BY LINDA WILLIAMS, RN
Keeping residents safe while on the go
|When you think of resident deaths and injuries associated with nursing home staff negligence, transportation safety probably doesn’t come to mind. Yet every year residents are injured needlessly by accidents that occur during transport-often within sight of the facility. Unfortunately, most of these accidents could be avoided if simple precautions are followed. It’s one of those commonsense risk exposures that administrators may have a false sense of control over, until it happens to one of their residents. Please take the time to review the circumstances surrounding the following case and make changes as appropriate at your facility.|
Within a few months, the woman developed a significant cough with congestion and was transported to the hospital by ambulance. At the hospital, x-rays indicated she had developed pneumonia and marked diffuse osteopenia, which left her bones brittle. She was successfully treated with antibiotics and returned to the facility, but she continued to have sporadic upper respiratory infections.
Over time, the woman developed a habit of leaning forward whenever she sat for long periods of time in her wheelchair. Her leaning contributed to several falls during the next four years. Fortunately, she was never seriously injured and always expressed an understanding when cautioned by staff about the dangers of leaning forward in her wheelchair. To minimize her need to lean, the staff made efforts to make items readily accessible to her while in her wheelchair. A “lap buddy” was even used on occasion.
One day, the woman was driven to a podiatry appointment in the nursing facility’s van. While returning to the facility, the van driver stopped at a drive-through restaurant to purchase some food for the woman to eat back at the facility. As the driver drove across a bridge nearing the facility, she heard the woman cry out that she was slipping from her wheelchair. By the time the driver could pull the van over, the woman had already fallen to the floor of the van.
| Fortunately, the driver was able to obtain the assistance of two delivery men to return the woman to her wheelchair. The woman’s knees were scraped, but she thought she would be all right, so the driver drove her back to the facility where she was subsequently placed in bed. After consuming the take-out food, the woman began to complain of bilateral knee pain, as her knees began to noticeably swell. Mobile x-rays were taken, which indicated possible fractures. The woman was immediately transported to the hospital emergency room, where arrangements were made for her granddaughter to meet her.|
At the hospital, the woman and her granddaughter were told that she had sustained bilateral tibia and fibula fractures. An orthopedic surgeon was consulted who felt that surgical intervention was not a viable option and recommended a course of bed rest and pain medication. Over the next few days, the woman suffered a marked decline in her respiratory abilities. She was not placed on any machines, because of her DNR status, and instead was treated with intravenous fluids, antibiotics, and a diuretic.
During her hospital stay, a sputum culture and sensitivity test indicated that the woman had developed an upper respiratory infection of Staphylococcus aureus, pneumonia, and a urinary tract infection of E. coli, Pseudomonas aeruginosa, and MRSA. The physician adjusted her antibiotics in response to these lab findings. After discussing the woman’s condition with her granddaughter, the physician directed the hospital staff to provide comfort measures only. The woman passed away five days after the accident. The cause of death listed on her death certificate was cardiopulmonary arrest, congestive heart failure, and hypothyroidism.
The nursing facility staff were devastated by the incident. The administrator reported it to the state regulating authority, which launched an immediate investigation. The driver told the state investigators that she was substituting for the person who normally drove the van, who was out sick on the day of the incident.
The driver said the woman’s wheelchair was fastened to the floor of the van in the appropriate manner. When the woman fell, the wheelchair remained secure, but the lap buddy that she used to secure the woman to the wheelchair had come undone because of her pressing weight and forward movement. The driver stated that she applied the lap buddy across the woman’s waist and around the arms of the wheelchair before securing it in the back of the wheelchair. Because of the woman’s size, the driver was not able to tie a complete knot at the back of the wheelchair.
When a larger-size seat belt was found stored in the van, the driver alleged that she had never been trained by the facility on the proper use of seat-belt restraints when transporting residents and was unaware of the other seat-belt option. The investigators issued a fine and citation to the facility, and an in-service was held the next day to educate staff on van transportation safety.
The plaintiff’s demand for settlement was well over $1 million. Years later, the case was eventually brought before mediation and settled for $700,000.
How to Protect Your Facility
You can protect your facility and residents from this type of tragedy by developing guidelines for the safe transport of wheelchair passengers and by providing appropriate training for implementation. The following guidelines should be considered:
Proactive risk management is an ongoing challenge, but all of the time and trouble is definitely worthwhile if accidents such as this can be avoided.
Linda Williams, RN, is a Long-Term Care Risk Manager for the GuideOne Center for Risk Management’s Senior Living Communities Division. She previously served as Director of Nursing in a CCRC and as a nurse consultant for two corporations with numerous long-term care facilities in Iowa. The GuideOne Center for Risk Management is dedicated to helping churches, seniors living communities, and schools/colleges safeguard their communities by providing practical and timely training and resources on safety, security, and risk-management issues. For more information, contact Williams at (877) 448-4331, ext. 5175, or email@example.com, or visit www.guideonecenter.com. To send your comments to the author and editors, e-mail firstname.lastname@example.org. To order reprints in quantities of 100 or more, call (866) 377-6454.
Topics: Articles , Facility management , Risk Management