Poor documentation, positioning top risks in perioperative malpractice cases

Editor's Note

Failure to document thoroughly, position patients safely, and follow facility policies are leading causes of malpractice claims against perioperative nurses, according to an analysis published in the AORN Journal on May 28. Although physicians are more frequently named in malpractice suits, nurses are the primary provider responsible in 9% of claims, with allegations commonly tied to monitoring failures, communication breakdowns, and deviations from standard protocols.

As reported in the article, legal nurse consultant Alexis Chaudron, EdD, MSN, RN, draws on perioperative nursing records to evaluate malpractice cases. Her case reviews center on whether documentation accurately reflects patient care, including key elements like positioning technique, support devices, and equipment use. In one case, a lack of documented padding in a lithotomy-positioned patient with postoperative nerve pain was seen as a potential contributor to the injury. The record's silence on protective measures raised concerns that none were used, despite high-risk positioning.

The article stresses that inadequate documentation can raise doubt about the quality of care provided. When the record omits critical details, such as the type and placement of padding or positioning equipment, it becomes difficult to defend the care in a legal setting. Thorough documentation—especially in high-risk scenarios like extended procedures or vulnerable positioning—can directly influence case outcomes.

Positioning-related injuries, including pressure ulcers and nerve damage, are among the most frequently cited reasons for litigation in the perioperative setting, the outlet reports. Proper padding of bony prominences and ensuring no pressure is applied by instruments, surfaces, or staff is essential. Nurses should also be vigilant in documenting every support used, including stirrups, pillows, and foam, to show alignment with best practices.

Beyond documentation and positioning, Chaudron highlights the importance of safe equipment use. Nurses should remove malfunctioning tools from service, report issues through formal channels, and ensure all supplies are used according to manufacturer guidelines. Per the article, adherence to hospital policy remains a key area of risk, with nearly 84% of malpractice cases between 2013 and 2020 linked to staff failing to follow existing protocols.

The article concludes by calling for a stronger culture of safety. Psychological safety, consistent event reporting, and open communication among team members are crucial to preventing errors and improving patient outcomes. Chaudron advises nurses to submit event reports with their names to encourage transparency and collaboration, ultimately supporting safer perioperative care.