Don’t Fall Down on the Job: The Importance of Following and Documenting Protocol

The standard of care for a nursing home requires a comprehensive assessment of each resident upon admission.  The resident’s functional status is assessed to determine whether they can perform activities of daily living.  The assessment allows the nursing home to identify risks to its residents and implement the appropriate interventions to address the areas of concern.

When faced with an increased risk for falling, some interventions may include increased room checks, a lower bed, and use of a bed alarm and bed mat.  These interventions form the basis for the resident’s fall risk care plan.

In October 2014, the USDC for the Western District of Virginia evaluated the opinion of the Plaintiff’s nursing expert concerning the standard of care in a fall case.  In Pruitt v. BROC, LLC, Case No. 4:14-cv-6, the resident was admitted to the nursing home and assessed as a high risk for falling.  The nursing home placed him on fall precautions.  Despite the precautions, the resident fell and suffered a fractured femur.  The resident died of pneumonia 22 days after the fall.

Plaintiff’s nursing expert opined that the nursing home nurses failed to act as reasonably prudent nurses when they did not prevent the resident’s fall at their facility.  The expert claimed that the resident either did not have a bed pad alarm or that the alarm sounded, but the nursing home staff failed to come to his aid.

In the incident report, the nurse on duty stated that the bed alarm sounded and that the roommate called for assistance.  However, this same nurse did not document that the alarm sounded in the contemporaneous nursing notes.  Relying on these nursing notes, the Plaintiff’s nursing expert opined that the alarm was not on.  The expert further supported her opinion  based on the fact that the CNA did not document that the alarm was on, the bed alarm was turned off earlier in the evening when the resident was out of his room, and there were past incidents where the resident was out of bed and the nursing notes did not document that the bed alarm had sounded.

The nursing home filed a Motion to Exclude Plaintiff’s nursing expert, contending that the expert could not explain how and why she reached her opinion or how the nursing home was negligent.  The nursing home also argued that Plaintiff’s expert was essentially testifying that the nurses were lying.

The Court denied the nursing home’s Motion, finding that the expert gave a thorough accounting of her opinions, based upon the documented evidence.  The Court further noted that Defendant’s objections to the expert’s testimony are arguments that can be made to the jury, but not grounds to exclude her testimony.

This case illustrates that as a practical matter, nursing homes should review their nursing notes, ADL flow sheets and incident reports after a fall to ensure all pertinent information is documented and consistent.  Additionally, nursing homes should put a particular emphasis on all fall prevention measures that were in place at the time of the fall.