Hops requiring nurses sign no Falling contract, Is this legal???

[psmith118]

My acute care facility is requiring nurses to sign a no fall policy with each patient. The patient is stating they will not fall and the nurse is stating she/he will do everything they can to help their patient not to fall. Is this legal and if a patient does fall and gets hurt or even dies, would the responsibility fall on solely on the nurse? I don't like this one bit. Esp on a fast paced med/surg unit where you are always busy.

Any thought???

[Anonymous865]

Wow!

What is the hospital going to do if the patient refuses to sign it? Refuse to treat them? Aren't they already admitted by the time the nurse presents this contract to them? Are they going to kick the patient out of the hospital?

I'm not a lawyer, but I do know there are 5 elements that must be present for a contract to exist. They are listed on this web site:

Elements of a Contract – Contracts

One of the elements is Consideration. Each party must provide something of value. This can be a promise to perform an act that they are not legally required to do Isn't a nurse/hospital legally required to take steps to prevent someone from falling on their property? If they are, then what of value are they committing to provide/perform?

Consideration – Contracts

You would think that the hospital had their lawyers review the contract before implementing it which would make you think the lawyers thought it was legal.

It certainly isn't good PR for the hospital.

Can you imagine what is going to happen the first time they ask a lawyer or the family member of a lawyer to sign something like that?

[psmith118]

What worries me is that the RN will be legally responsible for any law suit that may come of a fall, heaven forbid the die from it. We presently use bed alarms, hourly rounding etc, this just seems a little fishy to me. And can someone with dementia even sign a contract???I feel like this is bad news and leading to the hospital pushing any legal ramifications off solely on the nurse.

[roser13, ASN, RN]

I would never sign such a contract.

[mmc51264, BSN, MSN, RN]

what about those with AMS? they are the ones that fall the most. They are incapable of consenting themselves or participate in informed consent

That is so stupid. Like we WANT our pts to fall???

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

In reading the original post, it says nothing about a contract. It states 'policy'. It seems to me that a specific policy has simply been highlighted as being amongst the most important to bring awareness to patients' responsibilities to help keep themselves free from injury....kinda like a 'you have to help me help you' type deal.

If the patient still falls and all safeguards have been implemented, the RN cannot be held responsible if she has other patients to tend to as well. The patient didn't uphold his/her responsibility such as calling for help and waiting for that help to arrive before attempting to get up.

In short, that form is to let the patient know that we have expectations of them, too. That's how I would interpret that policy.

[Anonymous865]

What worries me is that the RN will be legally responsible for any law suit that may come of a fall, heaven forbid the die from it. We presently use bed alarms, hourly rounding etc, this just seems a little fishy to me. And can someone with dementia even sign a contract???I feel like this is bad news and leading to the hospital pushing any legal ramifications off solely on the nurse.

I question whether it is a legal contract. If it isn't a legal contract, then neither party can be held responsible for failing to meet the terms.

No. A person with dementia cannot enter into a contract. For a contract to be legal, both parties must be competent - i.e. be over 18, not be mentally incapictated, not be intoxicated.

"Contracts entered into by persons under the influence of drugs or alcohol are also voidable at that person's discretion, but only if the other party knew or had reason to know the degree of impairment."

"Persons who are intoxicated from prescription medications are treated the same as persons who are mentally incompetent or insane and are generally relieved from their contractual responsibilities more readily than are persons intoxicated from non-prescription drugs or alcohol."

Again, I am not a lawyer, but I doubt that the hospital could push legal ramifications off on the nurse. Generally employers are responsible for the actions of their employees. Business owners are responsible for taking reasonable steps to insure the safety of people on their property.

It looks to me like this is an attempt to scare patients into "behaving."

I wish RiskManager would respond. S/he would be able to answer better.

[cleback]

Is it really being treated as a contract? Or just a way to review fall precautions with patients and document it?

[Anonymous865]

In reading the original post, it says nothing about a contract. It states 'policy'. It seems to me that a specific policy has simply been highlighted as being amongst the most important to bring awareness to patients' responsibilities to help keep themselves free from injury....kinda like a 'you have to help me help you' type deal.

If the patient still falls and all safeguards have been implemented, the RN cannot be held responsible if she has other patients to tend to as well. The patient didn't uphold his/her responsibility such as calling for help and waiting for that help to arrive before attempting to get up.

In short, that form is to let the patient know that we have expectations of them, too. That's how I would interpret that policy.

That is a good point. She said "contract" in the title, but "policy" in the text of the post.

Do hospitals generally ask patients to sign policies?

By asking the patient to commit to something and sign the document, it sounds like they are trying to make it legally binding.

[RiskManager]

I have seen and used these sort of agreements or policies before. We call similar agreements 'contracts' all the time, even though they usually don't meet the legal definition of a contract. For example, patient behavior contracts, no self-harm contracts, or patient medication adherence contracts. I typically call these particular documents fall assistance agreements. But 'contracts' is a colloquial term that most people understand.

Usually, the fall agreement says something along the lines of the patient will not try to get out of bed by themselves, they will not try to reach something by themselves, will use the call button as needed and they will abide by the other fall precautions, etc. For the nurse, it says something like the nurse will round on the patient at least once every hour and will offer toileting or other assistance, and they will try to respond to the call button within X amount of time.

Patients and families (and perhaps staff) take this more seriously when you write it down and ask them to sign it. There has been some interesting literature showing the use of these agreement can dramatically cut the fall rate.

From a legal perspective, the hospital is still of course vicariously liable for the actions of the nurse, and having the patient/staff sign this agreement does not change that one bit. It is not going to be used to beat the nurse with if the patient ends up falling. Although I would be asking questions about how the patient fell nonetheless, so we could continue to refine our approach to reduce falls. It would be pretty non-contributory to ask someone who is demented or otherwise incompetent to sign such an agreement; they could neither understand nor abide by it.

Finally, RiskManager is still a he, and for the OP, you should be asking your facility risk manager these sort of questions. This is exactly the sort of thing for which we love to help.

[Susie2310]

I don't see how requiring a patient to sign a "fall assistance agreement" could be legally or ethically valid no matter what setting the patient is receiving care in. Acutely ill patients/inpatients are likely to experience altered levels of consciousness for any number of reasons: their specific illness/es; medication effects (expected/therapeutic and usual side effects and adverse effects; electrolyte imbalances; changes in fluid balance; effects of procedures/treatment, and so forth. Fall prevention should be addressed in the plan of care and measures implemented to mitigate the risk of the patient falling. Insufficient staffing to provide for a patient's safety is not remedied by forcing patients to sign such an agreement. The nurse is already legally responsible for assessing a patient's risk of falling, implementing measures to prevent this happening, evaluating the effectiveness of these measures, taking necessary action to advocate for the patient and ensure the patient's safety needs are met and is responsible for modifying the care plan as necessary. The responsibility and accountability are already there; the facility is responsible for providing adequate staff to ensure the patient's safety needs are met. This cannot be waived by requiring a patient to accept responsibility for their own safety; that responsibility is the responsibility of the facility.

[KRVRN, BSN, RN]

Every nurse, every shift?