Publications - Assessing The Risk Of Defending Claims Involving Patient Falls

In 2005, the Joint Commission of Accreditation of Hospitals developed several national patient safety goals in order for accredited healthcare organizations to maintain focus on the most critical patient safety issues. One of the 2005 goals was to reduce the risk of patient/resident/client harm resulting from falls.

Falls account for a significant portion of injuries in hospitalized patients, long term care residents and home care recipients. The Joint Commission established the requirement that the facility assess and periodically re-assess each patients risk for falling, including any risks associated with the patient’s mediation regimen and take action to address any identified risks. Many hospitals have fall risk assessments built into the initial nursing assessment. Many facilities do not require the nurses to complete reassessments when the patient’s condition changes or when the treatment plan changes and it changes the patient’s fall risk assessment. For example, some patient’s fall risk increases when they are provided certain drugs. Other patients will report that they are “dizzy.” Pursuant to Joint Commission goals, this would require a new fall risk assessment and a prevention action.

The Joint Commission requires implementation of a transfer protocol in its fall reduction program. Many falls occur during patient transfers (i.e. bed-to-chair, bed-to-commode, sit-to-stand….). If a person is at risk of falling during a transfer then the transfer should be planned to avoid such a risk. For example, if a nurse is transferring a patient who is diabetic and lacks feeling in the bottom of his feet or if a nurse is transferring a person who typically walks with a walker or if a nurse is transferring a person with a disease, where ambulation is difficult or non-existent in the home environment, then that patient should not be transferred without some forethought given to avoid falling during the transfer.

The Joint Commission has recently announced the 2006 National Patient Safety Goals and Requirements and fall reduction continues to be identified as a goal that needs to be achieved.

The Risks Associated with Claims from Falls
It is commonly believed, among consumers (and thus jurors) that patients should not be injured while in the hospital. Consumers also believe that hospital care was inadequate if a person was injured from a fall in the hospital. Injuries from hospital falls result in a fair number of lawsuits. The hospitals who are defending these lawsuits enter the litigation arena with consumers (jurors) who have the preconceived notion that someone must have been at fault in causing this fall. Jurors rarely blame the patient when an injury from a fall occurs. With this in mind, healthcare organizations are well served if they consider the risk of liability in light of the patient safety standards and consider getting the claim in a early settlement posture.

The Joint Commission guidelines are typically adopted by the hospital when forming their policies and procedures and the well prepared plaintiff’s attorney will have the guidelines at his or her disposal. Healthcare facilities will be queried, in discovery whether the hospital employees had a fall reduction program to follow and, if so, whether they followed the guidelines.

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