Falls (kinda long, sorry!)

  1. I had my first pt fall recently. I'm upset about it, but I'm not sure which part is upsetting me. This pt is a middle-aged, NOT confused person with a hip condition which makes it impossible for her to walk without help. She KNOWS that. On this particular day, she put on ther call light and the PCA went into the room, came out and told me that the lady wanted pain meds and that she was crying. I could hear her crying, so I finished what I was doing (giving someone else pain meds) and then went to get this pt's meds (her scheduled meds - 2 of dilaudid SQ and 60 of oxycontin SR PO, PLUS a sleeping pill). Anyway, by the time I got into the room, I found the pt on the floor. She was sitting up and leaning on the footboard of her bed, and she was bawling. I mean throwing a fit like a child. The more I tried to calm her down, the worse it got. I gave her the dilaudid and got people to help me. She said she didn't hurt herself and that she more or less just sat down, so I wasn't really worried that she was injured or anything like that. We lifted her back into the bed and I took a look at her - couldn't even find any red marks or bruises. Her room is right next to the nurses station and there were several people in there, and nobody heard anything, so I don't think she fell that hard. Anyway I finally got her to calm down and take her pills, and she was able to tell me what happened. Basically she said that "nobody would help me and I wanted something cold for my back, so I tried to get to the refridgerator by myself". She never told anybody that she wanted anything for her back because the PCA had JUST been in the room. I know that it takes a few minutes to get stuff out of the pyxis, but it can't take THAT long, can it? I know that when you are in pain, time has no meaning, but I am still angry about this. I had to call the MD and call the family and tell them both, and I felt like a total jerk!

    The thing is, I don't know who I am upset with. I am pissed at the patient because she knows better! One of the reasons she is there in the first place is that she had been falling at home. And like I said, she's not confused! But I still feel bad about it, like it was my fault. She fell on MY watch, you know? Neuro saw her today and say that they can't find anything in any of her tests that would be causing her pain. Their theory is that it is anxiety that makes her pain worse and then she gets to the point where she is out of control. They consulted psych but I don't know if they have seen the pt yet. So, maybe there are some underlying psych issues that are making the whole problem worse. Anyway, I feel like a bad nurse! I feel like it's my fault that she fell, and that if I could have just been quicker about getting the pain meds, this never would have happened. But then rushing causes med errors, and that's something I definitely want to avoid. Right now I am just so frustrated that I feel like I don't want to be a nurse any more. I'm not really sure what I expect anybody to say about this. I guess I just needed to vent. Sorry that it was so long.
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  2. 10 Comments

  3. by   Goldenhare
    Yikes! Don't be so hard on yourself! It is sometimes hard to predict pt behavior. You could try making a 'safety' contract with her and tell her that you will check on her every ___minutes and that she should be prepared to tell you about any concerns she is having at that time or anything that she wants. Possibly you might be able to bribe her. If she is allowed, could you say to her that you will give her some pudding or graham crackers or whatever if she stays in bed a set amount of time. I haven't had to resort to bribery-yet (and for those of you who might fuss and say that you shouldn't bride pts or children of husbands for that matter-I ask you this. What is a paycheck? A bribe for showing up Right? :chuckle ) I have found it useful to tell pts that I will be back between say 2100-2130, and they seem to respond well to that. I guess they don't feel ignored then. If they don't hold up there end of the bargain, then you can ask them why not and modify the contract.
  4. by   adrienurse
    Yes, you're being very very hard on yourself. We are nurses and there are only somethings that we're able to control. We cannot stop all falls, and we cannot force people to take our advice or follow directions.

    The best thing for your to do (I think anyway) is to spend some time learning about what causes falls and how they are best prevented. Too many nurses do not have a good understanding of this. So Here's some information that will help to boost your confidence:

    http://www.health.qld.gov.au/fallspr...ce/default.asp

    http://www.phac-aspc.gc.ca/seniors-a...es/intro_e.htm

    http://www.rnao.org/bestpractices/PD...%20practice%22
  5. by   1st edition
    After you advise her to ask for help by way of using call lights and whatever other methods your facility uses chart that she was advised to not transfer self w/out assit and verbalized understanding. CHART that every time. Cover yourself. If she contiues to "fall" then you are protected and your butt is covered w/ documentation.
  6. by   barbyann
    This situation is not a fall. It was not witnessed. She was "found on floor". There is big difference. Also pt stated "she sat down".

    I would have her on bed alarm from now on. Don't over think this one. Sounds like she has had these issues for awhile.
  7. by   miko014
    I think I would be upset no matter what, but I am ticked off at her! I really think she did it on purpose because she thought that I wasn't going to bring her her meds, even though the last time I had been in the room (maybe 30 min before), I had told her when I was bringing them, and I had them with me when I found her.

    I did chart it, believe me! And to my knowledge, this is her first fall in the hospital...she did fall a lot at home, and when I talked to her husband he just said "Oh my GOD" in a really exasperated tone (sounded about how I felt!) and said thanks for letting him know. I don't think he was upset with me, I think he was frustrated with her. I won't know until I go back, I guess.

    Oh and she said that she "sat down HARD".
  8. by   Antikigirl
    Man have I seen this scenero a few times...sheesh! I have had pts actually put themselves on the ground to illicit a responce of many people to tend to a need instead of waiting...because they feel they won't get help otherwise (same tactic as used by pts saying they have higher pain levels than normal so they can get medication feeling that if they say a lower number they won't get it...I tell my pts to tell me the low end times so it can take less medicine, spaced well, and control before it gets large!).

    Do not feel down on yourself...even if legit it is not your fault if a person gets out of bed despite being told the risks! Some people also have a very bad time with realistic views of time itself. Some folks feel that two minutes is 30 minutes and so on...and will get up after two minutes feeling it had been 30 or more to 'do it themselves'. Can't help that...but it is an underlying probelm you can try to work with! (I have given folks stop watches!).

    Despite what we are told...you can not prevent all falls! You can lower the risk, be there promptly when it happens to initiate care for injury...but not completely take falls out of the picture (unless pts are tied up!!!).

    All we are expected to do, and can do is lower the risks as much as possible by using implementations available (and trial and error!), and being there quickly if one was to occur (the biggest fear of pts and of nurses is not the fall as much as a pt down for long periods of time unattended to~! So put these into perspective for yourself rationally!).

    To tell you the truth...I am even scared of falls myself. I fell last week walking on a gravel road that just had its first rain. People teased me for it and told me I will be in a home at 50! I would giggle, but what a scary thought! I think we need a little more reality when it comes to falls...that or change gravity? LOL!

    I have broken both ankles as a child and not the most graceful of folks...so I am prone to trips or falls (especially in cold weather...my ankles feel locked up). It scares me that nurses will forbid me to walk unless assisted and suggest a care home...to me that would be the end (as it is for many people..think about that when you deal with pts that are on activity limitations post fall...that is a freedom we are taking away for their safety yes...but may not be rational to the pt and they may feel..."oh boy...I fell...to the home I go!").

    So don't put yourself down...just be there for pts, try to prevent it, and be quick to help if possible (and sometimes that isn't possible and you really must depend on a good staff to help). Put a bit of human reality into the picture...we fall...darn that gravity stuff! LOL!
  9. by   ArmyMSN
    There are nursing textbooks dedicated just to falls and falls prevention. Its down to a science where you can predict patients at high risk. There are a few assessments that every patient in my hospital gets (Morse is one, I think) and falls precautions are implemented - doesn't take much to be on precautions. Having a PCA pump or IV pump, history of previous falls including at home, multiple meds (including narcs/anxiolytics), eyeglasses, dementia, etc. It seems like everyone of our surgical patients needed to be on special falls precautions with the screenign tool we use (we end up putting up signs (hipaa?), bed alarms, communicating fall risk in change of shift reports).

    I used to have to investigate and report why falls occurred on our unit, and usually my personnal conclusion was that the unit was understaffed, too many admissions/post-ops were returning at once - and rarely was it the nurses's fault. Most of the time it was a system's problem (like most medication errors, too).

    Having one patient fall on your watch makes you very diligent to keep from having it happen again. But what used to burn me up was if the same patient fell more than once during the same hospitalization. Then you start to wonder if we nurses even talk to each other about these kinds of things at change of shift.

    Sorry to see that it happened to your patient. Sounds like you're very conscientious and will learn a lot from the experience.
  10. by   Goldenhare
    Quote from 1st edition
    After you advise her to ask for help by way of using call lights and whatever other methods your facility uses chart that she was advised to not transfer self w/out assit and verbalized understanding. CHART that every time. Cover yourself. If she contiues to "fall" then you are protected and your butt is covered w/ documentation.
    :yeahthat:
  11. by   miko014
    I have been charting EVERYTHING on her, believe me! It seems that the general consensus on the unit (MDs, nurses, case managers, even her family) think it's an attention thing (like I said, she has a history of "falls"). Which is weird since my tech was in that room 5 minutes before I was. I have had this pt again and it has been hard for me, but I have managed to keep her under control. I don't deny that she has pain, but it seems to most of us that she has pain and anxiety. She will start to feel the pain and then just freak out and get herself so worked up that the next thing you know she is screaming and carryng on (like a child, as I said before). I have had adult pts who were in so much pain that they cried, and I have never seen anything like this. She acts like a 4 year old at the grocery store when Mommy says "no" to candy. The thing is, her bt is q1h, plus scheduled q3h and q12h, and they added tons of anxiety and psych meds! We never say no! If she can't have her pain meds, she gets her anxiety meds! So I am not as upset as I was, but just shaking my head now. Thank you all for your support!
  12. by   jill48
    I have been an LPN for 11years. Some of that time was spent in med/surg, but most of it spent in geriatrics. Falls are almost a daily occurence. We are told now that "patients have the right to fall"; how insane is that? Do what you can to keep them safe, but you can't predict or prevent every fall. Make sure the call light is always within reach. Bed rails up when ordered. One trick I've learned over the years is if you have a patient sitting up in a wheelchair who likes to try to get up by herself, put a a bedside table in front of her. Now here is where it gets tricky, because if you put an empty table in front of her, it's considered a restraint. But if you put something on that table to keep her busy, its just a table, not a restraint. Older, confused ladies like to fold washclothes, so I put a pile of washclothes on the table and they start folding. Just check on her every few minutes to make sure they are not all folded or she will get bored again. Some patients like to color. I make copies of my kids' coloring books and keep them in my locker for this reason, plus some crayons. Or you can giver her a snack on that table. Once a patient does fall, my staff knows not to move her until I assess her. Obviously you are looking for bruising and stuff like that, but an easy way to assess for a broken hip is to extend both legs while the patient is lying on her back. This accomplishes two things: first, look at the ankles and if one leg is rotated in or out, there is a problem; second, if one leg is shorter than the other there is a problem. This is not the be all end all of the assessment, but it's a quick way to check for the displaced hip. In your charting, chart where she was found, how she was found, who found her, what time she was found, what time she was last seen before the fall and her condition at that time, what she says about the fall when you ask her what happened (even if her answer makes no sense), any witnesses, any changes in condition after the fall or possible injuries, and most important - covering your butt. This entails charting that the last time you checked her her call light was in reach and and bed rails were up (if this is the case). Then begin with the calls; the doctor should not be surprised, this is a constant problem. And the family will just have to get over it. There's only so much you can do. I've had families who ask why I can't just sit with her for my entire shift and my answer is that I have other patients, but it would be okay with me if they want to come in and sit with her all day. And sometimes they do. Hopefullly at your facility you use the fall risk forms that will help you to keep track of possible causes for the fall such as psychotropic meds or things like that to look at. Good luck to you, I'm sure you will get used to this sad, everyday, sometimes unpreventable occurence.

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