Patient fx hip after family refused alarm - page 6

by Emilyinsc 14,323 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


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    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...
  2. 1
    Quote from malestunurse
    As long as you documented everything you probably have a case for unfair dismissal.

    ?? In what country?
    anotherone likes this.
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    Quote from Sun0408
    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.
    Last edit by psu_213 on Oct 4, '12
    maelstrom143 likes this.
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    Quote from jennyrn2012
    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.
  5. 1
    Quote from artsmom
    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.
    wooh likes this.
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    Quote from sharpeimom
    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.
  7. 1
    Quote from psu_213
    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.
    anotherone likes this.
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    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.
  9. 5
    Quote from 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...
    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?
    Orange Tree, anotherone, psu_213, and 2 others like this.
  10. 0
    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.


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