Patient fx hip after family refused alarm

Nurses Safety

Published

  1. Whose at fault?

    • 9
      the admission nurse
    • 27
      the nurse on duty night of fall
    • 14
      the nursing home
    • 112
      no one since the family refused

162 members have participated

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 since she didn't place the alarm on wed (but remember the family refused). Who is responsible? the admission nurse who wasn't present on the night of the fall? the nurse on duty? or the NH? or no one since the family since refused the alarm & it was documented.

LET ME KNOW.

Specializes in LTC Rehab Med/Surg.
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.

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.

Specializes in Oncology, Medical.

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!

Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
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.

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.

Uh, that isn't a "I work in a hospital and think that is an unreasonable" thing.

In my state, it's treated very similar to a restraint.

Just because someone is in a LTC facility doesn't mean they lose all their legal rights to choose their care, assuming they are mentally competent. I have seen stroke victims that couldn't pronounce their names or brush their teeth but their mind is 100% intact and they understand everything that you are saying.

It's a case by case basis.

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.

Just because they terminated you doesn't mean it was a just termination.

So what if you checked on him, that doesn't stop him from falling two seconds after you walk out of the room.

Specializes in Critical Care.

I'm sure the family and the nursing home will blame the nurses involved!

I think the nursing home terminated you so fast because they are scared and hoping swift action will keep a lawsuit at bay.

Specializes in PCU.

We are there to protect the patient. However, with that being said, we cannot/should not force care upon a patient if it has been refused, as this can be seen as unethical and a breach of the patient rights. We can refuse to admit the patient or we can chart/chart/chart. If my patient's family refuses a safety device, I will take it to the charge/supervisor and have them follow up. Once they have followed up, if still refusing, then I chart the refusal, my actions, the follow up results and ensure I chart each and every single time the patient attempts to get up without assistance and/or has any action that could lead to a fall. I continue to reinforce safety, letting family know each and every time patient has stumbled, tripped, become unsteady, and the repercussions should a fall ensue (ie fractures, intracranial bleeds, increased mortality, etc.).

We are there to protect the patient. But, we are not baby sitters nor are we legally allowed to force care where it has been refused.

My patient fall (first one in over 4 years) occured due to the PAs from the doctor refusing to allow restraints or a sitter9 (bed alarm ineffective as he was able to remove it), despite the fact the patient had several near misses (4 within 30 minutes). They refused my request on the phone, were nasty to me, then refused my request in person. I charted each and every time he almost fell, tripped, and wobbled backward almost hitting his head in the bathroom as I &/or my staff attempted to keep him safe. at 0728h, the PA went in, talked to him, warned him, then told him to "be a good boy." At 0733h, he had an assisted fall. At 0735h, I went to the PA who was still working on his chart, informed her of his assisted fall and the incident report I was filing. "Oh, please get him a sitter." Needless to say, I feel that I went above and beyond to keep him safe, as did the rest of the staff. We do the best we can within the legal limits of the law.

OP, so this other nurse that was working at the time this happened got terminate too, right? To be honest, I am not sure how that is completely your fault, if it is at all. Yes, you were the admitting nurse who documented refusal, but an alarm can be placed at any time. Not only at admittance.

When I worked at the hospital, the policy was that the patient was assessedfor fall risk and then, if they needed an alarm, they got one. If they didn't want it or refused it, they signed something saying they refused and the hospital was not responsible and it was documented in the admission charting. They were educated about possible risks, etc. but it was ultimately up to the patient (if alert and oriented and able to make their own decisions) or up to POA. I am not sure how if the family/patient refused (esp. with him being A and O x 3) that that is your fault.

It makes all this documenting and paperwork and legality useless/pointless/have no validity if it is not upheld. Why go through all this stuff if the patient/patient's family can threaten a lawsuit when they were the ones who refused?

There are probably other things that could have been done such as low boy bed, posey hip protector, mats for side of the bed. I don't think moving patient closer to nursing station would work because it is a nursing home unless you have open beds (I could be wrong); do nursing homes have sitters? But overall, I am shocked that you could be terminated for that since the patient/family refused.

Specializes in PCU.
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.

That is just not right, esp if he was unchecked on for an undetermined amount of time :/

Specializes in ortho, hospice volunteer, psych,.

As an RN who has become disabled due to having a severe stroke caused by an aneurysm, I have very

strong feelings about the use of alarms.

I have been cleared as being "safe" to walk outside using either a hemi-walker or a cane, depending

upon the weather, and to walk unaided around our large house. I'll be the very first to admit that I

walk strangely, but that doesn't automatically make me unsafe. Good luck with that one!

I REFUSE to have someone here when my husband is working or out, I refuse to wear a LifeAlert,

I will NOT sleep in a hospital bed with a bed alarm and the side rails UP. Guess what? My neuro and

PT agree with all of the above.

I am alert and oriented x3 and, while I do have both medical POA and AIF in place, right now I am

perfectly legally competent. Down the road, when I'm no longer this tightly wrapped, new rules.

That's why I named cousin __ as my medical POA. Don't let just reading my medical hx alone determine

how you treat me. Get to know me and realize that although I may "talk funny" now, I most assuredly

am NOT senile and may still make my own medical decisions, for now.

The point of this rant is that everyone who has a medical problem or is old, is automatically a candidate

for whatever.

+ Add a Comment