Injury of Unknown Origin

  1. I'm a new grad working LTC. My DON came to me today to tell me that she heard I checked "unknown origin" on an incident report AGAIN.

    My resident had three HUGE skin tears on her arm. It was pretty clear when assessing the tears that they came from her arm falling down between her body and the Geri chair, and her jerking it back up. I added that information to my Skin Issue Report accompanied with the Incident Report. Well, DON told me that I shouldn't have called it an "Injury of Unknown Origin." Help me out here! To me that IS. I didn't see it happen. The resident is not oriented enough to REALLY confirm that is what happened, though when asked she stated it is. However, when you ask this resident "Why are you hollering? What's wrong?" "I don't know." Or if you ask her, trying to do a little small talk during a treatment "Where did you grow up?" "I don't know."

    She told me that "Unknown Origin" initiates an investigation and means that I think it's possible that there was abuse or neglect. I don't think that. I would have checked "Abuse" on the Incident Report if I thought that.

    HELP ME OUT!!! In my vernacalur, finding skin tears that I didn't witness and no one else did is "unknown." And if their must be an investigation, so be it. It's likely the conclusion of an investigation would be that her arm got hung up on the Geri Chair. Like I said, but in common English it's still "unknown." No one saw it and the resident can not adequately confirm!!!!

    HELP! I like LTC, I enjoy my residents. I enjoy my coworkers but the paperwork is a major never ending trip. (and it's all paper. No computers.)
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  2. 11 Comments

  3. by   lrobinson5
    I think you make a great argument, but I'm just a student. To me it makes sense to check unknown, but then again I've never had to document :/

    Good luck!
  4. by   thinkertdm
    I think that you are right, technically, it is "unknown" because it is, well, unknown. However, that label is used when there isn't a plausible explanation of the event. You had one.
    The abuse label is the opposite- you don't want to click it unless you know for sure-100% beyond a doubt sure- that it is abuse. Otherwise, put "unknown" for that.
  5. by   mercurysmom
    Is there a way for you to document "not witnessed" rather than "unknown?" While you can't speculate about the cause of the injury, you could note that you've seen her putting her arm between her body and the chair, especially if the dressing is disturbed when she does this: "Left forearm dsg re-applied at 0800 and 1230; kerlix displaced when resident ___(describe what you've seen her do while in the geri chair.)" I'd also chart attempts to redirect her, as well as any attempts to prevent her from putting her arm inside the chair, such as filling the gap with a pillow or rolled blanket. The pillow might not stay there, but at the very least it would give her something to do besides scraping her arm against the chair.
  6. by   NurseHopefulInOH
    Ive learned that for falls STs anything of the nature in LTC they basically want you to make up a story or "speculate" as to what happened. They have to launch an investigation every time something happens and come up with a way to "fix it" and stop it from happening again and a solid answer as to what occured...truth is some things are just freak accidents with no ryme or reason! or events that occured and lets face it the 90 somethin dementia resident is not gonna be able to tell you what happened! Basically they want you to produce something even if not exactly possible. saying nothing or..i d unno.. whats them look bad. Facilities just want to cover their a$$. So i woud put exactly like u said even though u did not see it. Maybe not in NN but in the incident report or whatever u guys have to fill out.
  7. by   HurricaneCasRN
    Quote from thinkertdm
    I think that you are right, technically, it is "unknown" because it is, well, unknown. However, that label is used when there isn't a plausible explanation of the event. You had one.
    The abuse label is the opposite- you don't want to click it unless you know for sure-100% beyond a doubt sure- that it is abuse. Otherwise, put "unknown" for that.

    Thanks, Thinker. It's helpful to know that this is the standard practice for the reporting.
    I'm totally new to the game, and as we all know, orientation just isn't long enough to cover all the ins and outs. Plus, this particular form is new to the facility so even the veteran nurses aren't entirely positive how to answer. I swear, these forms are worse than care plan projects.
  8. by   debRN0417
    You are absolutely correct. An injury of unknown origin is one which you did not witness, and the resident cannot tell you what happened. IT MUST be investigated to rule out abuse. What if someone was mishandling her? You did the right thing.
  9. by   Isabelle49
    By saying the injury is of 'unknown origin' you are saying you don't know how it happened. As I understand, you are documenting the patient pulling arm up along arm of jeri chair and that is how injury occurred, so you do know how the injury occurred. It's one or the other.
  10. by   nola1202
    Quote from Isabelle49
    By saying the injury is of 'unknown origin' you are saying you don't know how it happened. As I understand, you are documenting the patient pulling arm up along arm of jeri chair and that is how injury occurred, so you do know how the injury occurred. It's one or the other.
    Huh?!
  11. by   debRN0417
    It was unwitnessed. An "investigation" had to be done to determine what "could have" caused the skin tears. You have to rule out other causes, even if you are pretty sure what happened...but again- it was unwittnessed, so how do you know for sure until you investigate? You may never be able to determine the actual cause, but you have to rule out abuse.
  12. by   SuesquatchRN
    Don't document unknown. Seriously. If you can figure out how it happened it is known. Unknown does several things: requires that witness statements be gathered for a bunch of shifts back, and also sends a big red flag to the state surveyors to investigate a possible abuse situation like flies on poop. The point of the investigation is to RULE OUT abuse. Bottom line. Identifying areas of care that could be improved is certainly important, but don't give the surveyors any ammunition.
  13. by   Mestisa57
    You can ask the patient what he/she was doing when they slid to the floor. Likely reaching for something like a sweater, drink, etc. and they lost their balance when they leaned too far. So, a sentence like, "Resident was reaching for her sweater when she slid to the floor" would cover it.

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