Patient fx hip after family refused alarm - page 4

by Emilyinsc 14,319 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
    I agree. Having an alarm will not prevent someone from falling. Increased supervision, hourly rounding, toileting schedule, more pt education, maybe even a sitter if the situaton called for it could have prevented the fall. I think this is a failure for nursing staff. I think every nurse that had this pt had the ability to stop this from happening. If there was no alarm there should have been more interventions in place. I'm not criticizing because I don't know the situation...and many of us have been there...just my 2 cents. I'm so sorry that you had to go through this.
  2. 0
    Quote from Emilyinsc
    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.
    I am sorry that you were terminated. Especially if this happend long after you admitted him, or was even his care nurse. A POA usually doesn't have too much to do with much unless the patient is incompetent. And in your post, it was not the patient that refused, it was the daughter. Who should know better being an RN. Sometimes, if a patient such as this needs a 1:1 sitter. Needless to say, it is a policy in most facilities that alarms be used. If the patient refuses, back it up with an order.
    Again, sorry that this happend to you.
  3. 3
    As long as you documented everything you probably have a case for unfair dismissal.
    Altra, IowaKaren, and maelstrom143 like this.
  4. 0
    I dont see how you can be blamed, after I read the latest. I would have insisted and documented the refusal also. I'm not a nurse (yet). The NH should have rules to protect their employees. I think the NH failed both the patient and their employees.
    Last edit by Carlos1 on Oct 1, '12 : Reason: more information came to light
  5. 2
    Quote from liveyourlife747
    I think the nurse is to blame in my opinion. The nurse should've explained the safety issues and why an alarm was needed. Although alarms don't always prevent falls, it does help. Seems like the family was uneducated. I would've put the alarm on. They could be mad at me but I'm there for the pt and the Pts safety.
    Don't think for a second that a family or patient will automatically pick the most reasonable choice after the risks and benefits are explained.

    Scenerio clearly states that the family was offered the choice/refused and that this was documented. Doesn't take two seconds to say, "your father could fall and break a hip if he gets up without assistance."

    The nurse cannot stay in the room 24/7, that is not reasonable nor expected. She has other patients.

    Our facility will not remove an alarm from a patient unless the family agrees to stay with the patient at ALL times, therefore, assuming responsibility. They sign a paper stating such.
    wooh and anotherone like this.
  6. 2
    Quote from sunnyskies9
    I would have put a bed alarm on anyway. Safety trumps pretty much everything. We are required to place an alarm on fall risk patients. I honestly don't understand why a family would refuse a bed alarm on their family member. Makes no sense to me. Was the pt A&O?
    Some states, such as mine, a bed alarm is treated very similar to a restraint. You have to have a doctor's order unless it's emergent and then orders have to be re-signed with necessity documented.

    A nurse can make the decision short-term (as in hours) but long term (over 24 hours), if the family refuses, she cannot go ahead and do it anyway any more than she can force anything else on the patient.
    Syrenia and anotherone like this.
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    Quote from Jory
    Some states, such as mine, a bed alarm is treated very similar to a restraint. You have to have a doctor's order unless it's emergent and then orders have to be re-signed with necessity documented.

    A nurse can make the decision short-term (as in hours) but long term (over 24 hours), if the family refuses, she cannot go ahead and do it anyway any more than she can force anything else on the patient.
    Nurses who have never worked in LTC simply can't understand the rules and regulations that control what the facility and nurses choose to do. LTC restraint policies might sound unreasonable to a nurse in a hospital. I know I was outraged the first time I heard that confused LTC residents have the right to fall.
    Syrenia, IowaKaren, wooh, and 2 others like this.
  8. 1
    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.
    Nicely stated. I totally agree with you and would have acted similarly.
    jadelpn likes this.
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    It depends on the facility's policies and the patient himself/the family. I did not know that some facilities require bed alarms. In my unit, there are no bed alarms at all! Literally, they do not even exist.

    However, it seems like bed alarms are not mandatory in OP's workplace, so let's assume that. Any patient, if they are competent, can accept or refuse any treatment or intervention. If the patient is not competent, then their POA can accept or refuse any treatment or intervention. If this man, the patient, was alert and oriented, did he refuse the alarm? What was his opinion of it? If he was not competent, however, why did the family/POA not want the alarm?

    If I were the admitting nurse, I'd ask the patient/family why they did not want the alarm. I'd explain the risks of not having the alarm on, as well as the rationale for using it in the first place. However, if they insist on refusing the alarm, then I'd document something along the lines of, "Patient/family refusing alarm. Nurse explained rationale of alarm and risks of not having alarm on. Patient/family continues to refuse despite education, therefore alarm left off." That way, if they ever take you to court, you have your documentation to back up the fact that you provided the necessary education to help the patient/family make an informed decision, but despite your advice, they continued to refuse the alarm. I'd also document what other precautions were put into place to prevent falls from happening, such as routine checks, side rails, etc. Bed alarms, after all, are not the only precautions you can put into place - like I said, my hospital unit has no bed alarms at all!
    IowaKaren likes this.
  10. 0
    Quote from Emilyinsc
    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.
    So sorry you were terminated. That's ridiculous. Blaming the nurse for everything. Glad i work in hospice.


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