Patient fx hip after family refused alarm - page 6

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  sharpeimom profile page
    1
    That would be just great... if I had the manual dexterity and coordination to turn it off myself or
    undress myself -- which I don't. Now what?
    wooh likes this.
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  3. Visit  enchantmentdis profile page
    2
    Unfortunately, because lawyers enjoy making a good living just like the rest of us, the family cannot be blamed. Sorry, but true.The lawyer won't sue the family for the patient falling. Heck, they wouldn't be suing anyone if the family didn't bring it to the lawyer's attention. The lawyer also won't sue the family on behalf of the nurse for not listening to her and supposedly causing the fall. The nurse taking care of the patient when the injury occured, and the nursing home for having such a negligent nurse on their staff are named the responsible parties. Do i agree that this should be the case? Nope. But under our laws, the nursing home is the respondeat superior, which means they are responsible for how the folks they hire treat patients. Though i feel rotten for any nurse who goes through this, it seems like the legal system is only on the side of the patient, even if the families are numbskulls. The patients have the BON but nurses have no one, unless they are willing to shell out bags full of cash to lawyers.
    Last edit by enchantmentdis on Oct 6, '12 : Reason: ?
    jrwest and redhead_NURSE98! like this.
  4. Visit  enchantmentdis profile page
    0
    I noticed some nurses replied by saying "alarms don't prevent falls". Only problem with that is if a nurse was in a civil suit wherein that facility routinely used alarms. If the nurse said no alarm was in place for maybe 15 mins, etc...she'd lose her case. The lawyer could ask "well, if alarms don't work why use them? An expert witness could say the facility still uses them and some falls have been prevented because of them. The lawyer would also know from the outset if the facility insists on, namely has a policy in place that all high fall risk patients be alarmed. He would also question the definition of "high fall risk."

    Often the high fall risk patient is on narcotics, anti-insomniacs, anxiolytics, anti-psychotics, and a veritable cornocopia of other meds; which may cause confusion, clumsiness, and/or poor judgment. Some folks are confused and uncoordinated with no meds. Some folks are uncoordinated, yet not confused. Sorely, scores of folks have been plagued by poor judgment irregardless of what meds they consume. Some are nearly irreversibly ignorant or worse yet, dumb-nut stubborn.

    Sounds like the patient and his family were ignorant and stubborn, needed tons of teaching, to the point of patronization. Hey, if it means a nurse's job or license will be spared, teach, teach, teach. Blah, blah.

    Some say the admit nurse is responsible. Only if the facility patently states it is in their protocol that all high fall risk patients will have an alarm. If she allowed the family to talk her out of the alarm, just once, then the admit nurse is culpable. The lawyer would most likely go after the admit nurse, nurse caring for the patient, and the nursing home to maximize his chances of a good settlement.

    What nursing home would turn away an a and o x4 patient who doesn't want an alarm? Oops, their mistake.

    Follow the policy in your facility, whether you believe alarms work or don't; continue to teach the family and patient; document as if a lawyer is salivating while reading the chart looking for errors; go up the chain of command to get the job done, and do more frequent checks on the patient, and document each time you check or approach a superior about the issue. Delegate other staff to check the patient while you take a break and document that too. Ever notice how the CNAs don't get sued?
  5. Visit  enchantmentdis profile page
    0
    Quote from redhead_NURSE98!
    Why would I laugh at someone knocking at your door? I knock on every patient's door before I go in the room. Almost all doors are closed because there are no privacy curtains anymore.

    I still don't get how placing a bed alarm affects your dignity, but I do see where you're coming from on people being treated like they're not all there just because they walk or talk a certain way. Like the comedian Josh Blue, talking about how people come up to him and talk really slow and say "Heyyyy, budddyyyyyy" because he has CP and has a contracted hand and an altered gait.

    Hah. Lo blanking L!!
  6. Visit  psu_213 profile page
    2
    It's a bigger issue than if alarms prevent falls or not. It is about the basic ethical principle of autonomy. There is no way that autonomy can be taken away in the name of prevention of falls or because the alarm is facility policy. What role alarms play in the prevention of falls is a side matter that takes away from the bigger issue here.
    wooh and sharpeimom like this.
  7. Visit  jrwest profile page
    0
    why is this so complicated? It's very simple- if you want to keep your job, you follow the rules, albeit very stupid unproven rules. I hate the idea, but it's the rules, and im not about to lose my job because someone doesnt want the bed alarm. If you are aox3- then feel free to sign out. I didnt make the rules- the idiot hospital admiistration did. I think I will tell my pts to take it up with them,but untill then, on it goes.I need my paycheck , and a rule is a rule.
  8. Visit  psu_213 profile page
    0
    Quote from jrwest
    why is this so complicated? It's very simple- if you want to keep your job, you follow the rules, albeit very stupid unproven rules. I hate the idea, but it's the rules, and im not about to lose my job because someone doesnt want the bed alarm. If you are aox3- then feel free to sign out. I didnt make the rules- the idiot hospital admiistration did. I think I will tell my pts to take it up with them,but untill then, on it goes.I need my paycheck , and a rule is a rule.
    You blood pressure is 250/138 and you are refusing your BP medicine? Our standards say that we have to treat that. Feel free to sign out (while you still are A&Ox3).
  9. Visit  jrwest profile page
    0
    yes- and I've had that happen before.
    Ive been told by the patient's they can refuse. It's my job to educate, but if they refuse that, what are we to do? get a psych eval?
    Makes me wonder why anyone comes in to the hospital.Maybe they wanted the free meal.
    oops , sorry to derail original topic.
    Last edit by jrwest on Oct 7, '12 : Reason: forgot something.
  10. Visit  redhead_NURSE98! profile page
    2
    Quote from psu_213
    You blood pressure is 250/138 and you are refusing your BP medicine? Our standards say that we have to treat that. Feel free to sign out (while you still are A&Ox3).
    Oh my God! I'd just go ahead and call a stroke alert.
    anotherone and enchantmentdis like this.
  11. Visit  sharpeimom profile page
    0
    Quote from redhead_NURSE98!
    Oh my God! I'd just go ahead and call a stroke alert.
    May you never ever ever have the very rare type of stroke that I've had FOUR of and not have the conditions of your living will and DNR document respected. I've been there before. If I would choose to have all treatment measures but comfort measures withdrawn or withheld and I'm legally competent, heads will roll. Legally, if I sign a form absolving you of any and all responsibility in the event of such an event, (did I sound just a bit like one of my parents or other relatives?!)you're off the hook legally.

    Back to bed and chair alarms before the thread is totally derailed.
  12. Visit  redhead_NURSE98! profile page
    2
    Quote from sharpeimom
    May you never ever ever have the very rare type of stroke that I've had FOUR of and not have the conditions of your living will and DNR document respected. I've been there before. If I would choose to have all treatment measures but comfort measures withdrawn or withheld and I'm legally competent, heads will roll. Legally, if I sign a form absolving you of any and all responsibility in the event of such an event, (did I sound just a bit like one of my parents or other relatives?!)you're off the hook legally.

    Back to bed and chair alarms before the thread is totally derailed.
    .....this was more of a joke about blood pressure. Honestly I thought I was in the "things you'd like to say to a patient but can't thread" when I replied.
    anotherone and enchantmentdis like this.
  13. Visit  tyvin profile page
    0
    Why did the patient have a POA if they were so rightfully A&0x3?. Bed alarms may not prevent falls but if you get there quickly it can. Also you are then alerted and the patient doesn't stay on the floor too long (any amount of time is too long). I would have put the alarm on anyway. If he threw a big fit about it I would've called the doc. Then if that didn't work I would wait until he fell asleep and then put it on. Are they going to sue you for following safety protocol? It sounds like the family had the problem. What kind of bed alarm was it? I think if places are going to honor requests such as not putting an alarm on a person whose score off of whatever tool they use to assess fall risks clearly indicates they are a fall risk. Have them sign a contract as suggested previously absolving responsibility (would that hold up in court?).

    Sorry you were fired. That means they might sue. Does the facility have a p/p that says the bed alarms are mandatory if patient is assessed as a fall risk? Why didn't anyone call the doc? I don't mean to beat a dead horse but the information could be valuable for others reading this.
    Last edit by tyvin on Oct 7, '12 : Reason: editing
  14. Visit  Altra profile page
    1
    It sounds to me like the LTC had a policy that bed alarms were to be used if resident met xyz criteria ... but no back up plan if alarms were refused.

    So they feel like they have no choice but to fire the nurse who allowed a circumstance to exist that the LTC has no policy to deal with.

    I think the OP might possibly have a case for wrongful termination.

    The lesson I would take from this is ... if you're in a situation that goes outside of your facility's policies ... in addition to documenting it in the patient/resident's record ... you need to make sure that you have documentation that you notified the rest of the appopriate chain of command via email, etc.
    wooh likes this.


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