Falls can be problematic with the elderly in Nursing Homes—especially so after a hospitalization. Often the returning patient can be disoriented and at a heightened risk for falling and require additional interventions to keep them safe. Ongoing nursing assessments are crucial for keeping patients safe with appropriate safety interventions maintained.
CASE REVIEW: Patient Fall: County Paid For One-To-One Monitoring, But It Was Not Provided
When the elderly patient was returned to the nursing facility after hospitalization for liver failure the hospitalist recommended one to one monitoring due to her extreme fall risk.
Her physician was concerned with that recommendation and the county public conservator who allocated funding made available for a 24/7 sitter.
After a couple of weeks, the physician at the nursing facility apparently misunderstood the requirement that the conservator review and re authorize funding every two weeks to mean that funding had only been authorized for two weeks and then was stopped. That was not true; funding had been continued.
On that basis, the physician changed the order to q 15-minute checks rather than constant monitoring. The patient fell and sustained a fatal subdural hematoma. The California Court of Appeal found grounds for the family to sue for elder abuse.
Hernandez v. Health, 2018 WL 6499453 (Cal. App., December 11, 2018).
In my opinion, information that was lacking here included any nursing assessment of this patient regarding the fall risk status at the time the MD changed the order. Nursing assessments are crucial for keeping patients safe with appropriate safety interventions maintained. All assessments should be well documented ~ this can often make or break a case……