Falls and incident reports in LTC

sd90mac · Mar 18, 2006

Ok.

I am the risk manager where I work. It is very important to do the incident reports. We had a resident show up with a fractured hip. I had to do an Adverse Incident with the state. On completion of the investigation, the nurse was terminated because she said she didn't think the resident was injured so she did not do one. This was not the first time she had done this. The resident was demented and could not verbalize pain. 2 shifts later, he developed what the nurse thought was belly pain because he cried when the CNA's got him up. A flat plate was negative. The next shift nurse whipped back the covers and found external rotation and shortening of the leg. Any questions? Always always always do an incident report. If something is found later, you have proof you checked the resident and doccumented for 72 hours. It could save your bacon!

Do it for all skin tears, bruises, etc.

Marie:nono:

geriRN1993 · Mar 18, 2006

Ok.
I am the risk manager where I work. It is very important to do the incident reports. We had a resident show up with a fractured hip. I had to do an Adverse Incident with the state. On completion of the investigation, the nurse was terminated because she said she didn't think the resident was injured so she did not do one. This was not the first time she had done this. The resident was demented and could not verbalize pain. 2 shifts later, he developed what the nurse thought was belly pain because he cried when the CNA's got him up. A flat plate was negative. The next shift nurse whipped back the covers and found external rotation and shortening of the leg. Any questions? Always always always do an incident report. If something is found later, you have proof you checked the resident and doccumented for 72 hours. It could save your bacon!
Do it for all skin tears, bruises, etc.
Marie:nono:

We had a similar incident in my LTC. In our case there was an investigation by the Illinois State Police months later. Believe me it was not fun. The initial incident occurred where the aides said that the resident was lowered to the floor when she nearly fell during a transfer. It was 3 days later that a spiral fracture was identified and looking back there was no incident report and NO documentation. The nurse on duty at the time said that she did assess the resident but felt that there was no injury. Pain started 2 shifts later but the nurses after knew nothing of the "near fall" and didn't even suspect a fracture. So, it is not only important that we do incident reports for falls but near falls also. What I tell my aides is, "If you were not there to catch them and lower them to the floor, would they have fallen?" They now know that the need to report everything that happens.

Recently, we had a state survey and they sited us for not fully investigating all falls. They want to see that the nurse at the time of the incident identifies the "CAUSE" of the fall. The report must have all of the details of the investigation including any witness statements attached.

cindyjean · Mar 18, 2006

Yes..always . Unfortunately, ours is a 6 page form even an investigative officer would groan out load about..but it is an absolute necessity to be done.. No matter how long it takes nor how small the incident is. As a busy nurse I just cringe if a CNA comes to tell me about a small skin tear the patient got brushing against a door..or a patient strikes out at someone and so forth..all incidents have to be reported..some immediately to our state within 24 hours, for example a hip fracture

sd90mac · Mar 18, 2006

I can relate. As the risk manager, it is my job to do the investigation. 20 pages later, and statements from all staff involved, we have to determne if it is an adverse incident or not. That's the tricky part. We also have to determine if an employee is at fault or not. That is why all staff is required to check for all safety devices, alarms, etc. and make sure they are in place. I hate to have to talk to a nurse or CNA and question them about what happened. I always tell them to rreport any incident immediatlly and I'll fight for them, but if they don't and try to hide it, I cannot help them. Many are learning I mean what I say. They have stopped complaining about having to write statements and coming in to speak with us. I make sure Human Resources is involved in all discussions for the employees sake and mine. Our incident report is 3 pages, but the initial investigation I do is 3 pages or more. I am teaching the nurses to write everything they can think of, floor wet or dry, shoes on or barefoot, any obstructions, was the safety device on correctly or not on, anything that can help with the investigation. They are beginning to get the message.

Marie