The continuing saga...I went to the UM this morning - page 2
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... Read More
Jul 3, '03I have no idea why question marks came out as apostrophes. If someone can figure this out for me, I'd appreciate it. Thanks.
Jul 3, '03Pete495, 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.
Jul 3, '03night 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.
Jul 3, '03Pete495
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.
Jul 3, '03Sounds 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.
Jul 3, '03I 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.
Jul 3, '03Boy, 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.
Jul 4, '03Wow 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!