Patient fx hip after family refused alarm

Nurses Safety

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  1. Whose at fault?

    • the admission nurse
    • the nurse on duty night of fall
    • the nursing home
    • no one since the family refused

162 members have participated

sharpeimom

2,452 Posts

Specializes in ortho, hospice volunteer, psych,.
Why did the patient have a POA if they were so rightfully A&0x3?.QUOTE]

Because you need to get a POA when you're still A&Ox3 because once the great decline begins, you're aren't considered competent enough to give the consent

required to set one up. There are different kinds of POAs, including various medical POAs.

Short OT here... There is also something called an AIF or Attorney In Fact which is largely archaic today, but can be very useful under certain circumstances. My husband and cousin have joint medical POA for me and my husband has an AIF for me. It allows him to sign documents for me by signing: my name/his name/AIF.

Penmanship is nearly impossible for me now. I can sometimes manage a single signature, but no more. The AIF does not give him the same broad legal rights he would have with even a limited POA. Not because I don't trust him implicitly, because I do, but rather because I can still make financial decisions for myself.

What able bodied persons need to remember is that those of us who are impaired physically (and occasionally cognitively) are still pretty much who we always were

before and need to be treated as such. If I become mentally incapable of understanding the inherent risk to being unalarmed (I just made that a word!:eek::cheeky:)

then, new rules go ino effect.

J.R.theR.N2b

45 Posts

how restraining is a bed alarm? i consider myself to be the pickiest, anxious, most restless patient a poor nurse could ever have to endure. i am very severely claustrophobic and, as a result, am unable to tolerate restraint of any type. i cannot even lie still and toss and turn continually all night during sleep. i have been evaluated by professionals both for sleep apnea and for claustrophobia. the sleep test was continually interrupted by the therapist entering the room, imploring me to please keep the oxygen mask on, and was finally terminated because i was unable to comply. i was under the care of a psychologist while being treated for my claustrophobia, and he recommended a therapy he termed as "flooding", which came to an abrupt end, after i suffered such terrible anxiety attacks that even scared the psychologist, who stated he had never encountered claustrophobia as severe as mine. this is why i asked my original question. on research done on the internet it appears that all a bed alarm does is to sound an alarm alerting staff that patient is rising up in bed. if the patient is not restrained in any way, i fail to see why he nor his family would object.

maelstrom143

398 Posts

Specializes in PCU.

there should be a legal document to sign where if the patient and/or family responsible refuse safety protocols they relinquish their rights to sue if the patient should fall &/or injure himself/herself due to their choices. It is called taking responsibility for your actions and decisions. Used to be a very popular concept in the old days...jmho. Seems like our society prefers to blame everyone else except the ones really at fault for catastrophic failure.

sharpeimom

2,452 Posts

Specializes in ortho, hospice volunteer, psych,.

I wish there were such a document for those of us to sign. I would willingly sign one and I'm equally sure that my mom's 93 year-old twin sister would sign one too. My mother was also very independent and as long as she remained in control of her care until her last

week.

Some of us are reared to be most independent women (people) and giving up ANY control is almost impossible. I think if the subject of safety matters were broached with the patient's dignity in mind, we might be more receptive -- maybe. Good luck to the poor unfortunate who approaches any of my older relatives (especially the female ones) who are still competent despite their advancing years and frail bodies, and treats them as turnips or as though they were already senile.

That's MY family.

My husband's family tends to regard women as lesser citizens simply because they happen to have been born female. :banghead: The elderly men are treated with the same respect as always.:banghead: My poor mother-in-law, a bright and delightful woman, was treated as though she didn't have two brain cells close enough t make contact.:cry: I hope that will change as the generations change.

His family.

To sum up: I feel strongly that the wishes of the elderly (if A&O and understand the possible consequences of a fall) should be carried out and the member holding the MPOA required to sign a release of negligence and responsibility form, so they understand that they may not sue should an adverse event happen. If the patient is confused or even borderline confused, the above would not be in place.

J.R.theR.N2b

45 Posts

i am also from the old school and believing in assuming resposibilities for my actions. it is easy to determine from my post there are specific things i cannot tolerate, with any type of restraint heading the list, and i expect any and all medical staff to accept and honor my request. but, at the same time, i cannot and will not hold staff responsible for whatever bad outcome may result from these choices.

Poochiewoochie

178 Posts

Since my Mother recently passed away from complications from a hip fracture that happened at the nursing home she was in I have to say something about this.

When she was admitted almost 3 years ago she was identified as a high fall risk and even though she was able to walk they put an alarm on her chair. When she moved or got up the alarm went off and the people at the nursing all but made her stay in her seat when she was awake. All that did was make my Mom mad so my Dad eventually told them to remove it. That was when the falls started and eventually she fell and broke her hip in December and a month later she fell again and broke her femur. That time she was alarmed. She passed away 2 weeks ago and according to the coroner it was due to complications from the hip fracture.

Seeing as she was alarmed when she fell the second time I don't believe one would have helped the previous times. All alarms do is make it easier for the NH personal. I've seen them "force" residents to stay seated which IMO is a form of imprisonment which is illegal.

Oh, and for the record, the NH did a great job with taking care of my Mom. In my heart I know they gave us extra years with her because the way she was going before we placed her she would have been dead in a short time. She was controlling and refused basic care from me-she needed to be in a controlled environment and for the most part the nurses in the NH were wonderful with her.

drowningdaily

106 Posts

Patients do and should have the right to fall. Patients can refuse ANY treatment. They still have the right to care and to stay in a facility. To force someone to leave AMA for refusal, as someone suggested, is beyond idiotic. We as nurses advocate for our patients. We need to explain to them why we use alarms and encourage compliance. But we need to respect their choices.

And for those on this thread unfamiliar with bed alarms, they frequently get triggered with every little movement and keep people up all night.

It really sucks that OP got fired for no reason. Only thing at fault in this case is gravity.

Specializes in PCCN.

Sure , people have the right to fall, but that doesnt absolve the facility from having a sentinel event. How can they have the right to care, then refuse it??Or pick and choose as they see fit. Well , yes , that part is true, but I don't need some facility dragging my name in the mud because so and so wants"fill in the blank" and it's my fault I "allowed it" to happen.

I don't think someone signing out AMA is idiotic. It's realistic- people don't want treatment- well , buh bye- someone else who WANTS treatment is waiting in line right behind them.

And yes, those alarms DO suck, but I'm sure they are in place as part of facility's attempts to not get their butts handed to them on a platter. It was a precedent set, especially since some people don't seem to give two hoots about there "loved One" getting injured unless they see dollar signs in it.We AND the facility's all suffer.( when I say facility, I am referring to hospitals- can't speak for anywhere else)

drowningdaily

106 Posts

To tell someone that they have to leave AMA and can't get the skilled care they are in a facility for because they won't consent to a bed alarm? I will say it again- idiotic. Someone refuses alarms - first educate, then document and take every precaution you can. Bed low. Bell in reach. Belongings in reach. Frequent toileting. Frequent rounding.

Refusing care would get facility in way more trouble than a sentinel fall. Being a nurse means advocating for your patient, including his right to fall.

RN1996

2 Posts

Specializes in Jack of all trades..

You can have 3 different types of alarms on and a person can still fall. Anyone on any of the shifts from admission to fall could have changed things, added something. What about staffing or layout of building etc. So many factors. Document, document, document!

Specializes in Dialysis.

Generally, the alarms are put on when the patient is shown an inability to judge. Like dementia or confusion. If someone has an altered LOC, then they can't judge as well if they can walk safely. You can educate, but you can't rely on the retention of information. This plus impulsiveness makes for a dangerous combination. If they are AOx4 and simply stubborn, then educate and document like crazy.

drowningdaily

106 Posts

Many facilities have a blanket policy for alarms. I have worked on one that put every person in alarm X 72 hours. And one that alarmed everyone as policy. It is not uncommon for aao x 3 to refuse. To make a federal case out of every refusal as some people are suggesting would prevent the nurse from doing her job. Keep in mind we are discussing an oriented person - a dementia or confused patient would need their POA to refuse alarm on their behalf. That is an entirely different can of worms.

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