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]

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.

[redhead_NURSE98!, ADN, BSN]

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.

[sharpeimom]

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 If I would choose to have all treatment measures but comfort measures withdrawn or withheld and I'm legally competent, heads will roll.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.

[redhead_NURSE98!, ADN, BSN]

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 If I would choose to have all treatment measures but comfort measures withdrawn or withheld and I'm legally competent, heads will roll.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.

[tyvin, BSN, RN]

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.

[Altra, BSN, RN]

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.

[nelcoy4]

At my hospital they have a form for the pt or POA to sign that is very detailed for alarm refusal. Also in the alarm refusal form it goes in depth about forfeiting rights to sue in a result of a fall (something like that, the form is very long and in small print). If I was a patient and saw that form I would say never mind turn the alarm on. Lol! After they sign the form we still have to document every shift about the alarm refusal on our fall flow sheets.

Also the nurses and MD can import a video about it on patient's tvs. They can not watch whatever they want to watch on tv until this video is played. Once they watch the video, it is noted on the chart electronically that they watched the video.

Kind of off topic, but there was a pt at my hospital that fell and he did not sue the hospital, but he sued the nurse only because she forgot to turn the bed alarm on. That scared me. I just follow the policies and teach the patients/families why they are in place. I make sure forms are signed and my documentation is detailed.

[slidster]

I hate that. Right to fall? Ok. Enjoy your right to bust a hip!!! GRRRR

[martymoose, BSN, RN]

^ yep, as we get to enjoy their right to sue us

[Maremma]

Well geeze! In our facility they have removed all bed and chair alarms. We are not allowed to have them! How do you like that? They said there are complaints (not sure from who, state maybe?) that they are being used as "babysitters" to negate our responsibility to keep them from falling!

Yes then on top of that they decided to cut our staffing even further so we cannot have a staff member watching all our fall risks in an activity room while we scramble to do even more work from the staff cuts they said we no longer needed. It has definitely been a nightmare for us. These people are demanding to be put in bed but we can't put them there because they then try to get up by themselves and wind up on the floor. Our halls are lined up with all the "fall risk patients" 24-7.

We are flirting with disaster. Pressure sores on all these people are going to be piling up around us. Pretty hard to change their positions at least every two hours when they are stuck in chairs all the time. Of course any legitimate concern that could in any way cost this multi billion dollar corp money is just ignored and brushed under the carpet.

My facility made us believe the removal of the alarms was a universal thing that some government entity was forcing on us. EVERYONE had to remove them. I should have known better! It must REALLY be the cost of the alarms and replacement of batteries etc why we can't have them anymore.

[Emilyinsc]

Hello all, I have been out of work for 1 month since this incident. Apparently, alot has been happening on nightshift at the LTC/nursing home.

Apparently the night after this guy broke his hip, they had two more falls, one requiring tx in the ED.

the a day and 1/2 after that a woman on the same hall broke her femur from a fall.

and most recently, someone fell (on the same hall/nightshift) and broke their pelvis.

So in summary, all these falls are happening on night shift, bed alarm or not, and sustaining fx's.

Maybe it was a blessing in disguise that I got fired. Now they'll have to find another scapegoat!

[Nismo]

I am figuring that the patient was confused and unable to make own choices. Family refused - alarm is a treatment. But is interupting with patient safety. You CAN put the alarm on even though the family refuses. Who is responsible, the hospital and the nurse. There is no reprecussions on the family. Any time the family is obstructing patient safety, I am sorry but I ask them to leave if they continue putting the patient in harms way. Its your as* and the patients health on the line.