Facility mandatory DPH reporting for fracture

Nurses General Nursing

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Specializes in Med-Surg, Ortho, Subacute, Homecare, LTC.

So on Saturday night a patient fell during my shift. The CNA was helping her transfer from toilet to wheelchair when her knees just gave out. We helped her into her chair and put her in bed as she requested. On initial assessment of this situation, I didn't really like the way she had fallen on her legs. She's very heavy and was putting alot of pressure on her lower legs.

She was complaining of lower left leg pain just above the ankle. I had notified the on-call doctor and explained the incident and asked if I could have an order for an Xray. She said she "wanted to take the conservative route and just do ice". I thought that this was not sufficient, but she wouldn't give me an order.

So today, we have a meeting and during the meeting they mention the incident and the woman's fracture... Ugh. I knew it. I did write in my notes that the doctor refused an order for the Xray. Will that cover me? I really was very thorough in my notes and assessment. They have to report to DPH. What will happen after this point? I'm sooo nervous!

Thanks!

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Specializes in Hospice.

I don't know if it's a state-by-state thing or not, but I work in LTC and I in our state any unwitnessed fall or fall resulting in an injury (witnessed or not) must be reported. I don't know if that applies to hospitals as well but I wouldn't be surprised. If reporting of any fall with an injury is mandatory, then reporting a fall does not necessarily mean that anyone did anything wrong. I don't know why the doc wouldn't order the x-ray, though I have run into that myself. On the surface (without knowing all the details) I'd say you most likely have nothing to worry about.

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Specializes in Hospital Education Coordinator.

it does apply to hospitals. We have a protocol and it includes "incident reports". That way the Risk Mgr is notified in case legal action is taken at a later date. As for worrying, no need at present. I would recommend you brush up on policies in your facility related to this.

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Specializes in LTC, Hospice, Case Management.

In my state in LTC we are only required to report a fall with a fracture of a dependant resident (dependant per the MDS definition).

I have to admit, after all the years I have been around, I can be ornery if a Dr. does not give me an order that I'm sure I need in a situation like you describe. I will call the family and sweetly inform them that "Mom seems to be in quite a bit of pain from fall and is not bearing weight as usual. I asked Dr xyz about an Xray and he said no but I could always call him back to inform him you would like Mom sent to the ER for evaluation".

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Specializes in Med-Surg, Ortho, Subacute, Homecare, LTC.

Yea, thanks guys. I was told already that it's mandatory to call DPH. So, I knew that much was true. The funny thing is Nascar Nurse, I wouldn't even have to send them out for Xray. We use a Mobile Xray company... Kind of irritated about her saying "No, I'd like to take a more conservative route." :mad:

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Specializes in LTC, Hospice, Case Management.
Yea, thanks guys. I was told already that it's mandatory to call DPH. So, I knew that much was true. The funny thing is Nascar Nurse, I wouldn't even have to send them out for Xray. We use a Mobile Xray company... Kind of irritated about her saying "No, I'd like to take a more conservative route." :mad:

Well I'd only do what I said if I was pretty certain it was broke to begin with. Afterall, once it's confirmed fracture they are probably going to have to go anyways.

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Specializes in M/S, ICU, ICP.
In my state in LTC we are only required to report a fall with a fracture of a dependant resident (dependant per the MDS definition).

I have to admit, after all the years I have been around, I can be ornery if a Dr. does not give me an order that I'm sure I need in a situation like you describe. I will call the family and sweetly inform them that "Mom seems to be in quite a bit of pain from fall and is not bearing weight as usual. I asked Dr xyz about an Xray and he said no but I could always call him back to inform him you would like Mom sent to the ER for evaluation".

Give this nurse a standing Ovation. That's who I want to take care of me when I get older.

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Specializes in LTC, Hospice, Case Management.
Give this nurse a standing Ovation. That's who I want to take care of me when I get older.

Awe shucks! I just learned to play the game! :)

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