Safety First: Strategies for Preventing Falls in Elderly Patients

Falls in elderly adults can happen anywhere – including inside your healthcare clinic.

As evidenced in this claim study, falls in elderly patients can happen quickly and without warning. Consider how your staff can determine each individual’s risk factors when preventing falls in elderly patients.

How a Routine Doctor Visit Becomes an Incident

Our recent claim features a 98-year-old male patient with a significant medical history under the care of a cardiologist. His last check-up — before the medical malpractice complaint — indicated he was active despite his age. Thorough documentation in his medical record noted that he rode his tricycle daily in good weather and used his walker to travel up his driveway.

The claim’s inciting incident occurred at a follow-up appointment six months after his initial visit. The patient arrived at the ambulatory clinic with a walker. Upon arrival, he was greeted by reception staff. After a short stay in the waiting room, he was escorted back for his initial assessment.

The patient was escorted down the hallway to the weight scale by an LPN with his caregiver also present. His walker was moved next to the scale and the patient was able to navigate onto the scale to obtain his current weight. The scale had two grab bars, one on either side.

While being assisted off the scale, he lost his balance and fell to the floor.

He was immediately taken to the Emergency Department and diagnosed with a hip fracture.

The patient underwent nailing and reduction of a left peritrochanteric hip fracture. Although the procedure went well with no complications, the patient began presenting with renal decline post-surgery.

Two days after surgery, he was able to stand without issue but was experiencing nausea after having difficulty swallowing that morning. Fecal occult blood tests and ultrasound were ordered, revealing significant renal disease.

The patient was also anemic, requiring transfusions, and continued to experience decreased oxygen saturation levels.

The patient continued to decline. Pursuant to his DNR order, he was stabilized and transferred to extended care until he passed away.

The Malpractice Claim

This incident led to a malpractice claim filed against the healthcare provider. The plaintiff’s attorney argued that the clinic staff failed to properly assess the patient for potential fall risks. The attorney also argued the staff had placed his walker too far from his reach while disembarking from the weigh scale.

The LPN later testified under oath that she asked the patient if he was able to get onto the scale and he confirmed. Throughout the weighing, he was alert and had no complaints of discomfort or dizziness. She testified that she had her arm at his side while he took the steps down from the scale and that he just fell too quickly for her to prevent his fall.

Despite the Medical Review Panel finding a question of fact as to the care delivered, our defense of the clinical staff continued.

A trial date was set. Given the strength of testimony by staff, we moved for a directed verdict at the beginning of the trial. The basis of our motion was that there was no evidence presented supporting a breach in the standard of care.

The judgment was granted, and the case was dismissed.

Use Risk Factors to Identify Potential Patient Falls

The National Institute on Health (NIH) states that no one fall incident or balance scale assessment can accurately predict fall risk. Staff in a clinic setting need to be educated on the risk factors for falls in elderly patients and create a safe environment of care based on the potential risks – despite what the patient says.

In a clinic setting, a staff member bringing a patient to a treatment room may have limited knowledge of the patient’s history. Rely on knowledge of age-specific care and patient observation factors like these:

• Patient’s Fall History. Any history of a previous fall doubles a patient's chances of falling again.
• Age. Patients over the age of 85 should be considered a red flag for fall risk.
• Medication History. Review the patient’s medication list for medications that potentially cause dizziness or mental impairment as side effects before calling the patient back.
• Mobility Impairments. Observe the patient’s gait. In the case above, the patient used a walker — a visual indication of mobility or balance disturbance.
• Cognitive Impairments. Mental disorders like dementia make regular falls more prevalent.
• Foot or Leg Conditions. Foot pain or poor footwear increases the risk of falls.

Document Subjective Information in the Medical Record

In the case described above, the nursing staff documented the incident well. They were able to capture subjective information from the patient indicating he would not have a problem with navigating on and off the scale.

Subjective information from the patient is an important part of the record. Be sure to include it and even quote using quotation marks.

Proper documentation can make or break your defense against potential medical malpractice claims.

Refresh Your Team Knowledge with Fall Prevention Education

Because preventing falls in elderly patients is a constant challenge, we want our LHA Trust Funds members to be as knowledgeable and prepared as possible.

Search our Fall Prevention Toolkit for the CDC’s Stopping Elderly Accidents, Deaths, and Injuries Initiative resources to help reduce fall risk among your older patients.

Want more tools? Our Fall Prevention Resource Guide offers fall prediction and intervention assessment strategies that enable nursing staff to prevent falls based on the patient’s level of risk. Consider reshaping your organization’s fall prevention program for elderly patients this fall.

About the Authors

Jamie Lamb
Director of Claims Operations, LHA Trust Funds

Jamie Lamb began her career in claims in 1997. Her experience includes handling multi-line claims in the areas of general liability, medical malpractice, automobile liability, commercial and personal property, excess and umbrella policies, and professional liability. Her experience comes as a former Manager and Litigation Specialist for the American National family of companies. She has been highly involved in the education and training of both internal and external customers her entire career. Ms. Lamb attended both Evangel University in Springfield, Missouri, and Loyola University in New Orleans.

Stacie Jenkins, RN, MSN, CPSO
Vice President of Patient Safety and Risk, LHA Trust Funds

Stacie Jenkins is a registered nurse with a master’s degree in nursing informatics. She has more than 20 years of experience in healthcare, working in patient care and quality/performance improvement positions. As the Vice President of Patient Safety & Risk at LHA Trust Funds, she works closely with hospital administrators, risk managers, and nursing staff to improve patient safety and establish best practices. She conducts on-site assessments and gives presentations designed to help clients address their patient safety risk management challenges.