Nursing Home Staff Neglects Physician's Orders

Case Overview

This case takes place in Florida and involves an elderly patient who suffered injuries resulting from a slip and fall accident. He was placed in a brace collar of his neck and discharged to the nursing facility where he lived. The physician ordered that the brace remain in place indefinitely until his next check up and office visit. Despite these instructions, a staff member of the nursing facility removed the collar without instruction to do so. The patient subsequently became paralyzed, allegedly the result of improper bracing. He is now incapable of using her lower and upper extremities, and the patient will require a lifetime of 24-hour professional care.

Questions to the Hospital Administration expert and their responses

Do you oversee a long term care facility that cares for elderly patients who are placed in brace collars of the neck and shoulder on a routine basis?

Any rehab facility would have physician orders that are supposed to be followed by the nursing staff - that is a regulatory standard.

If so, do you have specific guidelines to ensure that patients are appropriately monitored and cared for - to avoid a misunderstanding like what's been described above (ie: inadvertent removal of a brace which has been ordered by an orthopedist)?

Issues may include if it was Dr. orders were clear that the brace was not supposed to be removed (as opposed to being used indefinitely), whether it could be removed for bathing or other necessary interventions, if the resident had a fall or other contributing factor, for how long the brace was not properly placed. I am not able to comment on the medical effects, but only on nursing home policy and procedures, whether Dr. Orders were followed, quality improvement (or in this case quality assurance and supervision) and if care delivered met usual and acceptable quality standards. That being the case, it seems clear that good practices were not followed in this case if the removal of the brace led to such a significant injury.

About the expert

This expert has been an administrator in every kind of long term senior living community, from independent living through nursing homes. He has actively participated in long term care peer organizations and served on numerous boards and committees in the nursing home/assisted living community field. Formerly, this expert was an administrator at Hampton Court Nursing and Rehabilitation Center, a 120 bed nursing home and rehabilitation center, and Lake View Care Center/Coral Gables Nursing and Rehabilitation Center, an a 88 and 120 bed nursing home, responsible for the full range of management functions. Previously, this expert was the executive director of residential living at Miami Jewish Health Systems, where he was responsible for six Alzheimer's facilities and Alzheimer's Day Care. Currently, this expert is a consultant in the long term care field.

E-000387

Specialties:

Hospital Administration

Nursing Home Staff Neglects Physician’s Orders