The continuing saga...I went to the UM this morning

[night owl]

Asked if I could speak to her in her office because I had something I had to get off my mind. Told her the whole story and she says, "Yes I know,------- told me yesterday afternoon at 3:30 when she came in. She came in the door and then came right to me." (She was the nurse who called the doc, but failed to tell him the part about finding the resident on the floor and falsified the nurses note and the 24 hour report note) I'm thinking the other nurse whom I questioned about why she didn't make out an incident report and why no one told the doc he was found on the floor next to his bed, probably called----- at home and told her I was questioning her. I had the incident report all made out, but didn't give it to her since ------ told her about it already. The UM said, "The doctor is aware of the alleged fall and examined him and found no injuries. It's too late to make out a report because it has to be done within 48 hours of the incident." (I don't understand the reasoning behind that. Anything to do with injuries that may occur within that time frame?) She also said, "Thank God he didn't sustain any injuries, but I'm going to have to talk to these two about documentation whenever an incident occurs." I said, "Don't forget to tell them about 'telling the truth' in their documentation also and that falsifying reports could cause them to lose their license." And she said,"Oh don't worry, I will! And had he sustained any injuries from this alleged fall, they'd certainly be praying hard today because I would have presented this to the Board of Nursing!" I asked, "why do we attract these people?" She said I wish I knew so that we could fix it!" I said, "well don't worry, I'm sure we're not the only place that has them."

So there you have it. The charge nurse fessed up, but I didn't know it and went to the UM anyway. When I went in to work last night, I expected to see ------ to ask her about this whole thing, but guess what? She left early...naturally...I am relieved that she told the UM herself, because I really didn't want to be placed in the middle of it all. But I think the outcome should have been handled alittle more severely. I don't know, maybe it was and she just didn't tell me. I wonder though. Had I not questioned the nurse that found him and asked her why she didn't initiate an incident report and why the doc wasn't informed that he was found on the floor, I just wonder if the truth would have been revealed by -------. Maybe my questioning was all I really had to do to get ------ motivated to speak up. I don't know. But you better believe that the next time I witness something like this, I will initiate my own incident report and state the facts as I saw them.

Thank you so much for all your feedback everyone. You don't know how much I appreciated it and how much encouragement you gave me to go to my UM even though I really didn't have to in the end. You guys and gals are the greatest! This is why I can't stay away from here even if I tried to. Hugs to you all....and may God bless...

[Pete495]

Unlike others, I?m going to be the devils advocate in this one. I understand the falsifying of documentation, and omission of information to the docs. That is just plain wrong. But to me, it sounds as if this patient has been doing this consistently. The fact that no incident report was filed did not bother me as much as mis-documenting the incident. Sounds as if this patient jumps out of bed a lot. So are you going to write an incident report every time a patient jumps out of bed or screams because he spilled his milk? If you have time to do that, then I want your job. I agree that nursing documentation should be complete and concise, but I have had many instances where situations have been kept cooler because I handled it in a discrete manner. I'm not saying I've never filed an incident report. I have in fact filed one, but only on my own patient where I was well aware of the entire situation. I'd much rather handle the situation with doc involvement, and document in my nursing notes.

Basically, I'm just saying you should consider why things were omitted. Maybe they just thought it wasn't that big of a deal, and if it happens a lot with this particular patient, simple documentation on nurses notes might be sufficient. Even though the documentation was totally wrong, you could have simply made suggestions for the nurses involved to correct it. I'm not so sure I would have gone to the nursing manager over this. For one thing, it wasn't your patient. Second, it was 3 days later, and you decide to go back and check up on other nurses documentation? Also, why couldn?t you simply ask them to correct their documentation, and file an incident report?

I don?t know how that sounds to you, but I probably wouldn?t be happy if some nurse came in 3 days later, looked through my documentation, and made accusations when she hadn?t even cared for the patient.

After simply mentioning to the nurses that their documentation was incomplete, tell them to adjust it and consider filling out an incident report w/ the UM if they haven?t already done so. I think after this I would conclude my Business in the matter. I?m not sure I understand why it was necessary for you to get involved any more than that, esp. 3 days later. It?s not your patient, the patient was looked in upon, and it?s not even your ass on the line. I would just be careful in the future, or you will find yourself in hairy situations where you aren?t totally informed about what is going on. From your second post, it?s obvious you didn?t know that the nurse caring for the patient followed up with the indident. Maybe there is more to this than meets the eye is all I?m saying. And you wanted to report them to the Board of Nursing? That?s just wrong too if you don?t mind me saying.

I?ve found many nurses put their heads where they don?t belong, and sometimes people get hurt, even patients in some instances. I don?t feel it?s right for someone else to make a patient assessment without knowing history or very little about the patient. People criticize and jump to conclusions because they aren?t totally informed. The bottom line was the patient was ok. The doc checked in. Nurses checked in. If there would be a lawsuit, it wouldn?t be your ass on the line.

Please Don?t Hate me for being Different.

[Pete495]

I have no idea why question marks came out as apostrophes. If someone can figure this out for me, I'd appreciate it. Thanks.

[Tweety, BSN, RN]

Pete495, if there are any risk management nurses they are probably cringing right now.

You're right an incident report doesn't save anyone's butt. It's the documentation, the MD involvement, etc. that you said is what's going to save them.

The incidents reports are to make the risk management aware, so they can do their job. If I were the hospital lawyer and this patient repeatly fell, thus perhaps indicating negligence on our part, and I didn't know about it I would be furious.

The incident reports are not a documentation of the incident, that is done in the nurses notes. It's mainly to make management aware of the incident, and perhaps figure out how to prevent future occurrences.

You make some good points. But regardless, Incident Report Every single time. No, we don't always have that kind of time. Too bad, it's too important. Make time, stay late. Whatever. Just do it.

[Tweety, BSN, RN]

night owl, glad things worked out. You did the right thing.

Again though, if there is a risk manager reading this, they are going to cringe to know you're in pocession of an incident report. :)

[night owl]

Pete495

From the nurses statement who found him on the floor, "I told --------(UM) about this. He needs a low bed. If he was in one, this wouldn't have happened.".... I gathered that, yes, this probably has happened before, many times and nothing has ever been documented in the nurses notes. As far as the incident report goes, if I had to make 10 of them out in one shift I'd have to find the time to do it. Risk management needs to know and I need to know I'm doing my job. I was involved Pete. First of all, he was my pt prior to the shift change and second of all, I assisted in picking him up off the floor and placing him back to bed. I made no accuisations, he was on the floor, and yes their documentation was all wrong. I need to call the shots as I see them for the pt's safety prevention of self harm. I made an incident report out for him and for my records. UM said it was too late to turn it in; needs to be done within a 48 hour time frame. (?) so I kept it for myself....juuuust incase.

These nurses need to know that when an incident occurs, they need to fill out a report. If the pt stubs his toe, they need to fill out a report...anything that brings harm to the pt or could bring harm to him like finding him on the floor next to his bed with siderails still up. "Maybe they just thought it wasn't that big of a deal" Huh? And what policy book did they read from? It is our policy to fill out such reports when such incidents occur. Whether or not I was involved, it wasn't done. The pt had a right to be examined by the doc and he was deprived of that right and I think that was wrong. I did what I was supposed to do and that, to me, is all that matters. Sorry Pete, but for Pete's sake, they need to learn to advocate for the pt, not just for themselves.

[moonchild20002000]

Sounds like your patient needs to be on a mattress on the floor. If it is known that he dives out of bed how can you keep him in a regular bed????

Of course sending him back to a psych unit sounds like a good plan too.

Good luck ,CYA.

[night owl]

I wish we could send him back to psych believe me, but our psych dept. doesn't take pt's with medical problems such as with trach and GT. I don't think it would be wise to let him roll around on the floor matt with a trach and a GT and all the tubing. He'd probably hang himself with the tubing, or pull the kangaroo pump over on himself, then there's infection control and he'd prolly try to get up and run with tubing and all still attached then pulling everything out! We'd have a bigger mess on our hands. Right now he's in bed with mitts and wrist restraints. I hate seeing him tied down like that all the time, but it's the only way to keep him contained for now and not diving onto the floor. I figured that an enclosed bed with only the mitts would give him alittle more freedom with less possible injury occurance. I wish they could make beds like cribs, with high side rails. Those regular padded siderails aren't protecting anyone especially when an air mattress is applied and makes the pt lying on the mattress almost level with the top of the rail. What's the point of having the rail up at all then? Of course my fellow nursing buddies, any other suggestions would be greatly appreciated.

[Pete495]

Boy, I knew I would stir some stomachs with my comments, trust me. That's what this discussion board is for though. Maybe that is what I was trying to do a little bit.

Night Owl, If the patient was yours prior to the shift, why didn't you fill out an incident report right away? I'm kind of wondering why you did not complete one yourself if you were partly responsible, or else make sure it was done before you left the floor.

Secondly, why would you need an incident report for your records? You think that is going to be good 6 months from now? The only thing it will do is help yourself remember the incident, and that is the only thing it would be good for.

As far as filing an incident report every time someone stubs there toe, I find this kind of funny. I don't scream bloody murder every time I stub my toe!!!!! I had a patient last night who woke up, and came out to the desk, and wanted to call the police on us. He was a nice old gentleman who was just confused. Do you think I should have filed an incident report?

Maybe you could mention in ONE incident report that this has happened repeatedly with the same patient, instead of filing 34 different incident reports for the same patient.

You know what I think. Incident report filing is a whole other discussion, and maybe we should start a thread for it. The decision to file or not to file is left up to the nurse(s) involved. I guess you were pretty well involved, but I think you took it too far in saying that you were going to report the incident to the Board of Nursing. If you did, you would have to report yourself as well. Even though you passed report on, your still legally responsible as long as your in the facility.

Like I said, I was just playin the devil's advocate. I'm not saying if you were right or wrong, because it's a discussion board, and I wasn't there, and don't know the whole story. Just here to give you something to think about, and raise questions for all of us, so that we can all advocate the best and safest care for our patients.

[Pete495]

I started another thread. Please feel free to leave your comments.

[ChainedChaosRN]

Wow NightOwl, I haven't been on for a few days...what a weight on your shoulders. You handled it well. I wish I had you on my staff.

Re: Incident reports, we IR everything, every bruise, lab draw or not as soon as it's noted, even if it is over 48 hours or 4 days. An investigation is done on whatever requires an incident report. It is time consuming, we average about 65 incidents per month. This not only helps us, but always brings new interventions for the patient.

Re: patient..can you bolus feed him? Sounds like you definitely need to get him closer to the ground and far away from siderails. Bed alarms? Rolled edge mattresses? I won't do restraints in my facility, I'll do a bedsite sitter first. Good luck!