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.

[sharpeimom]

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.

HOW it would affect me is very very simple, but not easily understood by the nondisabled population, including many nurses. People -- including nurses --

sometimes tend to treat everyone with certain diagnoses, such as CVA, as though

we are senile. Some of us have offbeat conditions, despite the ages we happen to

be. It affects me BECAUSE I DEMAND to be treated with basic respect and dignity

at all times and I am fully aware that there are a great number of nurses and aides

who will look at my broken body, hear my distorted speech, and immediately decide

that I must be demented, senile, and that I must therefore, lack orientation x3.

If the cousin who has medical POA thinks I need a bed/chair alarm, then on it goes.

If my husband (if he's still alive) thinks I need one and I am not in any condition to make a legally competent decision, then on it goes.

If I were forced to live in a nursing home, it would be just that: my HOME, and the

door to my room would remain closed and people would be asked to knock before entering. It is, afterall, my residence. I can imagine you doubled up laughing. Laugh away! The plan also includes private one-on-ones, which is doable financially.

[redhead_NURSE98!, ADN, BSN]

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.

[wooh, BSN, RN]

If you're A&O before you get a bed alarm, it will take only about an hour after the bed alarm before you're no longer A&O. That loud alarm every single time you adjust your position? I'd prefer a broken hip to living with the alarm.

[sharpeimom]

Some understand and some don't, just as while you state you would knock first, almost no

one does. In fact, I was told when I was in stroke rehab, and talking to my husband and our

attorney, that I had NO LEGAL RIGHT to close the door. Wanna bet?? and

[redhead_NURSE98!, ADN, BSN]

Well that brings up a good point. If I was AOX4 and they put a bed alarm on me I'd just reach over and shut if off, LMAO

Uh not shut the door? I don't THINK so. Anyone who put that on me would find me naked in the bed when they walked by my room and they'd wish they had let me close the door! We do try to leave the door open on safety risk patients, but if they insisted on closing the door there's really nothing I can do about it.

[sharpeimom]

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?

[enchantmentdis, BSN, RN]

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.

[enchantmentdis, BSN, RN]

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?

[enchantmentdis, BSN, RN]

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!!

[psu_213, BSN, RN]

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.

[martymoose, BSN, RN]

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.

[psu_213, BSN, RN]

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).