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Opioids, muscle relaxants increase fall risk

Some fall risk tools don't account for these factors, and can lead to nursing medical malpractice

As a former hospital administrator, I’m mindful of the amount of interviewing and paperwork that must be done when a patient comes into the hospital. In the emergency room (ER) setting, there’s the added triage nursing function, which involves prioritizing care and determining which patients need to be seen by a physician or ER provider first.

While it’s not always possible for the ER team to begin the assessment, diagnostic, and treatment process for every patient immediately after intake and triage, it is the hospital’s responsibility to provide every patient with a safe environment while they’re waiting for their turn for health care.

One of the important safety concerns identified by the nursing standard of care is the requirement for every patient to be assessed for fall risk upon intake or triage in the emergency room or admission to the hospital. The fact that most falls should be avoidable is underscored by healthcare accrediting agency The Joint Commission’s consideration of any patient fall to be a sentinel or never event.

Healthcare researchers have developed a number of clinical aides to allow fast assessment of patient fall risks. Some of the helpful tools that are available include the Morse Fall Scale, Johns Hopkins Full Risk Assessment Tool, and the Hester Davis Fall Risk Assessment Tool. Many hospitals or systems have adopted one of these tools for use by the nursing staff in their facilities.

While the tools very, there are some common themes, including a patient’s history of falling, mobility or ambulation status, and mental status.

I like these tools because they are often incorporated into the electronic medical record system, which requires nursing staff’s attention to fall risk before advancing to the next step of patient recordkeeping. The tools also highlight many of the important factors that a nurse should assess for every patient’s fall risk.

Like any tool, aide, or shortcut, the fall risk tools are not and cannot be comprehensive for every situation and patient. In other words, it’s not enough for the nurse to substitute checking some boxes without the exercise of sound clinical judgment.

That’s a concern that we have in a new medical negligence case that we’re investigating at one of the large hospitals in The Woodlands, Texas.

Our client, the patient, was an elderly man who went to the hospital ER with lower back pain that was radiating to his legs. Diagnostic radiology studies revealed no concerns, so the ER physician diagnosed him with a pulled muscle and wrote prescriptions for Tylenol 3 with codeine, a powerful opioid painkiller, and Flexeril, a muscle relaxant. Both of these medications can cause drowsiness and dizziness.

Two days later, when the symptoms had not improved, the patient returned to the same ER. The triage nurse went over his medication list with him, including the opiate and muscle relaxant, but used one of the standardized fall risk assessment tools to rate this elderly man as having a non-existent fall risk.

The triage nurse also determined that he was a low acuity patient who did not need immediate medical attention and didn’t institute any fall precautions for him. While the patient was waiting for his turn to be seen, he got up to go to the bathroom, fell, and broke his hip.

Even though the fall risk tool didn’t identify the increased fall risk for patient taking an opiate painkiller or muscle relaxant, the nurse should have identified it. Medical research has shown that patients who fill the opioid painkiller within the prior two weeks have over double the risk of suffering an injury during fall. Another study found that elderly patients on opioids have a whopping five times greater risk of breaking a bone. Yet another study reached a similar conclusion for elderly patients taking muscle relaxants—an increase of two times the odds of a fall-related ER visit.

While clinical aides are helpful to busy nurses who have demanding jobs, they’re no substitute for a qualified nurse providing a detailed assessment of the patient’s fall risk using the nursing process.

If you’ve been seriously injured because of a fall in a hospital Texas hospital, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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