Pt fall- need advice

[dma13]

Recently had the misfortune of having a patient fall under my watch. It was the first time I've had such an event in my career and I have been very upset with myself over it. Fall was unwitnessed. I had been in another room caring for a patient. As soon as I finished and as I was heading into said patient's room I was notified they had just come off the monitor. I rushed into the room to find the patient laying on the ground on her side. Pt had shown some signs of delirium prior but had been A&Ox3-4, following commands, and cooperative for the most part. And there had been no prior incidences of patient trying to get up out of bed before. Patient thought they heard something on the other side of the room and was trying to see what it was.

To sum up, patient did not suffer any serious injury or harm, no bleeds /breaks/ or bruises thankfully. Incident report was filed and family was notified. Have to fill out another more detailed report now. Although many safety measures had been in place, I'm afraid the bed exit alarm may not been reset from the last time we were in the patient room. Secretary said that the bed alarm did not go off. And when I had gone to check the bed, it was not on at the time. This report specifically asks if the bed alarm was on.

My question is, how honest should I be with this report and indicating the status of the bed alarm. I believe honesty is the best policy, but I also want to make sure I protect myself as well. I always been vigilant about bed alarms, its something I do all the time. But the one time I didn't, patient unfortunately got up and fell.

I want to be honest but I don't want to implicate myself either. I don't know what the consequences could be if I am too honest. I'm not sure what the best way to approach this situation. Any advice would be appreciated.

[Newbie_RN17]

You need to be honest. Integrity is everything, imo, and the secretary said it didn't go off. They *should* remediate vs punitive measures, especially since no harm came to the patient. We all make mistakes and for all anyone knows, the pt turned it off. Lying or skirting the truth, especially in this instance, will not work out in your favor. Good luck to you!

[CalArmy]

You absolutely need to be honest about the bed alarm. However, you can put you thought it had been reset and wasn't. Bed alarms and scales are sensitive and can have errors. You were diligent about the patient's safety but something was lost during that time. Unfortunately you could sit with a patient 23 hours and 45 minutes a day and they will fall in those 15 minutes. Falls happen despite multiple safety measures being in place.

[bagladyrn, RN]

When you write this state "bed alarm found in the off position". Don't conjecture as to who turned it off or how. Simply state the fact.

[dma13]

Should i add that it may have been forgotton to be reset, because it had been on but when we turned her in bed we must have forgotton to reset it.

[RotorRunner]

No, you stately objectively what you saw when you walked into the room. No reason for any more conjecture.

[dma13]

Can I PM you?

[Ben_Dover]

Do not or I must say "Never" (strong word but yes NEVER) ever alter or fabricate an incident. Best you can do is chart defensively.

One example of defensive charting is noted down below.

bagladyrn "When you write this state "bed alarm found in the off position". Don't conjecture as to who turned it off or how. Simply state the fact. "

[Meriwhen, ASN, BSN, MSN, RN]

Should i add that it may have been forgotton to be reset, because it had been on but when we turned her in bed we must have forgotton to reset it.

NO

Stick to the facts. The bed alarm was off when you entered the room. It could have been off due to 1 of a 100 reasons, from your forgetting to reset it, to another staff member not resetting it, to it malfunctioning, to the patient turning it off themselves (and yes, that can and DOES happen), or many other reasons.

But you don't know the WHY and HOW for certain. All you know for certain is that the bed alarm was off. And that is what you report. Anything else is speculation.

Now if you intentionally turned it off and the patient fell, that's a different story.

[dma13]

thank you, this was helpful

[MunoRN, RN]

It seems like you're feeling fully responsible for this fall because the bed alarm wasn't on, and if the bed alarm had been on then the patient wouldn't have fallen. Keep in mind there's no evidence that having the bed alarm on would have decreased the potential for a fall.

[dma13]

Yes this is how I'm feeling. I know the patient could very well have fallen even if I had the bed alarm on, but its just one thing I feel like if I had in place might have made a difference. It would have also been easier to accept/ swallow if I had done everything I could on my part to avoid this from happening. The fact that the bed alarm was not on makes me feel responsible. And it happened on my watch. And I know when I put that on paper, that's what everyone will focus on the most.