Medication usage leads to fall at Gilman Healthcare Center

IDPH has cited and fined Gilman Healthcare Center nursing home after a resident fell and suffered a fractured arm and suffered additional complications after being given a dose of Ativan.

In our law firm, we usually look at two main factors as being the major drivers for nursing home falls: (1) musculoskeletal issues, balance problems, or general gait dysfunction and (2) intermittent or constant confusion.  This combination says that the resident has something physically wrong with them that predisposes them to fall, but because of their mental/psychiatric state, they can’t be counted on to follow instructions or make good decisions regarding their own safety.  In our office, this accounts for the great majority of the nursing home fall cases that we handle.

Of course, these are not the only risk factors and most nursing home take an array of other factors into the fall prevention care planning process.  One of those factors usually is medication usage.  Many nursing home residents take medications which contribute to fall risk.  Usually this is due to some of the known side effects of the medication or even its intended effect, as in the case of diuretics (or water pills).

Ativan is one of those medications which contributes to fall risk.  It is an anti-anxiety medication which is sometimes given as a scheduled medication, other times on an as-needed basis.  Its known side effects include: sedation, dizziness, weakness, and unsteadiness, all of which can influence fall risk.  When this medication is given as a scheduled medication, its effect is something which tends to become well-known to the staff.  When it is given on an as-needed basis, its effect on the resident is a bit less predictable and requires close monitoring of the resident.

The resident at issue was given a dose of ativan on an as-needed basis for “behaviors” and a few minutes later was walking down the hall with a nurse behind her when she fell forward.  The next morning she was noted to have discoloration and swelling about the shoulder and a painful range of motion.  The nurse notified the resident’s doctor who ordered her sent to the emergency room.

At the hospital the resident was diagnosed with a dislocated shoulder.  After the dislcocation was reduced, a repeat x-ray showed a fracture of the humeral head.  The resident was sent back to the nursing home in an immobilizer with orders to remain in the immobilizer until a follow-up with the orthopaedic surgeon.  However, when the resident was returned to the nursing home, she was tugging at the immobilizer so it was removed.  The following day, the staff saw that there was edema and warmth of the right arm and that the resident was very guarded with it.  The resident was sent back to the hospital where she was diagosed with a blood clot or deep venous thrombosis (DVT)  in the right arm. The nurse practitioner interviewed by the state surveyor stated that the failure to keep the shoulder immobilized would have caused increased pain and increased the rish of developing the DVT.

This will likely need to be treated with long-term use of an anticoagulant, or blood thinner, medication which places this resident at increased risk of suffering a brain bleed in a later nursing home fall.

There are a couple of major issues with the care that this resident received:

1.  The staff failed to monitor the resident for the effect that the Ativan and provide her with assistance backto her room.  Federal regulations relating to nursing home falls require that residents receive supervision and assistance necessary to prevent falls.  Ativan has a known series of side effects which contribute strongly to fall risk, and this resident should have been assisted back to bed.
2. There was a failure to follow the orders from the ermergency room where the should was not kept in the immobilizer which caused this resident to experience increased pain from the underlying injury.  This may have also led to the DVT’s occurring which will lead to her needing to stay on blood thinners for an extended period of time.

One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result.  Order our FREE report, Built to Fail, to learn more about why.  Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are.  Contact us to get the help you need.

Other blog posts of interest:

Champaign-Urbana Nursing & Rehab resident breaks hip in fall

Fall with head injury at University Rehab

Resident falls from bed at Spring Creek

Resident’s third fall at Bria of Chicago Heights nets brain bleed

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