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PTA Blog Talk

Choices

Published December 28, 2011 8:04 PM by Jason Marketti

A patient falls because of a bad decision he made by getting up without calling for assistance or using an assistive device. The facility may see on a yearly survey that they did not provide adequate care for the resident even though all safety procedures were in place and documented.

What will not show up on survey is a patient with lung cancer who chose to smoke while at the facility and is now actively dying. Should the facility be at fault for not protecting the patient who developed cancer through bad decision-making? No? Why then are they at fault for a patient who falls because of bad decision-making?

Would the facility be at fault if a patient came back to the facility intoxicated after being out with family or friends? The patient is an adult and should be able to make informed decisions. However, the medication the facility provides to the patient may impair those decision-making abilities, and yet the facility would still allow the patient to exit the facility even though they know the implications.

Should we, as therapists, ever allow a patient to walk free and independent in the facility? What if that patient fell and accused us of malpractice because we did not warn him of the potential of falling at 3 a.m. in the bathroom with the lights off? Or we did not warn him that the medication he is on will cause dizziness and blurred vision? Would we rethink the phrase "independent mobility" in a patient?

4 comments

We have a duty of care to the people walking through our doors for treatment. While your example of the smoker making a conscious choice seems similar, in many ways it is different. The smoker most likely developed the habit prior to entry, has not come to the facility to change the habit, and in most facilities I know of, must leave the grounds in order to smoke.

Patients who come to my outpatient facility (a falls clinic) have come specifically to address a physical need and part of my duty of care is a comprehensive assessment on all risks to their well being (including to smoking cessation if applicable). They are also overwhelmed with medication management, previous medical ailments, social issues, well meaning relatives, and a host of risk factors. As a professional it is my job to identify and educate about those risk factors (yes, including handouts) and to ensure that the facility is as safe as possible while allowing for maximum self determination. Have people fallen in our facility? Yes. In that case we do a root cause analysis to determine the reason for the fall. If it is our shortcoming, we fix it. If not, we re-educate.

I question the idea of conscious poor decision making in the instance of falls. Some people do make poor choices. Others are impaired by cerebral vascular events, dementia, medications, or alterations of perception. They honestly don't know or can't remember what the "right" choice would be. In this case, it is absolutely our responsibility to assure their safety whilst in our care. It is rare that I see people fall solely out of arrogance and bad decision making.

Dean Metz December 29, 2011 12:49 PM

The key is education with handouts!!  I work in the OP settings and get some patients that come from a short rehab stay in a SNF unit that my friend works at.  I go over safety education and prevention that was taught in the SNF  unit and 50% of them dont remember, possibly due to the effects of the meds.  The ones that remember the most, are the ones that received handouts that i also have and we review them.  

 So dont forget those handouts!!

Steve Wilson, OP - PTA December 29, 2011 10:35 AM
SHERMAN TX

The problem is, bad decision or not, if the patient falls the facility is responsible.  No one wants a law suit or even the threat of one.  

A lot of the patients I work with are falls waiting to happen.  We protect them from themselves while in the hospital. Then they fall when they return home.  Have we really accomplished anything?

Toni Patt December 28, 2011 5:56 PM

hi from Spain! I think is very diffiult to put "the line" in the right place doesn,t it? Every pacient is a world and is our decission the treatment and the risk it come with.

Perhaps the good way to do this is try to do the best in each pacient.

Thank for the post. You make me think! ;-) (and sorry about my english... surely i have wrote something wrong... ^^ )

Acosta Fisioterapia, manual therapy - fisioterapeuta December 28, 2011 4:09 PM
Cáceres, Spain

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    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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