ICU Patient Falls Out Of Bed: Hospital Faulted For Inadequate Staffing

[NRSKarenRN, BSN, RN]

check out: the legal eagle eye newsletter for the nursing profession

since 1992, the legal eagle eye newsletter for the nursing profession newsletter has focused on nurses' professional negligence, employment, discrimination and licensing issues.

the goal is to reduce nurses' fear of the law and litigation.

here is a sampling of cases discussed in the newsletter. karen

icu patient falls out of bed: nurse not at fault; hospital

faulted for inadequate staffing

legal eagle eye newsletter for the nursing profession (4)8 may 96

the hospital itself was negligent for understaffing the cardiac intensive care unit. how could a nurse be in two places at once, watching her own patient and responding to a code in another room? court of appeal of louisiana, 1996.

http://www.nursinglaw.com/understaffed.htm

a ninety-two year old female patient was placed in the cardiac intensive care unit in a room with a window wall for observation. her family was not allowed to stay with her.

she was getting lasix for congestive heart failure and pulmonary edema. both side rails of her bed were raised, but she was not restrained in bed. she began getting out of bed unassisted to go to the bathroom. she had been warned to the contrary. these incidents were fully documented in her chart by the nursing staff.

the attending physician visited the patient, read the chart and spoke with the patient. it was apparent to the physician that the patient was not oriented to the fact she was in the hospital, but believed she was in bed in her bedroom at home. verbally reorienting her did not seem to help.

the physician decided not to order restraints for the patient.

the nurses continued to write chart notes to the effect the patient was at times oriented x3, but at other times stated she believed she was at home.

a few hours after the physician had visited and decided against physical restraints, the patient was found on the floor. she stated she thought she was at home, and wanted to go to the kitchen to prepare dessert for the family. she stated she was unable to get out of bed on the right side or on the left side, and so she had tried to get out of bed by crawling down to the foot of the bed and out.

she sustained a fractured right hip which required open reduction and internal fixation. the surgically repaired fracture healed unremarkably, and she was discharged to her home. however, she returned six months later with the same cardiac problems and died at the hospital. the hip fracture was not a factor in her death. after her death, the family filed suit seeking damages for the patient's fall, under a state law to the effect that the right to sue for personal injuries survives the patient's death and may be asserted by the family and heirs even after the patient has died.

the court of appeal of louisiana accepted the jury's verdict that the attending physician had not departed from the standard of care in declining to order restraints for the patient.

the court went on to rule that the staff nurses were not negligent, during the seven and one half hours between the physician's visit and the patient's fall, for not having advocated in some manner for restraints to be ordered for the patient, even though it was apparent the patient was disoriented and it was probable she would try to get out of bed again.

however, the court did find the hospital itself negligent, on grounds of inadequate staffing. a nurse assigned to a patient in the cardiac intensive care unit was assigned solely to just one patient, due to the patient's need for close monitoring and for a ready response to any problem which might develop.

at the same time, the nurse was expected to respond to any code which came up in the icu. following hospital guidelines, the nurse left her patient to participate in a code, at the very same time her own patient was attempting to get out of bed, falling and fracturing her hip.

the court ruled the nurse could only be in one place at one time. she was not negligent for leaving her patient, pursuant to hospital directives, to participate in a code involving another patient. the hospital, however, was ruled negligent. merritt vs. karcioglu, 668 so. 2d 469 (la. app., 1996).

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failure to pass medications: nurse convicted of a crime

legal eagle eye newsletter for the nursing profession (5)4 apr 97

http://www.nursinglaw.com/passmeds.htm

a nurse's willful failure to administer required medications to the nurse's patients in a nursing home is a violation of the law for which a criminal conviction is an appropriate sanction, the new york supreme court, appellate division, has ruled. the court record did not indicate what sentence was imposed on the nurse in this particular case.

willful failure to administer medications means the nurse has acted knowingly and deliberately in not administering required medications to patients. a negligent, unintended oversight is not considered willful for purposes of the court being able to convict a nurse of a crime and impose criminal sanctions. people vs. spence, 648 n.y.s. 2d 636 (n.y. app., 1996).

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operating room: training of personnel must be documented, court says

http://www.nursinglaw.com/training2.htm

quick summary: a surgical facility must be able to prove that all surgical personnel present during a specific procedure had been cleared and documented before the fact as competently trained for the specific tasks and procedure in question.

assignment of surgical personnel to specific tasks and specific procedures in the operating room must be based on their individual qualifications.

it is negligent for a surgical facility to permit a surgical technician to perform tasks, such as holding retractors, for which the technician does not have specific training.

it is negligent for a surgical facility to assign a surgical technician to a procedure with which the technician is unfamiliar.

training and familiarity with procedures performed on adults is not necessarily directly transferable to pediatric situations.

surgical techs should have an understanding of human anatomy, as it relates to the risk posed by improper handling of their responsibilities. supreme court of alabama, 1997.

to protect its patients, a hospital or other healthcare facility offering surgical services must see that its operating room personnel have been adequately trained.

to protect itself from civil liability for negligence, a surgical facility should document, before the fact, that its surgical personnel have been adequately trained for the specific tasks they will be asked to perform and that they are familiar with the specific procedures they will be involved in, according to a recent case from the supreme court of alabama.

this case involved a surgical technician. at the time of the incident in question, the court noted, surgical techs were not subject to mandatory licensing or required certification under state law. the court nevertheless looked for guidance to the then-current version of "standards and recommended practices for perioperative nursing" published by the aorn. this publication was accepted by the court as evidence of the legal standard of care. the court believed the publication established a necessity for surgical personnel to have specific training in the tasks and procedures they were asked to perform.

specifically, the surgical technician in this case should not have been allowed to hold retractors in a pediatric hip arthroplasty. never having been trained for that task with pediatric patients, the technician was not aware of the risk to the sciatic nerve that could result from even the slightest deviation from the surgeon's manual positioning of the retractor.

the court was willing to accept the qualifications of a registered nurse with considerable operating room experience, who had held local offices with aorn, and who was well versed in the joint commission's standards for perioperative nursing practice, as an expert witness. she testified against the hospital. the verdict against the hospital was in excess of $800,000.00. healthtrust vs. cantrell, 689 so. 2d 822 (ala., 1997).

[nanb]

How about all RN's, LPN's, MD's, PA's and acute and chronic care centers choose to only treat their friends and relatives and let the rest of the world fend for itself. Then maybe the court system could do their REAL jobs and deal with CRIMINALS!! And, when lawyers and judges need medical and nursing attention...oh well.........:barf01:

[tddowney]

Glad to see that the nurse wasn't expected to be in two places at one time. It is somewhat unusual for juries and judges to show that much sense.

Unfortunately, the nurse likely had to spend $ thousands of personal funds to defend the suit.

It was also curious that the family waited until after the pt had died to file suit...........call me a cynic, but perhaps they didn't want to share the money with grandma?

[Midwest4me]

Even though this post is OVER 4 years old, I read it and it made me think/wonder if short-staffing would be alleviated faster if more people whose loved ones suffered falls(and especially injuries associated with the falls) filed lawsuits against hospitals for inadequate staffing??????

[ERYNN]

Its sad day indeed for all of us in ICU..