Patient fx hip after family refused alarm - page 2

by Emilyinsc 14,340 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. 1
    I would rather have the family be upset over something as small as a bed alarm than deal with a potential death of the pt.
    TJ'sMOM likes this.
  2. 8
    Quote from jennyrn2012
    Regardless of whether or not the family members were the POA, it is the responsibility of the nursing home to ensure the patient's safety so the alarm should have been placed. If the nurse cannot explain to the family the necessity of the alarm, then the DON should have been called to do so and if the DON can't, then the administrator. I am an ADON and have been dealing with this issue recently. If the family does not want an alarm, then they can take their loved one to a place that is negligent and allows refusal of safety measures.
    If I am alert and oriented, I can refuse ANY and ALL treatment or medication. As long as I am not putting someone else at risk, you have no right to force me to do anythi g and if you did this to me, I would be on the phone to the Department of Public Health.
    sharpeimom, imintrouble, KelRN215, and 5 others like this.
  3. 5
    Quote from CapeCodMermaid
    If I am alert and oriented, I can refuse ANY and ALL treatment or medication. As long as I am not putting someone else at risk, you have no right to force me to do anythi g and if you did this to me, I would be on the phone to the Department of Public Health.

    While that is true; the flip side is the family will sue for grandpa's injuries and claim negligence
  4. 0
    I agree with capecod mermaid. No one should rely so heavily on a piece of equipment. That is like expecting a specialty bed to prevent pressure ulcers.
  5. 4
    I think that alarms should be a condition of staying at the facility, if indicated by the resident's condition. If the family wants to refuse, they should be told to kindly find their relative a new place to live, or provide 1:1 monitoring, themselves. We can't be everywhere at once, and if a client has dementia enough to be non-compliant with waiting for assistance at times, a wheelchair or bed alarm could have saved them from falling, because they go off when the person starts to TRY to get up, giving staff time to RUN down the hallway and go rescue them. I have had countless times in our facility when I was working in LTC/SNF that a little lady would be sitting at the table and decides to take off without her wheelchair, or her walker- sure, people should be watching, but you only have eyes on one side of your head, and the alarm alerts you to look and see what's going on. If a family wants to refuse an alarm, because they don't think it's necessary, they can do 1:1 with that patient, thanks, because we don't have the staff to 1:1 every single patient -and they aren't the ones there 24/7 to see that their elder gets disoriented at night, or is only half as alert and oriented whenever they aren't present.
    teeniebert, *4!#6, Sugar Magnolia, and 1 other like this.
  6. 7
    Quote from DanidelionRN
    I think that alarms should be a condition of staying at the facility, if indicated by the resident's condition. If the family wants to refuse, they should be told to kindly find their relative a new place to live, or provide 1:1 monitoring, themselves. We can't be everywhere at once, and if a client has dementia enough to be non-compliant with waiting for assistance at times, a wheelchair or bed alarm could have saved them from falling, because they go off when the person starts to TRY to get up, giving staff time to RUN down the hallway and go rescue them. I have had countless times in our facility when I was working in LTC/SNF that a little lady would be sitting at the table and decides to take off without her wheelchair, or her walker- sure, people should be watching, but you only have eyes on one side of your head, and the alarm alerts you to look and see what's going on. If a family wants to refuse an alarm, because they don't think it's necessary, they can do 1:1 with that patient, thanks, because we don't have the staff to 1:1 every single patient -and they aren't the ones there 24/7 to see that their elder gets disoriented at night, or is only half as alert and oriented whenever they aren't present.
    Thank YOU!! at least someone has some sense in this thread.
    *4!#6, caroladybelle, JRP1120, RN, and 4 others like this.
  7. 4
    Patients/poas refuse recommended treatment or interventions all the TIME. Maybe we disagree but it is their choice. i work in acute care and this happens ALL THE TIME. We educate and document . I do it everyshift. Not all of the pts are uninformed or not educated sometimes they simply make choices we wouldn't make. i HAVE SEEN FAMILIES and PATIENTS turn off thier own alarms and refuse them . Not the nurses fault at all. Just because there is a bad outcome do to a choice the pt/family made, doesn't now make it someone else's fault.
    Altra, wooh, psu_213, and 1 other like this.
  8. 0
    Also have been on the unit when pts fell WHILE THEIR BED ALARM RANG. thanks to lack of staff to answer it......... but i guess it was discovered faster. luckily no bad outcome.
  9. 3
    The difference is though, between patients refusing treatment or interventions... is that they have to be competent and alert/oriented to do so... and at times, that can mean choosing not to remain in a facility, if the things they want to refuse are significant enough. The same family members who refuse alarms, tend to be the ones who play pharmacist and doctor and want to dictate for the nurse exactly how to care for their family member, and having them around is not always worth the liability.
    wooh, anotherone, and NyteshiftLVN like this.
  10. 0
    If one were to assign fault--and this fall could have happened if the patient was alarmed or not, it would be the nurses who took care of this patient.
    The family doesn't have the authority to refuse or not refuse anything. Although you did not state if the patient was competent or in the care of a HCP, the HCP could have said "no alarm" IF the patient can't make decisions for themselves, however, I would have then said to HCP (or patient depending on the compentency circumstance) that unless someone was going to be at bedside continually to assure a call bell was used and the patient did not get up without assistance, facility policy is such that an alarm needs to be used for safety.
    There are floor mats, posey alarms, bed alarms--and depending on the risk to the patient, any and all of these sometimes need to be used, especially when no family was in the room. If the family was on "24 hour watch" with this patient, then I would document what the patient wanted, or HCP "Patient/HCP is refusing alarm for safety. MD order obtained that patient is to be alarmed only when family not at bedside" I would get an order (and perhaps the MD WANTS the patient alarmed at which point you state to the family that it is a doctor's order, and they can take it up with the MD) Bottom line is CYA and document accordingly. Falls can't always be prevented, alarms are not the be all and end all, but to protect yourself and your license, you need to follow your facility's protocol or get an order to veer from the policy.


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