Director of Nursing Opines on Inadequate Fall Prevention Protocols

This case involves a patient who suffered a fatal fall while under the care of the Defendant hospital. On the date of the incident in question, the patient was under observation in the hospital following a minor stroke and was listed as a known fall risk. Nevertheless, the patient was left unsupervised in his room and taken off of his telemetry and oxygen for over five hours. During this time, the patient had evidently gotten out of bed to use the restroom, where he fell and struck his head on a railing. The patient was found dead by nursing staff several hours later. It was alleged that hospital staff failed to adhere to proper fall prevention protocols, and that the facility was not in compliance with federal regulations governing the same.

Question(s) For Expert Witness

1. Do you oversee the nursing staff of your hospital?

2. Have you ever had a patient develop this outcome?

3. What measures should be in place to prevent this from occurring?

Expert Witness Response E-008244

Over the years I have supervised a variety of staff, all of which were on telemetry units. Currently, I oversee 4-8 RN's on a Cardiac Intensive Care Unit. These cardiac patients are here for a variety of reasons - ranging from heart transplant to post MI (heart attack) care and valve replacement to lethal rhythm (V-tach and Vfib) monitoring and management. All patients are monitored 24/7 on telemetry. Previously, I oversaw a staff of 8-10 RN's working 12 hours shifts on a progressive care (ICU stepdown unit) cardiac unit housing 24-28 patients needing round the clock cardiac monitoring. Many of these patients were fresh out of angioplasty/PCI following a heart attack where they had stents placed or balloons were utilized to open vessels that led to the attack. This population depends greatly on close monitoring following these procedures to ensure new injury or re-occlusion does not occur. Familiarity with telemetry, cardiac rhythms, and general cardiac care is a must to manage a variety of conditions and potentially lethal outcomes. This particular unit monitored the telemetry/rhythms for the entire university system in the area in excess of 100 patients at any one time. Protocols and evidence-based practices are critical in guiding our practice, particularly with respect to the cardiac population needing constant ECG monitoring. An evidence-based approach to the care of this patient population is critical in protecting patients and the MD's and facilities. System-wide protocols based on a national, research-based set of recommendations are vital to ensuring that current best practices are followed and that harm does not occur to this specific patient population.