Patient fx hip after family refused alarm

[Emilyinsc]

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.

[martymoose, BSN, RN]

I re-iterate- Im sure this alarm BS is in place because of the lawsuits that have happened after falls, and the fact that , since the medicare wont pay for these complications- the hospitals want to recover their expenses. It's too bad that the aox3 seems to suddenly have no rights now as to refuse the alarms. I'm so tired of facilities talking out both sides of their mouth.Customer satisfaction, bla bla, but then its ok to totally upset the customer by forcing them to do this alrm crap, or having to force their room mate to have alarms, and keep them up all night.

This is another "beat the dead horse" battle that will never be won.

I think medicare is evil and corrupt.

[HeartsOpenWide, RN]

The family should have been informed that the alarm is a hospital policy and why (reason for the need) if the family still refused, an AMA form should have been signed to CYA...why did the family refuse?

[maelstrom143]

I understand that we need to keep our patients safe. However, this discussion really makes me wonder at what point a patient who is alert and oriented and his family members are made to take responsibility for themselves. I mean, really, I like my patients, but at the same time, they are grown ups and if alert and oriented and refusing care, as long as documented, I have covered my bases. A confused patient is a different story, but when talking about someone who is not confused, why precisely are we expected to babysit and blame ourselves when he /she decides to go against the safety protocols in place?

This is why we have so many frivolous lawsuits. It is everyone else's fault, never our own, no matter how misguided we may be...

[redhead_NURSE98!, ADN, BSN]

As long as you documented everything you probably have a case for unfair dismissal.

?? In what country?

[psu_213, BSN, RN]

While that is true; the flip side is the family will sue for grandpa's injuries and claim negligence

I totally disagree. If the pt is A&Ox3, you chart that they are A&Ox3 and that they refused the alarm. You chart that you educated them on the risks of not having the alarm/that the are a fall risk. You implement interventions to prevent falls/injuries and chart this...then they don't have much of a leg to stand on (no pun intended) to sue you or the facility. Their right to refuse tx trumps you desire to promote safety. Period.

[psu_213, BSN, RN]

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.

What?? I'm sorry, if I am A&Ox3 and refuse alarms, that is my choice. Respecting that wish and not putting an alarm on does not make a facility negligent.

Even my BP runs 180/104 regularly I have the right to refuse any BP medication if I so choose. By your logic, the facility is negligent if they don't force the pills on me.

[redhead_NURSE98!, ADN, BSN]

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

That is totally ignorant on the part of the NH if that was the case. It does absolutely nothing to keep someone from filing a lawsuit, unless something was signed to that effect. People who are going to sue are going to sue.

[redhead_NURSE98!, ADN, BSN]

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.

Well good, someone's here with personal experience to explain why you would refuse a bed alarm, specifically? I'm really not understanding how this affects you. If you get up why would it matter if staff came into your room when the alarm went off? All the better, I would think.

[redhead_NURSE98!, ADN, BSN]

I totally disagree. If the pt is A&Ox3, you chart that they are A&Ox3 and that they refused the alarm. You chart that you educated them on the risks of not having the alarm/that the are a fall risk. You implement interventions to prevent falls/injuries and chart this...then they don't have much of a leg to stand on (no pun intended) to sue you or the facility. Their right to refuse tx trumps you desire to promote safety. Period.

And they will sue and make the NH's life hell anyway, win or lose. Anyone can sue anyone for anything, and most courts will allow it to go right on down the road to a certain point and allow all kinds of costs to be expended for no reason. Plaintiffs' lawyers bank on it! They sue and press a company to settle and pay all kinds of money to the plaintiff and to them for very little reason. That is why we should have the "loser pays costs" rule. It would allow companies to fight all the way to trial without as much risk.

[MAISY, RN-ER, BSN, RN]

Since we really didn't have a lot of information-I will blame the nursing home.

The admission nurse documented family informed consent and refusal.

An automatic trigger should go off under these circumstances in which the nursing home must has a back up plan that involves: Case management, social worker, PT/OT and administration.

It's sad the patient fell, it's sadder it was due to the family's poor decision making, but saddest yet is that the facility did not respond enmasse to a safety refusal.

Mary

PS They probably blamed the nurse.

[wooh, BSN, RN]

I understand that we need to keep our patients safe. However, this discussion really makes me wonder at what point a patient who is alert and oriented and his family members are made to take responsibility for themselves. I mean, really, I like my patients, but at the same time, they are grown ups and if alert and oriented and refusing care, as long as documented, I have covered my bases. A confused patient is a different story, but when talking about someone who is not confused, why precisely are we expected to babysit and blame ourselves when he /she decides to go against the safety protocols in place?

This is why we have so many frivolous lawsuits. It is everyone else's fault, never our own, no matter how misguided we may be...

I'm also not understanding why every single thing slightly negative has to be blamed on someone. I have fallen down my own home's front steps THREE times, on my front walk twice, in the street in front of my house once. No blame to be placed. I pull a similar stunt in the hospital, and blame gets placed on which nurse who wasn't in the room with me?

[IowaKaren]

A shared negotiated risk form should have been signed by the family if this Resident was deemed a fall risk and the family refused to have alarms applied after the fall assessment was completed (per facility policy if they had that policy). Unfortunate that the fall happened so soon after just being admitted. Documentation is imperative though. Unfortunately at noc, staffing is at a bare minimum usually and depending on the duties given the night staff (laundry, cleaning that should be housekeeping's job, etc. and whatever else that is put on the night staff since 'someone has to do it and they all sleep at night' ) and the alarm at least would give a person half a chance to go running down the hallway and maybe (maybe) avoid a fall and or at least will be found sooner than later. It seems there is a no win situation in some cases and the threat of a lawsuit is enough to make one wonder if working in a LTC is really worth it or not. Growing old is not for the faint of heart and working in LTC is not for the faint of heart also. Good intentions or not, liability is still liability. Where I work, the bed would be sitting almost on the floor with mattresses placed next to it so if they tried to get up,... This of course, would be care planned immediately.