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Will our home be cited?



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Apr 09, 2007 04:49 PM

Will our home be cited?


One of the girls speculated that we will - here goes:

Yesterday, during the day shift, three different residents fell. One fella apparently died.
When I came in last nite I was told that Mr. X had fallen out of bed and died. But then I heard MORE of the story - apparently they found him with his head on a pillow, and a blanket covering him. Well, the nurse on that hall has come up with this fantastic theory - and she's dead serious - she's speculating that his implanted defibrillator shocked him enough to throw him out of bed. But if that were the case, then it caused him to completely change the direction in which he was laying, then covered him up???
After thinking about this, I'm betting the old guy climbed out of bed with his blanket and pillow, lay down on the floor - and died - but there will be no proving how it happened because it wasn't witnessed.

And apparently there were 3 falls last weekend. I have no idea if they were working short or not.

Ours is not a bad LTC - but some people are just going to fall - because no matter how many monitors you put on them, and how accessible the call lite is, they WILL try to get up on their own from time to time and fall - usually 10 minutes after you last checked them.

What do you guys think?


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12 Comments
No. 1
Old Apr 09, 2007, 05:03 PM

Default Re: Will our home be cited?
Well, that state is certainly going to show up. Just make sure your A&I's are complete and the safety precautions taken are well documented, and that the care plans reflect them, as well.

*sigh8 They have "the right to fall," and then we get into trouble when they exercise it. Which they do, with frequency.
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No. 2
from AirforceRN
Old Apr 09, 2007, 05:38 PM

Default Re: Will our home be cited?
Originally Posted by banditrn View Post
she's speculating that his implanted defibrillator shocked him enough to throw him out of bed. But if that were the case, then it caused him to completely change the direction in which he was laying, then covered him up???
I think that if it will do the dishes and the laundry too I'm going to fake an arrest and get myself one.
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No. 3
from dcnballmom
Old Apr 09, 2007, 07:21 PM

Default Re: Will our home be cited?
so what do you tell the state - that you were working short - thats a no- no where i work - or do you tell them what your findings were and hope for the best?
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No. 4
from fultzymom
Old Apr 10, 2007, 09:16 AM

Default Re: Will our home be cited?
Depends. Did someone report you to the state? If they come in for your annual review then you could get cited if these were charts that gets reviewed. Or if a staff member would volunteer the information to the state. Just because you have the falls does not mean that you will be cited for sure.
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No. 5
Old Apr 10, 2007, 09:40 AM

Default Re: Will our home be cited?
Was the fall unavoidable? Did you have documented safeguards in place?
Any fall with subsequent death HAS to be reported to the DPH and the Medical Examiner. Having 3 falls in one weekend doesn't make it a 'bad' home. The last facility I worked in was a 'good' home, but in one weekend we had 3 incidents which had to be reported to the DPH. Do a thorough job in your investigation,documentation and reporting and you'll be better off.
Good luck. Let us know what happens.
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No. 6
from banditrn
Old Apr 10, 2007, 06:24 PM

Default Re: Will our home be cited?
Do they only report the falls that result in death? Or injury? MY theory on the fella that they found dead is still that he climbed out of bed on his own and laid down on the floor and died - who else would have placed the pillow and covered him with the blanket? He was in a private room.
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No. 7
Old Apr 10, 2007, 06:47 PM

Default Re: Will our home be cited?
You are supposed to report any incident that results in an injury...fall with fracture, fall with death,fall and sent to the ER for sutures. You don't have to report a fall with a trip to the ER if there was no fracture or sutures. Also have to report resident to resident altercation...if they are both demented there has to be an injury. and of course you have to report anything of a sexual nature. We had one guy who liked to grab women's bosoms. He was demented ...the women were demented. I had to do 3 reports to the DPH in 8 weeks. We did not get cited. Had a fall with fracture. We put all sorts of interventions in place. ...we did not get cited.
From what you say, I think you're right. The guy put his pillow and blanket on the floor, went to sleep and died.
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No. 8
Old Apr 10, 2007, 09:31 PM

Default Re: Will our home be cited?
Originally Posted by CapeCodMermaid View Post
You are supposed to report any incident that results in an injury...fall with fracture

In my state, we only have to report fall with fracture of a "dependent" resident. Recently had a CVA resident in for therapy. Was back to independence, home eval complete and scheduled for discharge within 2 days. She was up in room, doing "normal activities", hip audibly cracked than she fell down (heard/witnessed by family present). In our state, that is not reportable. If she had required assist with transfers and and staff left her, say, sitting in bathroom unattended and she fractured hip.. than that is reportable.

Just pointing out differences state to state.
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No. 9
from banditrn
Old Apr 11, 2007, 03:52 AM

Default Re: Will our home be cited?
Originally Posted by Nascar nurse View Post
In my state, we only have to report fall with fracture of a "dependent" resident. Recently had a CVA resident in for therapy. Was back to independence, home eval complete and scheduled for discharge within 2 days. She was up in room, doing "normal activities", hip audibly cracked than she fell down (heard/witnessed by family present). In our state, that is not reportable. If she had required assist with transfers and and staff left her, say, sitting in bathroom unattended and she fractured hip.. than that is reportable.

Just pointing out differences state to state.
Oh, ouch, that poor lady!
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