Question

An 80 year-old male was transported by ambulance to the emergency department (ED) for evaluation after experiencing an unwitnessed fall in a local nursing home. The patient resided at the nursing home and had a medical history of severe dementia and osteoporosis.
Upon arrival to the ED, the patient was triaged by nursing staff. The triage documentation noted the patient’s vital signs were stable, that he was a poor historian and complained of “hurting all over”. After triage was completed, the patient was taken to a bed in the ED treatment area, which was located approximately 20 feet from the nurses’ station, but not in direct view of the station.
The registered nurse assigned to the patient documented that the patient was confused, uncooperative and incontinent. The nursing assessment was completed and noted the patient to be an elderly male at risk for falls. Specific interventions were also documented to implement fall interventions, to include side rails up, place call bell within reach of patient, maintain bed in low position, and consider patient placement close to nursing station.

Two hours later, the patient was evaluated by the ED physician. The physician noted the patient was restless and ordered a sedation medication in preparation for diagnostic tests which included a CT scan of the head, and imaging studies of the knee, pelvis and ribs. The registered nurse administered the ordered sedative and the tests were completed in the diagnostic imaging department. The patient was returned to his bed in the ED treatment area. The results of the diagnostic tests were reported as negative. Upon return to the ED, the nurse assisted the patient to the bathroom, noting that he was able to walk independently, but had an unsteady gait. The nurse left the room after returning the patient to his bed, placing the side rails up and the call bell within reach of the patient.
Thirty minutes later, housekeeping staff found the patient yelling, laying on the floor on his right side, next to the his bed. The patient complained of pain in his right hip, and his right leg was noted to be shortened and internally rotated. The patient underwent additional diagnostic tests, and the hip x-rays results confirmed a fractured right hip.

Please answer the following questions:   

• Who may have malpractice liability in this case- the nurse, the physician, the hospital?
• Did the nurse have a professional duty?
• Was there a breach of professional duty? How will this be evaluated?
• Did the breach cause injury? How would you know?

Answer 1

1, The main cause of injury at the hospital is falling. the patient has a history of dementia and osteoporosis. both indicate risk for fall. the patient must be closely observed when they are restless, uncooperative and incontinent. ED treatment area is 20feet away from the nurses' station, not in direct view of the station. so the nurse can not view the patient regularly. This is negligence and malpractice from the nurse. Though she used bedside rails up and call bell within the reach of the patient it is her duty to closely observe the patient for may adverse events.
2, When the patient with vulnerably ill or mental illness it is a professional cares responsibility to provide more attention by using knowledge, and skills, avoiding conflicts, following the law. making an interest in patient health is an act of professional duty. in this case, the nurse does not follow her professional duty. she did the work the same for the normal patients. she did not focus special attention on this dementia patient.
3, It is medical malpractice and form of negligence. there is an obligation to protect patient safety when the patient is confused. This is a breach of professional duty for the omission of moral duty. failure to fulfill their duty in a proper manner.
4, Breach of duty can cause harm or injury to the plaintiff. Because there is a cause in fact. the patient confirmed with fractured right hip.