Patient fx hip after family refused alarm - page 10

by Emilyinsc

13,629 Views | 100 Comments

Ok, the family for a short term rehab patient did not place an alarm due to family's refusal (this happened on a wed). He fell a day & a half later, breaking his hip and nose. The NH is coming down hard on the admission nurse... Read More


  1. 0
    Patients do and should have the right to fall. Patients can refuse ANY treatment. They still have the right to care and to stay in a facility. To force someone to leave AMA for refusal, as someone suggested, is beyond idiotic. We as nurses advocate for our patients. We need to explain to them why we use alarms and encourage compliance. But we need to respect their choices.

    And for those on this thread unfamiliar with bed alarms, they frequently get triggered with every little movement and keep people up all night.

    It really sucks that OP got fired for no reason. Only thing at fault in this case is gravity.
  2. 0
    Sure , people have the right to fall, but that doesnt absolve the facility from having a sentinel event. How can they have the right to care, then refuse it??Or pick and choose as they see fit. Well , yes , that part is true, but I don't need some facility dragging my name in the mud because so and so wants"fill in the blank" and it's my fault I "allowed it" to happen.

    I don't think someone signing out AMA is idiotic. It's realistic- people don't want treatment- well , buh bye- someone else who WANTS treatment is waiting in line right behind them.

    And yes, those alarms DO suck, but I'm sure they are in place as part of facility's attempts to not get their butts handed to them on a platter. It was a precedent set, especially since some people don't seem to give two hoots about there "loved One" getting injured unless they see dollar signs in it.We AND the facility's all suffer.( when I say facility, I am referring to hospitals- can't speak for anywhere else)
    Last edit by jrwest on Mar 10, '13 : Reason: stupid computer
  3. 1
    To tell someone that they have to leave AMA and can't get the skilled care they are in a facility for because they won't consent to a bed alarm? I will say it again- idiotic. Someone refuses alarms - first educate, then document and take every precaution you can. Bed low. Bell in reach. Belongings in reach. Frequent toileting. Frequent rounding.

    Refusing care would get facility in way more trouble than a sentinel fall. Being a nurse means advocating for your patient, including his right to fall.
    Anonymous865 likes this.
  4. 0
    You can have 3 different types of alarms on and a person can still fall. Anyone on any of the shifts from admission to fall could have changed things, added something. What about staffing or layout of building etc. So many factors. Document, document, document!
  5. 0
    Generally, the alarms are put on when the patient is shown an inability to judge. Like dementia or confusion. If someone has an altered LOC, then they can't judge as well if they can walk safely. You can educate, but you can't rely on the retention of information. This plus impulsiveness makes for a dangerous combination. If they are AOx4 and simply stubborn, then educate and document like crazy.
  6. 0
    Many facilities have a blanket policy for alarms. I have worked on one that put every person in alarm X 72 hours. And one that alarmed everyone as policy. It is not uncommon for aao x 3 to refuse. To make a federal case out of every refusal as some people are suggesting would prevent the nurse from doing her job. Keep in mind we are discussing an oriented person - a dementia or confused patient would need their POA to refuse alarm on their behalf. That is an entirely different can of worms.
  7. 0
    Maybe my facility is more strict- we USED to be able to document if a person refused the alarms. Now we are not allowed to even do that. If they have been deemed a fall risk, then the alarms go on. The facility even has random spot checks by auditors to see if we have them on. If one isn't on, the floor gets wrote up, and of course they find out who the nurse is who has that particular pt,so they get wrote up too.
  8. 0
    I would of explained to the family that it is required to have alarms , for residents who are risk for falls.. I'd they still refused I would of documented in detail , how it was explained and the family refusal .
  9. 1
    Quote from drowningdaily
    Patients do and should have the right to fall. Patients can refuse ANY treatment.
    With rights come responsibility. If the patient and family refuse to do what is necessary to keep the patient safe, the family should take responsibility for all costs incurred with the fall. They should also not be allowed to sue for damages as a result of the fall.

    Unfortunately, this isn't the case and the first person to be blamed will be the nurse. I'm all for advocating for my patients, but I'm my own advocate first. Someone (or their family) wants to place themselves intentionally in harm's way, I can't stop them, but I'm sure as a the world covering my own butt.
    jrwest likes this.
  10. 0
    We don't have bed alarms in my country at least in my experience. What exactly does it do? When does it alarm?

    And why do families refuse it? I'm confused.


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