Patient fx hip after family refused alarm - page 2

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... Read More

  1. Visit  nurse1952fun profile page
    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.
  2. Visit  DanidelionRN profile page
    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.
  3. Visit  sunnyskies9 profile page
    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.
  4. Visit  anotherone profile page
    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.
  5. Visit  anotherone profile page
    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.
  6. Visit  DanidelionRN profile page
    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.
  7. Visit  jadelpn profile page
    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.
  8. Visit  alika profile page
    3
    This happens often. "Mom doesn't need an alarm". As long as each nurse is documenting that mom is non-compliant with wearing Person alarm, staff is not responsible when mom falls and breaks her hip. Yes of course family will blame you, but as long as each shift is documenting they can't do anything. No personal alarm, sensor pad, or self- release lap belt is gonna keep a resident from falling if they are determined to get up and walk.
    anotherone, imintrouble, and merlee like this.
  9. Visit  Emilyinsc profile page
    1
    Well thank u for your responses. The patient was a&ox3. His daughter who was his poa happened to be an RN. He fell broke his hip and nose & went unchecked for a undetermined amt of time. The fall happened on night shift.
    I was the admitting nurse, and I documented the refusal. I wasn't the night nurse (the one he fell on).
    He fell 48 hrs after I had him. However, the NH did not see eye to eye with me.
    If we check our patients properly, there shouldn't be a need for alarms. An alarm doesn't stop someone from falling.
    It isn't a fix all. A patient has the RIGHT to refuse! Every one keeps forgetting that.
    I can't put into words how bad I feel for that patient right now.
    Doesn't matter anymore, I was terminated today. All I can do is the best I can. Sometimes we fall short, sometimes we f&*^% up, but we gotta keep trying and move on.
    anotherone likes this.
  10. Visit  jrwest profile page
    1
    where i work- we have the alarms on. too bad if the pt doesnt like it. or the family. I explain it's policy. we actually have a bed alarm person who audits us daily. I will continue to play the stupid corporate game if thats what they want, as i have no other skills for any other job. Of course, the poilicy is stupid- yay, the bed alarmm is going off- do you think we have the staff to do anything about it??? Hooray- i was notified that the pt is oob and has fallen by the time i got there. Of course this doesnt prevent falls. But I continue to play the game :-(
    anotherone likes this.
  11. Visit  alika profile page
    2
    Oh Yea and Also..I don't even know how many times I've had a family member tell me "They have the right to Fall!" My response is OK. Well I really hope that isn't the outcome>>>
    redhead_NURSE98! and anotherone like this.
  12. Visit  artsmom profile page
    1
    You were terminated over a fall? Even a bad fall shouldn't be cause for termination. I had someone fall yesterday- her head broke her fall. It happens. Alarms, documentation, and education are nothing against someone's will (or dementia). Being terminated is a bit harsh, unless there were more incidents before this one?
    wooh likes this.
  13. Visit  jrwest profile page
    1
    Don't forget - the hospitals are getting sued for this- and they also are not getting paid because of medicare for hospital acquired incidences . Of course the nurse is the scapegoat in this. Of course they are going to can someone over this.
    I have compropmised care of other pts when ive had pts who , despite having a bed alarm on ,insist on getting up and setting it off every 2 minutes.I take my chair and sit my butt where the pt is in direct view and tell them to sit down. Repeatedly.
    I know in this day and age of nursing , I will lose my job over things out of my control, and its just a matter of when.
    anotherone likes this.

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