▪︎ Preventing Patient Falls: Legal and Clinical Lessons for Nursing Professionals

By Laurie Elston, JD, RN –  Nurse Attorney and Legal Educator

An estimated 50% of nursing home residents experience at least one fall each year. Falls are not only a leading cause of morbidity and mortality in the elderly but also among the most common bases for negligence claims against nurses and health care facilities.

In recent years, hospitals, rehabilitation centers, and long-term care facilities have seen a sharp increase in serious adverse patient events, many of which are preventable. The Joint Commission’s 2025 National Patient Safety Goals for Nursing Care Centers emphasize that nurses play a critical role in preventing falls, medication errors, pressure injuries, and infections.

The 2025 Joint Commission Goals Most Relevant to Nursing Practice

• Goal #3: Improve the safety of using medications.
• Goal #7: Reduce the risk of health care–associated infections.
• Goal #9: Reduce the risk of patient and resident harm resulting from falls.
• Goal #14: Prevent health care–associated pressure injuries from occurring or worsening.

For each goal, the Joint Commission identifies Elements of Performance (EPs) that guide how nursing personnel and institutions should act to ensure compliance.

Preventing Falls (Goal #9)

Elements of Performance:

1. Assess each patient or resident’s risk for falls on admission, after any change in condition, and after any fall.
2. Implement interventions tailored to the individual’s risk factors—such as mobility limitations, medications, cognitive impairment, or environmental hazards.
3. Educate staff on the facility’s fall reduction program, including documentation and communication standards.
4. Educate the patient and family about fall prevention measures.
5. Evaluate effectiveness of interventions through audits, incident reviews, and trend analysis.

Evidence-Based Nursing Steps for Fall Prevention

From a legal and clinical standpoint, the following measures have repeatedly been recognized as standards of care in fall prevention:

1. Comprehensive Fall Risk Assessment:
   • Use validated tools (e.g., Morse Fall Scale or Hendrich II) on admission and after any change in condition.
   • Document risk factors clearly in the medical record.
2. Environmental Safety Rounds:
   • Remove clutter, secure cords, and ensure adequate lighting.
   • Keep call lights, phones, and personal items within easy reach.
3. Mobility and Toileting Support:
   • Schedule toileting rounds every 2 hours for high-risk residents.
   • Provide non-slip socks or shoes and ensure bed/chair alarms are functional.
4. Medication Review:
   • Collaborate with pharmacy to identify high-risk medications (benzodiazepines, antihypertensives, opioids).
   • Request dose adjustments or alternatives when sedation or hypotension increases fall risk.
5. Staff Communication and Hand-Offs:
   • Ensure fall risk status is clearly communicated during shift changes, transfers, and interdisciplinary rounds.
   • Use signage (e.g., yellow armband or door markers) per facility policy.
6. Post-Fall Evaluation:
   • Conduct a root cause analysis after every fall.
   • Review whether interventions were in place and properly implemented.

Recent Legal Case Summaries: Lessons from the Courts

Case 1: Failure to Implement Fall Precautions (California, 2022)

A 78-year-old rehabilitation patient fell while attempting to go to the bathroom unassisted. Nursing notes documented a high fall risk, but no bed alarm was activated, and toileting rounds were missed. The court found nursing staff negligent for failure to follow the facility’s fall prevention policy and inadequate staffing. The hospital settled for $450,000.

Lesson: Assessment without timely intervention or documentation equals liability. Nurses must ensure that care plans translate into consistent practice.

Case 2: Inadequate Monitoring After Sedation (Illinois, 2020)

An elderly patient received Ativan for agitation and later fell from bed. The nurse failed to reassess fall risk after medication administration. The appellate court held that a reasonable nurse would have anticipated increased fall risk due to sedation and implemented closer monitoring.

Lesson: Always reassess fall risk after administering sedatives or antihypertensives. Failure to anticipate medication effects constitutes a breach of the standard of care.

Case 3: Ignored Call Light and Delayed Response (Texas, 2019)

A long-term care resident sustained a hip fracture after falling when staff did not respond to a call light for 25 minutes. The nurse was named individually in the suit, which alleged reckless disregard for patient safety. The facility’s logs confirmed chronic understaffing and delayed responses.

Lesson: Documentation of call light response times and adherence to rounding schedules are key defenses in litigation. Delays are often used as evidence of negligent care or even worse, reckless disregard which opens the door to punitive damages.

Case 4: Failure to Educate Patient and Family (Florida, 2021)

A post-surgical patient with impaired balance fell after the family removed side rails, unaware of their importance. The court found shared liability between the nurse and the facility, citing failure to provide fall-prevention education to the family as required by the Joint Commission’s EP #4.

Lesson: Always document that both the patient and family received and understood fall-prevention teaching.

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Legal Takeaway for Nursing Professionals

From a legal standpoint, every fall should be viewed as a potential sentinel event requiring immediate assessment, documentation, and communication.
To minimize liability exposure:

• Assess, document, intervene, and re-evaluate.
• Educate and communicate.
• Follow facility policy consistently.
• Document everything clearly.

Remember: Courts do not expect perfection—but they do expect reasonable, evidence-based, and documented nursing judgment.

📚 Recommended Courses on Website:

1. ➡️ Legal Issues Surrounding Patient Falls (3.0 CE Hours)
2. ➡️ Documentation – What, When, and How Nurses Need to Document. (3.0 CE Hours)

🗨️ We’d love to hear from you!
Have a question, story, or experience about fall prevention to share? Drop a comment below and join the conversation.

Laurie Elston JD BSN
www.NursingLawCenter.com
Law Office of Laurie R. Elston Inc.
📞 T: (805) 481-1001
📧 Email: Elston@charter.net