Falls

Falls are all too common, and so are fall-related claims.

Failure to ensure safety from falls and fall-related injuries is the number one most frequent (49% of claims) and costly (55% of costs) allegation in the senior living setting. While falls are a known risk in both senior living and hospital settings, organizations still struggle with how to reduce and mitigate them because they are so complex and tend to vary by individual patient or senior living resident. Many factors play into fall-related claims, including internal risk factors like medication side-effects that can create balance issues, and external factors such as ambulatory devices and flooring. Poor communication, especially at transitions of care, can be a factor as well. The majority of fall claims in both the hospital and senior living settings occur in the patient’s or senior living resident’s room. Not surprisingly, because nurses are the primary caregiver in both hospital and senior living settings, they tend to be present during and/or after harmful fall events. For this reason, nursing team members are the top group of clinicians involved in fall-related claims, which is true across all settings. While falls account for only 10% of hospital claims and 4% of costs, they are still an area of risk management focus that has ample opportunity for improvement (see Risk Management Tips at the end of this article). Implementing a fall reduction plan, improving communication—within the care team and also with patients, senior living residents and families—and building critical thinking skills can make a significant impact on mitigating and properly responding to fall-related events.

In the hospital setting, claims alleging failure to ensure safety from falls and fall-related injuries is the fourth most frequent and seventh most expensive allegation.

Failure to ensure senior living resident safety from falls and fall related injuries is the number one most frequent (49% of claims) and costly (55% of costs) allegation in the senior living setting.

Case by Case

Lead contributing factors in fall-related claims are:

In senior living settings:

Errors in clinical judgment related to fall reduction, including resident monitoring
A policy not followed or absent
Communication breakdowns among care team members primarily about the resident’s condition, including their fall risk

In the hospital:

Errors in clinical judgment related to fall reduction, including patient monitoring
A policy not followed or absent
Communication breakdowns with the patient and family

Case 1

Senior living claim: An unanswered senior living resident call results in head injury and death.

An 87-year-old woman living in a senior living center was assisted to her bathroom by a team member as outlined in her care plan. It was the woman’s normal routine to request privacy while in the bathroom and then call for assistance after she was done. After being in the bathroom for 10 minutes, a team member checked on her and she requested more time. When the woman was ready for help, she turned on her call light. The call light went unanswered for over 30 minutes, when a team member found the woman on the floor under the sink in the bathroom with a head injury that was bleeding. The woman was transported to the hospital where she was admitted with a C2 vertebrae fracture in her neck. She died 10 days later. During the investigation, it was revealed that the senior living center’s policy was to have team members carry pagers to alert them to activated resident call lights. The center’s policy was that if a bathroom call light went unanswered after 10 minutes, team members would receive a notice on their pagers. The morning of the fall, there were not enough pagers for each of the center’s team members. The woman’s family filed a malpractice claim alleging failure to ensure safety from a fall. The experts were critical of the senior living center for failing to respond to the call light in a timely manner and for failing to follow their policy on activated resident bathroom call lights. The case was closed with a payment to the family on behalf of the senior living center.

These contributing factors played a role in the allegation of failure to ensure safety from a fall and fall-related injury:

Errors in clinical judgment related to fall reduction including resident monitoring

Failure to follow facility policy

Case 2

Hospital claim: High-risk patient is left alone and falls; resulting injuries lead to untimely death within months.

An 85-year-old woman was admitted to a hospital with complaints of vertigo and double vision following recent cataract surgery. A fall risk assessment was performed by the admitting nurse indicating that the woman was at high risk for a fall and fall-related injuries. The nursing team placed targeted interventions on her care plan, including ambulatory assistance, as well as assistance while bathing and toileting. During the evening of her second hospital day, a nursing team member assisted the woman to the bathroom but left her unattended for privacy. The team member left the patient room to assist another patient. The woman fell off the toilet while attempting to clean herself, fracturing her right hip and sustaining a head contusion. The next morning during surgery to repair the fractured hip, she had hypotension that resulted in an acute kidney injury. Two months after hip surgery, she died. The cause of death was listed as acute renal failure. Her family filed a malpractice claim against the hospital alleging failure to ensure safety from falls in a known high fall risk patient. The experts who reviewed the care were critical of the nursing team member for failing to follow hospital policy and the patient’s care plan by leaving a high fall risk patient unattended while toileting.

These contributing factors played a role in the allegation of failure to ensure safety from a fall and fall-related injury:

Failure to follow hospital policy