Nursing Home Staff Member Fails to Report Fall

This case takes place in Alabama and involves a male nursing home resident who had been living in an assisted living facility for several months. The man’s mobility was severely limited following a stroke he had suffered a few weeks before the incident in question, and he required assistance to ambulate and perform many other basic tasks. One morning, after the patient indicated that he needed to use the bathroom, a nursing aid attempted to pick the patient up and carry him to the bathroom by himself, an action that was against the facility’s protocols. The nurse assistant dropped the man on the floor, causing a range of serious injuries including fractures and severe bruising. In spite of the patient’s serious injuries, the nurse assistant did not immediately report the incident to anyone else at the facility. The man’s mobility and quality of life were further reduced by the injuries he received, as well as the delay in care.

Question(s) For Expert Witness

1. Have you ever had a patient develop the outcome described in the case?

2. Do you believe this patient may have had a better outcome if the care rendered had been different?

3. Please tell us why you're qualified to serve as an expert reviewer of this case.

Expert Witness Response E-011221

I have provided nursing care for many patients that obtained various types of fractures as a result of a fall in my role as a registered nurse in an acute care setting. In my prior role as a nursing home nurse manager, I worked on a team to help reduce the incidence of resident falls in the senior living setting. I definitely believe that the patient would have had a better outcome if the care had been rendered differently. There are many variables impacting this incident that collectively contributed to this patient's negative outcome. The nursing aide practices under the delegation of the Registered Nurse based on the resident plan of care. The plan of care is, in turn, based on a comprehensive assessment completed by the registered nurse. In this case it is clear that the nursing aide did not follow the plan of care since, for whatever reason, the nursing aide did not call for assistance. The nurse aide failed to follow the plan of care, and since there was a failure to report to the physician, a delay of diagnosis and a potential for complications of the initial injuries occurred. This delay could have complicated the issue, for instance, if the patient attempted to move with the fracture, or if the fracture was not stabilized in a timely manner. A displacement of the fracture could have caused the client to have to have surgery, versus simple immobilization with a cast. The nurse has a duty to report falls to the physician.