Hospital Falls Nursing Care: Why Some Incidents Don’t Amount to Negligence

Understanding capacity, risk, and staff response in hospital falls nursing care

In the medico-legal world, not every patient fall in hospital signifies negligence. While falls may occur in high-risk clinical settings, expert opinion must differentiate between reasonable care and substandard practice. In this case, a hospital patient alleged that an ill-fitting slipper and insufficient observation contributed to an overnight fall. But what did the records show?

Why this hospital falls nursing care case didn’t meet the threshold for negligence

Following a surgical admission, the patient (anxious, mobile, and assessed as having full mental capacity) was issued non-slip hospital socks after reporting no appropriate footwear. Hours later, she fell while attempting to access the toilet independently.

A senior nurse expert analysed the care record, risk assessments, RCA report, and incident logs. The conclusion: care was appropriate, risk assessments were in place, and observation was proportionate to her needs.

Key findings included:

• The footwear provided was a standard one-size non-slip sock, not an oversized slipper.

• The patient had been assessed by physiotherapy and occupational therapy as mobile with a walking stick.

• Her capacity was confirmed prior to the fall, and she had been encouraged to use the call bell.

• Hourly rounding was in place, and a nurse had reviewed her shortly before the fall.

“This was not a patient who required one-to-one observation or specialling. Her location—near the nurse’s station—and regular checks were appropriate for her assessed risk.”— Apex Hospital Falls Nursing Care Expert Witness

When patient choice intersects with reasonable care

Importantly the patient did not use her call bell prior to getting out of bed and attempting to mobilise, an action she had previously been observed to do safely. While any inpatient fall can be distressing, nursing staff cannot forcibly restrict independent patients from moving freely especially those who have been clinically assessed as competent.

This case reminds legal teams of the criteria that must be met for a breach of duty to be established:

• There must be a departure from accepted nursing practice

• There must be a failure to act where action was reasonably required

• There must be a clear link between the act/omission and the resulting harm

Here, none of those standards were breached.

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