Arizona Nurse - January 2022

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Page 8 • Arizona Nurse January, February, March 2022 Think like an expert witness to avoid falls liability Georgia Reiner, MS, CPHRN An 88-year-old patient slips on the floor, falling and breaking his hip. Your immediate concern is getting him the help he needs, but you also wonder if you could be legally liable for what happened. By thinking like an expert witness, you can help determine if this concern is valid and whether you could have taken steps to avoid the situation in the first place. But first, you need to understand some background information. Elements of malpractice To be successful in a malpractice lawsuit, plaintiffs must prove four elements: 1. Duty. A duty existed between the patient and the nurse: The nurse had a responsibility to care for the patient. 2. Breach. The duty to care was breached. To determine if negligence occurred, the expert witness would consider whether the nurse met the standard of care, which refers to what a reasonable nurse with similar training and experience would do in a particular situation. 3. Injury. The patient suffered an injury. Keep in mind that an injury can be defined as not only physical injury but also psychological injury or economic loss. 4. Causation. The breach of duty caused the injury: Did the act or omission cause the negative outcome? Expert witnesses will consider these four elements as they review the case, and they will ask multiple questions (see Was there liability?). The questions primarily address prevention and what was done after the fall occurred. Prevention The following steps can help prevent falls and, if documented correctly, prove that the nurse took reasonable steps to protect the patient from injury: Take a team approach. Registered nurses, licensed practical/vocational nurses, and certified nursing assistants are ideal members for a team dedicated to creating a falls reduction plan for each patient. Assess the risk. A comprehensive assessment is essential to identify—and then mitigate—falls hazards. This starts with assessing the patient for risk factors such as history of a previous fall; gait instability and lower-limb weakness; incontinence/ urinary frequency; agitation, confusion, or impaired judgment; medications; and comorbid conditions such as postural hypotension and visual impairment. Keep in mind that assessment should be ongoing during the patient’s care because conditions may change. It’s also important to consider the environment, particularly in the home setting. An excellent resource for assessing communitydwelling adults age 65 and older is the CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative. Develop a plan. Once the assessment is complete, the patient care team, including the patient and their family, can develop a fallsreduction plan based on the patient’s individual risk factors. The plan should address locations that are at greatest risk, such as bedside, bathrooms, and hallways, and then detail action steps. Communicate. It’s not enough to create a plan; communication is essential for optimal execution. All care team members, including patients and their families, need to be aware of the patient’s fall risk and the falls reduction plan. The STEADI initiative has falls prevention brochures for patients and family caregivers at www.cdc.gov/steadi/patient. html. The falls risk reduction plan, communication with others, and education provided should all be documented in the patient’s health record. If a fall occurs Despite nurses’ best efforts, a patient may fall. An expert witness will scrutinize how the nurse responded to the event. The following steps will help to reduce the risk of a lawsuit or the chance that a lawsuit is successful: Was there liability? If a patient falls, an expert witness will likely want to know the answers to the following questions (developed by Patricia Iyers) when deciding if liability may exist: • Was the patient identified as being at risk for falls? How was that risk communicated to others? • Were measures implemented to prevent falls? • Approximately how soon was the individual found after they had sustained a fall? • What was done at the time of the fall? • Was the patient appropriately monitored after the fall to detect injuries? • What did the assessment (including vital signs) reveal? • Did the nurse communicate the findings to the patient’s provider? • Were X-rays ordered and performed? • Was there an injury? If so, how soon was it treated? • If the patient hit his head, was the chart reviewed to determine if mediations included an anticoagulant? If on an anticoagulant, was this information communicated to the provider so head scans could be performed to check for cranial bleeding? • Was there a change in mental status after the fall? • Were additional assessments and monitoring done as follow up? • Was the patient’s risk for falls reassessed after the fall and the plan of care revised to minimize the risk of future falls? Little Colorado Medical Center is a 25-bed, critical access hospital, located 50 miles east of Flagstaff, Arizona; a compassionate and caring facility in a family oriented community. Enjoy the stress free pleasures of small town living with benefit of a fast paced stimulating work environment. LCMC is seeking the following experienced staff: Registered Nurse Current AZ RN license or State Compact Current BLS/CPR certification New Grads accepted with 2 year commitment RN’s with 1 year experience eligible for sign-on bonus Relocation Package If you are clinically competent, a team player and have excellent interpersonal leadership and computer skills them come excel and grow in an outstanding team environment! Visit our website at www.lcmcwmh.com/careers and/or email: careers@lcmcwmh.com EOE Assess the patient. Examine the patient for any obvious physical or mental injuries. Do not move the patient if a spinal injury is suspected until a full evaluation can be made. Be particularly alert for possible bleeding if the patient is taking anticoagulants. When appropriate, ask patients why they think they fell and continue monitoring at regular intervals. Communicate assessment results. Notify the patient’s provider of the fall and results of the assessment. The provider may order X-rays for further evaluation. Remember to mention if the patient is taking anticoagulants, particularly in the case of a potential head injury, so the appropriate scans can be ordered. Revise the plan. As soon as possible, after the fall, work with the team to reassess risk factors, revisit the falls reduction plan, and revise the plan as needed. It’s important that actions are taken to prevent future falls and that those actions are documented. Document. Each step should be documented in the patient’s health record, especially all assessment results and provider notifications. Reducing risk Unfortunately, patient falls are not completely avoidable. However, developing a well-conceived prevention plan can help reduce the risk, and taking appropriate actions after a fall can help mitigate further injury. Both prevention and post-fall followup not only benefit patients but also reduce the risk of a lawsuit. \
January, February, March 2022 Arizona Nurse • Page 9 Article by: Georgia Reiner, MS, CPHRM, Senior Risk Specialist, Nurses Service Organization (NSO) MEMBERS ON THE MOVE RESOURCES Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice. StatPearls. 2020. www.ncbi.nlm. nih.gov/books/NBK470573. Centers for Disease Control and Prevention. Important facts about falls. www.cdc.gov/ homeandrecreationalsafety/falls/adultfalls. html. Centers for Disease Control and Prevention. STEADI: Materials for healthcare providers. 2020. www.cdc.gov/steadi/materials.html. CNA, NSO. Nurse Professional Liability Exposure Claim Report: 4th Edition. 2020. www.nso. com/nurseclaimreport. Dykes PC, Adelman J, Adkison L, et al. Preventing falls in hospitalized patients. Am Nurs Today. 2018;13(9):8-13. https://www. myamericannurse.com/preventing-fallshospitalized-patients. Iyer P. Legal aspects of documentation. In: KG Ferrell, ed. Nurse’s Legal Handbook. 6th ed. Wolters Kluwer; 2015. Van Voast Moncada L, Mire GL. Preventing falls in older persons. Am Fam Physician. 2017;96(4):240-247. https://www.aafp.org/ afp/2017/0815/p240.html. Dr. Ellen Poole, of Glendale, a Chamberlain University Professor at their Phoenix campus, has been recognized as Arizona’s Distinguished Nurse of the Year (2021) by the March of Dimes as part of their Heroes in Action campaign. The Distinguished Nurse of the Year awardee is selected from candidate finalists representing 15 nursing categories. Dr. Poole, PhD, RN, CPAN, CNE, FASPAN, who has a specialty in perianesthesia nursing, is being recognized for contributing to patient care, community service, and advocacy. She has been a Chamberlain nursing professor for almost 14 years, where she is dedicated to serving a diverse student population. In addition to teaching undergraduates, she teaches graduate programs that prepare students to become advanced practice nurses and nurse leaders. Some of her accomplishments include: • Induction into the inaugural class of the Fellows of the American Society of Perianesthesia Nurses in 2018 in recognition of her leadership, education and research contributions to the specialty. • Researched various topics in Perianesthesia Nursing, from family presence to patient education, for over 30 years • Published and presented nationally and internationally on critical care skills, staffing issues, and research methodologies. • Being a member of almost 20 professional nursing organizations, including the American Society of Perianesthesia Nurses and the Arizona Nurses Association. Congratulations to AzNA member Dr. Ellen Poole for being named Arizona’s Distinguished Nurse of the Year for 2021. Are you an AzNA Member with an accomplishment to highlight? Send to info@aznurse.org. Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Yuma, AZ RN POSITIONS AVAILABLE We have 1 RN Position & 1 RN-Case Manager position open within our 5-clinic primary care system. This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com. Join other post-acute care nurses and healthcare professionals to share best practices, expand your knowledge, and make lasting connections. Register now at AAPACN.org We are tasked with providing health care for the underserved. We are the largest Medicare and Medicaid provider in this area. The RN position is in San Luis area, the RN-Case Manager position is in the central Yuma area. Apply directly & download resume & application: jobs.mysunsethealth.org For questions: Debra Hunter, HR Director 928.329.5474 or dhunter@sunset-chc.org MYSUNSETHEALTH.ORG NursingALD.com can point you right to that perfect NURSING JOB! NursingALD.com Free to Nurses Privacy Assured Easy to Use • Completely online • No out-of-state tuition • Finish in as little as 2 semesters • Part-time and full-time enrollment available • Admission available twice each fall, spring and summer semesters • DSU has low costs for the students • Ranked as the 12th most affordable and 16th best quality RN-BSN online program in the nation E-mailed Job Leads For more information and to apply, visit https://dxl.dixie.edu/rn-bsn/ Program questions, call 435.879.4519 or email dru.bottoms@dixie.edu
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