Assisted "falls"

Sour Lemon · Jun 26, 2020

17 minutes ago, LibraNurse27 said:
Hi all, just curious if at your facilities assisting a patient to sit on the ground to prevent them from falling is considered a fall? T
I went to RRT on inpatient psych. Pt very sedated and weak. I was getting labs when she said she had to pee. There was a nurse and tech in the room. I said we should get a bedpan because getting her up wasn't safe. She was throwing her legs over the side but I think we could have redirected and they were both strong guys. They said they knew her and she would never use bedpan. I suggested bedside commode but they don't have commodes. They got her up and walked her to the bathroom with a lot of assistance. The nurse left the room, leaving me and the tech to help her back to bed. I wanted to get a wheelchair but he was already helping her stand up. While I was pulling up her pants she got too weak and started to fall. We assisted her to the floor very gently to sit down. No injuries and she got back to bed safely. Is this a fall?
I'm so upset because if she were my pt I would never get her up. I tried to advocate but I felt out of place since it's not my unit and I was just there for RRT. I felt intimidated disagreeing with 2 men although they were both nice. I'm upset that the nurse left knowing it would be hard for me to help get her up (she was a large pt) and that the tech started getting her up without making sure I was ready. Basically I'm annoyed with the whole thing but mostly annoyed with myself for letting it happen! I know pt is fine though. I would like to suggest they keep commodes on psych or get training on fall safety but I don't want to overstep. Their unit has a high fall rate and this pt has called 4 times this month, one where she hit her head but CT negative.

Yes, that would be an assisted fall at any facility I've worked at. That's the best kind of fall, too. You were there. You were helping, but you don't have super-human strength.

My psych unit doesn't allow bedside commodes for other safety reasons. They also don't allow call lights. Combine that with heavy psych meds and people who don't follow instructions well, and you're going to have a fall here and a fall there. No worries ...especially when your patient is just fine.

LibraNurse27, BSN, RN · Jun 26, 2020

OK thanks, that is reassuring! I don't work in psych so I didn't know about the no commodes. My manager makes a huge deal of any type of fall but they didn't seem concerned. Their manager said it wasn't even a fall. They kept telling me not to worry because I was just there for RRT and got tied up in it and she wasn't my pt and I deferred to her nurse, but I am still not happy. Well, time to calm down, the world has bigger problems right now! Thanks Sour Lemon ?

amoLucia · Jun 27, 2020

Like PP Sour Lemon said, most places consider it an 'assisted fall'. But regardless, a State surveyor advised once advised us that if a pt butt went to the floor, treat it like a regular fall. And then proceed accordingly per facility P&P. Report up the chain, do an incident report, charting entry, scrupulous detail to body check for injury/ROM, and FAMILY NOTIFICATION. Most esp family notification.

BE PROACTIVE! Nothing worse than some confused pt telling their family "I fell in the bathroom and was on the floor, and they left me there, and now I hurt, yada, yada, yada". You'll NEVER EVER live down the wrath of the family who'll now accuse you of all kinds of things and never trust you for anything ever again! Believe me, it CAN AND DOES happen! And they can also call the DOH to complain about pt abuse (all based on the pt's acct - doesn't matter that pt is psych!). Just give the family the correct details - short & sweet and NON-ACCUSATORY!

OP & others- you may have to do more or less other details per P&P. But I STRONGLY & EMPHATICALLY endorse that this approach also be followed for any bruises of unknown origins. Save yourself from any grief and suspicion!

PS - NO commodes is also the usual course in other units like locked ones, dementia, Alzh, etc. Anywhere a movable object may become a weapon OR its CONTENTS be used for NASTY things. ('nuff said!!).

PPS - And by NO MEANS should you consider anything re this episode a 'black mark'. They DO happen with a frequency more freq than you'd think, altho often NOT reported.

LibraNurse27, BSN, RN · Jun 28, 2020

Thanks amoLucia! Unfortunately this patient doesn't have much family involvement; the staff on the psych ward treat her like family though as she has been there so long. They really treat her well, I think they were just not used to having medically unstable patients and not being able to get people up. I was annoyed because I felt like if they had listened to me she wouldn't have fell.

Not to say I'm perfect, just used to unsteady patients insisting they can walk! They didn't want to say it was a fall because she barely sat on the ground and no injuries. If they enter it as a fall, as you said it would be reports, paperwork, waking her up for q 2 hr neuro checks, etc. We don't have a policy about family notification but I'm sure if it was a serious fall causing injury we would notify. She has fallen before, true falls, unassisted and they did all the fall protocol stuff. She is prone to seizures so waking her up for the neuro checks would have been bad for her, plus it seems so dumb to keep checking for signs of a head injury in someone who basically just sat on the ground LOL maybe we need different policies for incidents like this vs serious falls with injuries.

TriciaJ, RN · Jun 28, 2020

It does seem odd that policy would require neuro checks because someone's butt grazed the ground and her head never connected with anything and this was all witnessed.

Another example of administrative overkill. And I always hated when I'd strongly advocate for certain precautions, get blown off, and the bad thing happened. And I'd be the one held responsible.

Brush it off. The patient is fine and so is everyone else. All you can do is give your head a shake and move on.

LibraNurse27, BSN, RN · Jun 28, 2020

LOL good advice! I will give my head a shake hahaha

Luckily I wasn't blamed for the fall/almost fall whatever they want to call it, since I wasn't her nurse and was trying to stop what was happening. The next day after I cooled off we had a productive conversation where I taught them about fall safety and they taught me about safety precautions on psych. I admit I was severely uninformed on that topic! I learned a lot. So some good things came out of it ? And yes, I wouldn't want someone shining their penlight in my eye every 2 hours because someone helped me have a seat on the ground! LOL

amoLucia · Jun 28, 2020

It's obvious that your staff knows this pt & her family BEST. And again you would have to defer to whatever facility P&P directs this incident.

But like PP TriciaJ comments, the 2 hr neuro checks would be a bit overkill here! But hey! I'm from Jersey, and we have the most DOH over-regulated health industry in the country! Hey, I've seen State govt facilities issue memos on 'how to write memos'. I kid you NOT! ?

Most definitely, we'd have treated this episode like a fall. Likewise, we would do so also with those pts who sleep on the 'low beds' with the floor pads. Even if they slid off to the pads, their butts were on the floor, so again, we'd treat it as a 'fall'.

Like you, my background incl working with pts famous for underestimating their strengths. I gracefully 'assisted' MANY into a delicate 'swan dive/glide' to the floor. But we'd have modified the need for neuros & paperwork. There would have ben an essential minimum amt of documentation required. But I do stand firm re the need to keeping family in the loop re 'fall' behaviors.

Care planning for 'falls' prevention takes on new importance here. PT safety is always important, but here the safety of staff is critical. Esp when new staff are present, or as in your experience here, staff 'unfamiliarity' contributed to the 'slide'.

Am glad all worked out well for y'all.

LibraNurse27, BSN, RN · Jun 28, 2020

3 hours ago, amoLucia said:
It's obvious that your staff knows this pt & her family BEST. And again you would have to defer to whatever facility P&P directs this incident.
But like PP TriciaJ comments, the 2 hr neuro checks would be a bit overkill here! But hey! I'm from Jersey, and we have the most DOH over-regulated health industry in the country! Hey, I've seen State govt facilities issue memos on 'how to write memos'. I kid you NOT! ?
Most definitely, we'd have treated this episode like a fall. Likewise, we would do so also with those pts who sleep on the 'low beds' with the floor pads. Even if they slid off to the pads, their butts were on the floor, so again, we'd treat it as a 'fall'.
Like you, my background incl working with pts famous for underestimating their strengths. I gracefully 'assisted' MANY into a delicate 'swan dive/glide' to the floor. But we'd have modified the need for neuros & paperwork. There would have ben an essential minimum amt of documentation required. But I do stand firm re the need to keeping family in the loop re 'fall' behaviors.
Care planning for 'falls' prevention takes on new importance here. PT safety is always important, but here the safety of staff is critical. Esp when new staff are present, or as in your experience here, staff 'unfamiliarity' contributed to the 'slide'.
Am glad all worked out well for y'all.

memos on how to right memos ??? and sliding off a mattress that's on the floor is a fall ?oh boy LOL

**CalicoKitty, BSN, MSN, RN** · Jun 28, 2020

I've seen some places only require neuro checks if there was a suspected head injury. So, witnessed and assisted falls where the head did not hit anything would not require the neuro checks.

amoLucia · Jun 28, 2020

LibraNurse - God's honest truth!

And the 'memo' facility had a central supply director who wanted to teach a class for new orientation staff on 'how to requisition supplies, like LIGHT BULBS'. And she was dead serious! Like how else will they know how?!?!

I mean these were experienced LICENSED nurses, responsible for pts' health & safety and she couldn't think they could fill out a light bulb request on a pre-printed standard form?

And those pts on the low PVC floor beds - if they did roll off to the floor mats, it was considered a fall. On NOCs, we care-planned to 'prop' linens or extra pillow so the roll-out could be deterred. Most of the time, it worked. But it WAS a 'fall' if it happened.

Sadly, these silly 'assisted fall' occurrences were just time-wasting exercises in futility. But that was the 'falls' rule. And I'm talking New Jersey facilities who have to jump thru hoops & over barrels to make TPTB happy. We did what we had to do!

For OP in a psych facility with a 'freq faller' pt with seizures, I'd take the high road and go all full out for whatever the situation called for. Just to CYA.

PS - This post brought up memories and I know this is off-on-a tangent. But about 1 1/2 yrs ago I had to 'assist' myself to my BR floor to prevent myself from falling. Just a not- too-graceful slide down to prevent a hard 'going down' fall. Technically, I guess I assisted myself!

LibraNurse27, BSN, RN · Jun 29, 2020

Aww I'm sorry you fell but I'm glad you were able to safely assist yourself to the floor! And if I ever fall out of bed I hope it's out of a low floor bed!