Falls Risk vs Functional Independence: How Nurse Expert Witnesses Clarify Complex Cases

Mobility is Not Equal to Safety: A Nurse Expert Witness Explains Why Falls Risk Requires More Than a Score

When a patient suffers a fall in hospital, determining whether staff were at fault isn’t as simple as checking a risk score. As one of our senior nurse expert witnesses at Apex Experts highlights in this real case, falls prevention requires dynamic, patient-specific clinical reasoning and not just a green, amber, or red category on an assessment form

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This blog explores a case where a patient, already taking multiple medications and suffering from back pain, fell while showering independently. The legal challenge revolved around whether nursing staff failed to identify her as a falls risk despite a physiotherapist having assessed her as “independent” the day prior.

What the Nurse Expert Witness Highlighted in Their Review

In this case, the Claimant argued that she should have been placed on a higher falls prevention pathway, given that she:

• Was taking multiple medications including analgesics and diazepam

• Had a history of chronic back pain and leg weakness

• Reported urinary incontinence and mobility difficulty

• Had limited mobilisation during admission

However, nursing records indicated that:

• She had previously walked independently with a stick

• Physiotherapy assessments noted “independent standing balance”

• Nursing staff had observed her mobilising to the toilet without assistance

  
  

“Scores are only part of the picture. It’s clinical reasoning, supported by observation, that determines whether a patient should be supervised not a checkbox,” — Apex Nurse Expert Witness Report

Falls Risk Assessment vs Functional Independence: What's the Legal Standard?

According to both NICE CG161 (now replaced by NG249) and RCN Falls Prevention Guidelines, nurses must consider:

• Patient insight, medication side effects, and real-time functional ability

• Supervision needs based on both formal assessment and real-world mobility

• Escalation of risk when new symptoms or incidents occur

This patient had used her call bell but reportedly did not receive timely help. She was subsequently incontinent and went to the shower independently, where she fell. The Claimant alleged this outcome would have been prevented by proper falls categorisation.

The nurse expert witness determined that even with a revised score, clinical staff acted reasonably based on the patient's observed mobility and the information available.

Key Learnings for Solicitors and Clinical Risk Teams

1. Falls risk does not override documented independence

2. Call bell delays must be assessed in the context of ward pressures

3. Post-fall reassessment does not retroactively establish liability

4. Discrepancies between electronic assessments and clinician judgment require reconciliation

Ultimately, this case demonstrates the value of using experienced nurse expert witnesses to assess real-world clinical conduct not just paperwork accuracy.

Need to instruct a nursing expert witness? Get in touch with us at info@apexexperts.co.uk, call us on 0203 633 2213 or visit our contact us page.