Caring for aging patients: Liability risks for nurses working in long-term care settings

This content origi­nally appeared in the Spring/​Summer 2020 issue (PDF) of The Washington Nurse magazine. See the full set of stories on long-term care.

Consider this scenario: A nurse working in a long-term care facility ignored the facility’s policies and procedures on medication administration and gave a methadone injection to the wrong patient, which caused fatal respiratory arrest.

This case not only had a devastating outcome for the patient but also resulted in litigation against the nurse.

Nurses at legal risk

According to the most recent CNA/NSO claim report, “Nurse Professional Liability Exposures,” nurses who worked in an aging services facility, inclusive of long-term care, accounted for 16.9% of all closed claims against registered nurses and LPNs/LVNs over the five years studied. The average paid indemnity for closed claims at this type of location was $104,686.

Consider your patient population

Older patients are at an increased risk for negative outcomes due to changes in cognition, sensation, and physical condition. For example, loss of skin turgor makes older patients more susceptible to pressure injuries.

Older patients may often have to get up during the night to use the bathroom. Make sure pathways are clear of clutter, and a nightlight is present as a guide. Instruct patients who need help to call before trying to get up, and document this instruction in the medical record.

Sensory changes such as reduced vision and hearing means you must take special care with education. For example, provide education materials printed in a large font for a patient who has impaired vision.

Many older patients suffer cognitive changes such as memory impairment. You may need to create aids such as checklists to ensure they engage in proper self-care.

Prevent falls

Falls are a common yet largely avoidable source of both patient harm and litigation. While eliminating falls may not be a realistic goal, decreasing falls and mitigating the severity of fall-related injuries should remain a top priority for nurses in any health care setting. Over half of the falls in the NSO/CNA nurse claim report occurred in either the patient’s home or an aging services facility when an unattended patient failed to comply with caregiver instructions, attempted to self-transfer or self-ambulate, rejected assistance from staff or maneuvered into a wheelchair without assistance.

Nurses can help minimize falls and fall-related liability by following sound operational policies, environmental precautions and documentation practices, especially with respect to describing the patient’s condition and the specific circumstances of the fall.

The following suggested actions can assist in reducing the liability associated with patient falls:

• Focus fall prevention programs and care plans on the locations of greatest risk, such as bedside, bathrooms and hallways.
• Encourage teamwork in the care-planning process. Include certified nursing assistants in order to benefit from their unique knowledge of patients and families.
• Assess the environment for potential hazards, make patients and families aware of any dangers and encourage environmental modifications as necessary.
• Educate patients and families about fall-related risks and preventive measures. Encourage patients and families to mitigate fall risks by addressing such issues as hydration, medication management and environmental safety.

No matter where you work, an important part of preventing falls is identifying patients at risk. Consider factors such as a history of falling, medications, comorbidities and physical condition. Many organizations have staff “huddle” at the start of the shift to discuss patient needs; this is a good time to identify those at risk for falls.

Document completely

Proper documentation is a key force in whether you can successfully defend yourself against a lawsuit. Document your patient care assessments, observations, communications and actions in an objective, timely, accurate, complete and appropriate manner.