Should I inform the UM or should I wait for them to do it first?

[night owl]

I am just amazed how my coworkers covered up an incident that occured with so many witnesses and no one said a word about the true story. If I don't say anything, I'm just as guilty.

The story goes like this. Last Saturday morning about twenty minutes after the change of shift, we had a resident climb over the side rails and hit the floor. I was still around doing my charting on the computer when someone yelled, "------ is on the floor!" Myself and three other people ran to his room and there he was lying on his left side on the floor. We picked ------- up and put him back into bed. One of the other nurses did a quick assessment and said, "I'll go call the doc." I went back to finish my charting and then I left. It was their problem. I just helped put him back to bed on their shift. Sunday I was off. Monday we were so busy I hardly had time to go to the BR and really forgot about the incident. Today it dawned on me to look through his nurses notes to see what they had done for this resident. In the one note written by the nurse who said, 'I'll go call the doc!', she typed, "Mr ------ was trying to jump over the side rails.'' I couldn't believe what I was reading! nothing about him hitting the floor, but she typed that she got an order for restraints from the Dr. Now I'm thinking what if he broke a rib, or a hip or hit his head??? The nurse that found him on the floor arrived this morning and I pulled her aside and asked her, "Why didn't you make out an incident report or tell the doc he fell over the rail and hit the floor?" Her reply was, "Well I know so n so called the doc..." I said, "But YOU found him and YOU should have initiated the incident report. She went flipping through the 24 hour reports and found that the other nurse wrote the same thing...Dr notified, restraint order obtained due to him trying to jump over the siderail... I reminded her that he didn't try to jump over the rail, he DID jump over the hit the floor. And I recall her being the loudest when we were placing him back into bed that morning saying, "I've told ------- (the UM), that he needs to be in a low bed. If he were in one, this wouldn't have happened!" When I left this morning I told her she and the other nurse who is on afternoons today better rethink their story on what actually happened because if they don't I'm going to have to be the pt's advocate. I checked him out this morning and didn't see any bruises, lumps or bumps, vitals were good, but God only knows. I didn't want to run into the UM's office right away since he looked ok. .....OK,ok,ok,ok I know I probably should have, but I wanted them to change their story to the right story first so that I wouldn't look like a "Rat." I hate being stuck in the middle. How wrong am I? Should I even have gone there? If we want him in a low bed this documentation would only prove that he really needs one. I bet stuff like this happens more than I want to know, but why does it bother me so much? Because I know the truth! It surely didn't bother the other nurses, but it probably does now...It'll bother me more if I have to play the role of "The Rat." What does one do in this case???

[night owl]

Originally posted by tlc054

What was their reason for covering it up? Other than the mountain of paperwork we must do to document a fall/incident. We can't stop all falls but we can certainly do what we can to prevent future ones.

I don't understand this myself. There really isn't all that much paperwork. An incident report with a carbon copy, a nurses note in the computer and notation on the 24 hr report. I'm thinking it might have been too much trouble for them to send the resident to x-ray and if something was found, then they'd have to send him out to the hospital. I guess they were just trying to save themselves "the trouble". Awe gee... Anyway, I'm sure the UM will want to know why they failed to mention he was found on the floor by his bed.

He wasn't actually seen climbing over the rail, but he was found on the floor and it's that very reason why the Dr should have been informed so that the resident could have been examined. He had that right and they took it away from him. The poo can hit the fan, I really don't mind. I've been playing in it for all these years so it doesn't affect me anymore.

There's one thing I've learned in my years of nursing and that is always cover your butt no matter what. I guess because he didn't show any visible injuries maybe they thought it wasn't necessary to inform the doc. I've seen that before too, only in that resident's case, he had a humongus bruise and a Fx hip two days later. The unit physician found it during an annual physical.

The sad part about this story is, he'll be found on the floor again unless he gets his low bed.

[jnette, ASN, EMT-I]

Originally posted by night owl

I'm thinking it might have been too much trouble for them to send the resident to x-ray and if something was found, then they'd have to send him out to the hospital. I guess they were just trying to save themselves "the trouble". Awe gee...

Hate to say it, Moo, but I was thinking along those same lines..."too much trouble, more paperwork", etc. That's REALLY sad.

And what if he were to now be found with a fx. rib or hip ... how would it be explained away? Will it be assumed that he fell out of bed "without anyone knowing", and managed to climb back up over the rails by himself and put himself back to bed? C'mon.......

Yep, do what's right. If you saw him on the floor, be sure you document as much. Good for you.

[Tweety, BSN, RN]

Nothing can be gained by covering up. Our Risk Management says to write an incident report and HONESTLY report all incidents , even if it gets us in trouble.

The truth comes out the same every time. As Shamrock says, go with your gut. You've got guts.

[atownsendrn]

Night owl - do want you know is right for your patient. No one can fault you for that. Good luck

[night owl]

Thanks everyone for your great support. I knew I could count on ya'll in my time of need. I will write an incident report tonight and hand it to the UM in the morning. I'm not there for a popularity contest, I'm there for our residents. Thank you all again.

[atownsendrn]

Let us know how it goes. Good luck

[night owl]

I sure will. One question though. Could I lose my license for negligence beings I was giving them a hand on their shift and assuming they'd done the paper work? Oh brother.........

[LauraF, RN, ASN, CNA, LPN, RN]

Originally posted by night owl

I sure will. One question though. Could I lose my license for negligence beings I was giving them a hand on their shift and assuming they'd done the paper work? Oh brother.........

I think the negligence would come into play if you knew the other people had not done this and you did nothing about it. Or not following through in the first place, which your currently following through. You may check your employee handbook though. We have a policy about what happens if you do not report a fall. I guess also, I don't remember, if you had actually handed off keys and given report it is their responsibility then. Good luck!

[webbiedebbie]

Yes, I am glad you are bringing this to the UM's attention. An inservice needs to be done again for the staff on incident reports. Makes me wonder...if they cover this one up, what are they doing with other patients?

An incident report would generate that the patient would get a lower bed. Falls are not tolerated anywhere. It is not meant to point fingers at anyone. It is there to fix things that are wrong.

It is not anyone's fault if a patient climbs over the rails. You document that the patient was found on the floor with siderails up on bed. An initial assessment is okay, but we are not diagnosticians. That patient should have been followed up with tests. Restraints can minimize future injuries to the patient, but often are used to keep the patients in bed so the staff doesn't have to bother with the patient. These types of patients need to be checked frequently.

[jemb]

Originally posted by Nurse Ratched

Nightowl, I'd write that incident report today and hand it to the UM with the statement that it had come to your attention that the incident may not have been reported for some reason. Return to unit and wait for poo to hit the fan. Good luck!

This is what I was thinking, too. It put the focus on the patient's behavior while bringing the nurses' lack of factual documentation to the attention of the UM (and , most likely, others).

And... I can't imagine that you would be in any trouble for documenting in an incident report what you observed in a patient's room when you went to help the nurse that found him on the floor. Wouldn't your report simply state the facts -- that you "heard another nurse calling for help, and upon arriving in the room you found nurse X standing over patient Y, who was in _____(fill in the blank) position on the floor." ? I don't understand how you think that could make you appear negligent.

[krispynurse]

You need to go and get an incident report and fillit out with what you saw and who was there when the incident occured in detail, make a copy for yourself and turn the original in to your supervisor...I hate this saying but ---- Always CYA----cause no one else is....this is for the sake of the patient as well as for you. Don't worry about how your co workers will feel about it. You will feel better...believe me I had to do something similar to it before ... I witnessed a nurse who started an IV on a 5 month old without priming the tubing 1st and when the air entered the baby he became very cyanotic and became SOB. It happened too fast for me to pull the tubing out of the baby before I saw the air enter him IV. Mother and grandmother (who was a resp. therapist at our hospital) had no idea what was going on. Only I saw and I was freaking on the inside and trying to stay calm and help with the situation all at the same time. In all the activity the IV was Dc'd and thank God the baby started getting his color back after some O2 therapy. This was a small rural hospital with only me and another nurse in the ER at night & then 4 nurses on the wing so I went and reported the incident to the charge nurse on the wing who told me to call our DON and tell her. I wrote this incident up but the nurse who started this IV denied not priming the tubing. I guess what I'm trying to say is I felt that if anything had happened to that baby later I wanted this incident reported. He was admitted for observation for several days due to this and I caught hell from the other ER nurse for months but it didn't matter cause I did what I felt was right. It was never mentioned in this babies chart only on my paper in which I kept a copy for my records.

[debRNo1]

Originally posted by night owl

I bet stuff like this happens more than I want to know, but why does it bother me so much? ..........................................

What does one do in this case???

"There's one thing I've learned in my years of nursing and that is always cover your butt no matter what"

Having spent over 10 years in LTC Ill answer YES..............

This "stuff" happens more than we would EVER want to know.

I have filled out tons and tons of A&I's and honestly it was one of my reasons for leaving LTC. I was UM for 2 years and responsible for "concluding" that there was no abuse, neglect of mistreatment. I've done chart reveiws over the years and can tell you that the majority of nurse DO NOT cover their butts with documenting the facts ONLY. Some dont even document and feel that the report IS the documentation NO.............

I had lady with two "thumb-sized" eccymotic areas on her upper arms and upon investigation she was alert enough to give me a name and FULLY explain that CNA "squeezed her arms" the accused employee MUST be dealt with IMMEDIATELY. OK now it is my fault and they are all talking that I am getting so and so in trouble !!! It caused a near riot and the police were called when the union came to rant and rave in the parking lot.

Falls dont bother me as much as a "bruise of unknown origin" the best is that it turned out to be "a fx of undetermined age" !!!!!!

That was the one that made me leave it bother me so very much that so many people had seen this discoloration, some CNA's reported it and some didnt-assuming that it had already been reported. The nurses dont want to fill out the report and many times it was days before a report was filled out. Any

suspicious "injury" MUST be reported within 48 hours.

Once during a survey one of my A&I's was picked up and we received a tag for it. They said that I "assumed" that he got it after I saw the way he "leans" when he got up to the sink. When I tell you I did a thorough investigation it wouldnt be a lie, family was even involved, helping me and the resident was fully A&O. Nevertheless they said that I assumed and shouldnt have.

Last year even better one of my frequent fallers falls and breaks her hip DURING the survey !! The next morning when they asked about it I handed over the observations sheets we kept on her and they didnt make an issue of it, any and all intervaentions that we could have possibly done were fully documented and they were satisfied that we had done all we could- no tag there but a nightmare nevertheless.............

It never hurts for a nurse to fill it out and leave it to UM and DON who can always conclude that a report was not needed- better off that way and CYA in your note. NEVER mention the report but do a FULL assessment, VS, and include any qoutes from the resident. Never assume on the report like someone else said write what you actually see, " called to rm by ____ to find resident lying on left side adjacent to WC.................." I NEVER call a bruise a bruise- I always call it a discoloration, many times the nurses would state a bruise and it turned out to be a purpura confirmed and diagnosed by md.

Im in the hospital now as a staff nurse( its alot different) and A pt had fallen the previous shift, he seemed ok but the night nurse ONLY filled out the report and didnt write a note. I wrote up a "NH" type note which included a full set of VS,c/o pain, ROM, cognition, skin integrity, and all that good stuff that I would include to cover my butt. One of the nurses saw me writing and barked, "what are you writing a novel?" NO I was just covering my butt. Should push come to shove the night nurse will take the heat and not me. I always picture myself on the stand testifying (sick thoughts) when I document these things.

One am I arrive a see A&I in the box- a "bruise" on inner r arm. GREAT- It was the EASIEST one Ive ever done- the pt had had a PPD :imbar What kind of an assessment is that ?? The nurses would be intimidated by the cna's who insist that every little freckle be reported, the nurse was a fool to write that one up because I dont think she even LOOKED at the resident just went with what the cna stated. Case closed PPD negative............

deb