavicle and humerus, as well as a laceration above one eye. After his hospital stay was extended due to the injuries, he was transferred to hospice, where he later passed away due to complications from his cancer.

Question(s) For Expert Witness

  • 1.) Do you assess/monitor patients who are a high fall risk? If so, how often?
  • 2.) What measures should be put in place to protect these patients?

Expert Witness Response E-000437

I assess and monitor patients at risk for fall daily. Each patient should be assessed as to the potential for falls and appropriate measures be taken to prevent the fall. These measures include, but are not limited to, all of the measures above. However, I would consider the bedside commode as an obstacle which should have been removed from the room or placed out of the way of the path to the bathroom. This patient should have had ongoing education about the potential for falling including frequent reminders to call for help and not to get out of bed without assistance. The patient should have been moved closer to the nursing station for at least hourly observation. The nurse should ask the patient at least hourly about her bathroom needs and encourage her to go to the bathroom at that time. This would decrease the risk of an unattended fall.

Expert Witness Response E-006769

Because I work in the operating room and not in a typical patient care area, all of my patients are considered fall risks. However, the scenario does not say if the patient was in a room close to the nursing station for observation. If the room was free of obstacles as stated in scenario, how did the patient manage to trip over a bedside commode? Had the patient attempted this before? What was hospital policy for fall precaution patients? If the bed alarm was on, as stated in scenario, who responded? Did the staff even hear the bed alarm? Was the patient assessed for the need of a sitter? I would like to know more about the case and would be happy to review.


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