I have a question maybe you can offer some input. Even if you can't I need to vent a little to people who may understand.
I'm a relatively new ICU nurse. I've been on the unit for about 2 month now, 5 weeks or so on my own. I have never had less than 2 patients. Several weeks ago I had a very confused patient fall while I was next door working on a spontaneous breathing trial for a vented patient. I was told it was my fault because I should have asked someone to watch the confused one any time I stepped away from his room. OK I accepted this and took responsibility.
Fast forward to yesterday. I have a patient who is alert and oriented x 3. Orders are to get her out of bed and to bedside chair, commode, etc. I get her out of bed to the chair (with multiple BMs in the commode along the way). I look for a chair alarm - there are none - and I request it from our charge nurse. None can be located. Throughout the day we find 2 single alarms but utilize them for the 2 most confused patients on the floor.
Come shift change - this is long I know please bare with me - I give report to the night nurse and let her know about the lack of chair alarm. I also explain to patient that myself and night nurse will pUT her back in bed shortly. 5 minutes later I'm documenting and night nurse calls me and says she was in the room, saw patient attempt to stand up, aND she lowered the patient to the ground. Charge nurses are made aware, director is made aware. No injury.
Today I get in and am told that I am being held accountable for the fall because the patient was out of bed without a chair alarm which never should have happened .
Finally the meat and potatoes - your opinions are requested. Was this my fault for allowing patient to remain in chair with no alarm? Does the fact that we didn't have alarms matter? Would this fall under my shift given that I'd already endorsed the patient?
I should note that my employer is a huge corporation and that we are not provided sitters (not that an aox3 patient needs one), and we are unable to use restraint of any type except chemical if patient is agitated. Should I have left this patient in bed all day since we had no alarms? Moreover I pointed out today that the nurse being IN the room meant she was able to respond much faster than anyone would have upon hearing a chair alarm. No dice.
I feel this is going to become an issue and it looks very bad considering my newness. Would appreciate feedback.
OP set in motion the chain of events that led to the fall, that is, she violated policy. IT is true that the receiving nurse accepted the pt, so that does mitigate things. Also, the fact that OP asked boss for help in obtaining the means to follow policy mitigates in OP's favor.
The only thing she should have done differently is to have notified MD that no alarms were available so, by policy, she could not get pt up to a chair because she would be breaking policy by doing so. MD could then have pursued the matter with the powers that be. I bet an alarm would have been found, even if someone had been sent out to Radio Shack or Best Buy to get one.
I understand all about the benefits of activity to the pt. However, the real issue is that the employer did not provide the equipment necessary for OP to follow policy, so OP violated policy. However, we are now back to oncoming nurse having accepted the assignment - without the alarm. Knowingly. The fall is definitely not all on OP.
I don't know where you guys work but if I called one of our doctors about a missing chair alarm I might be looking for a new job.
I say get out of there! I quit working for a place many years ago because I gave report on a patient group, and as I was giving report on the last one, one of the others decided to climb over the bed rails. In view of the day nurse!
The day nurse demanded that i: fill out the incident report, get the patient assessed and back in bed, and since during my assessment I noted sat of 60....I called the rapid response team. Suddenly I was staying over 4 hours documenting all that mess too. They ended up going to the ICU and guess who had to transport them?
I got in trouble because I stayed over, because I filled out the incident report, and because I called the rapid response team. Oh, and because I had the NERVE to ask the house supervisor to get me help transporting the patient. Never mind that day shift refused to help saying it wasnt their patient, so they didnt need to help with the transport.
Yep....I got out fast! That place had the talking out of both sides of their mouth going on....because we kept being told to utilize the rapid response team, but every time we did (always legitimate reasons), they found something to write us up about.
My friend just got wrote up about a dead transfer from the ER. She went into the room as the ER attendant left and the patient was still sitting up in their wheelchair from home. Patient was stone cold dead. I don't know the whole story yet, but somehow she was supposed to have avoided calling a Code Blue. Not her fault they arrived dead already!
Well I really hope you didn't get in trouble. If you get called in for anything stand strong, remmber everything that happened and what you told us here:
1. there was no alarm, but she was the "most alert" out of the other alarms that were available and needed more by the other pts..
2. you tried to look for alarms
3. your shift was over and you had already given report, you just happened to still be there
4. ask how the nurse saw her fall, but helped her to the floor?- assisted fall or fall whatever it is, the other nurse was in the room and the pt wasn't on the floor- they were standing or sliding down, but that wasn't your fault
5. if this happens in the future with no alarms, but pt is supposed to be in w/c or wants to get in w/c- then ASK for a restraint in 1 arm... something needs to hold them down, because YOU CAN'T be with the pt. 24/7...
I had a pt. today basically jumping out of bed... well "jumping" he is TBI pt and very very active.... I mean we use Ativan a lot, because he pushes syringes away for insulin and pulls his vent off... or scratches his booty and opens his little mini scab... anywho I found him today feet on the floor- I slipped and ran to him ( and his foley was tugging ), he just slides right on out... luckily he isn't strong enough to get his chest up, but if we didn't have side rails, he could have easily slide all the way to the floor.. the bed was low yay...
Accidents happen, we try to be everywhere we can, but hey at least pt. didn't get hurt!
Sounds like you did all you could. One step further would be to notify the charge nurse of the concern, the lack of appropriate needed equipment along with orders to get the patient up. The charge nurse should have given you direction. Next step would be to document this conversation, document your concerns and document your frequency of checking on her. Also ensuring complete documentation of your other patients.
in this way you have covered all your bases and a review would clearly demonstrate you acted to the best of your ability. You're still left with the awful feeling that she fell but a reprimand would be inappropriate.
Unfortunately, there isn't much that you can do at this time. However I urge you when charting, please document not only the patient's status, but also the facts that there were no chair alarms available, and who you notified. Being owned by a huge corporation is no excuse for not having adequate safety supplies for the patients in their care. In addition, make out an incident report every time you do not have adequate supplies, involved in safe care for patients. This will put the onus on the corporation for providing substandard care.
Next time, when you contact the doctor for order clarification, take a verbal order. Just charting that the MD said it's ok doesn't cover you like having an order does.
Of course, the doctor can always deny having given a VO or TO.
I don't know where you guys work but if I called one of our doctors about a missing chair alarm I might be looking for a new job.
You are not calling to report a missing chair alarm. You know I didn't say to do that. You are calling to say you cannot get the pt up as ordered, as there are no chair alarms available, per Charge Nurse. Might you be in trouble for sharing the dirty little secret? Yeah. But I'll bet some alarms would magically appear - rapidito!
I am so sick of nurses afraid to speak up, I am sick of nurses letting employers step all over them.
You are not calling to report a missing chair alarm. You know I didn't say to do that. You are calling to say you cannot get the pt up as ordered, as there are no chair alarms available, per Charge Nurse. Might you be in trouble for sharing the dirty little secret? Yeah. But I'll bet some alarms would magically appear - rapidito!
I am so sick of nurses afraid to speak up, I am sick of nurses letting employers step all over them.
The only thing she should have done differently is to have notified MD that no alarms were available.
Actually that is exactly what you said, if I misunderstood then ok. To be clear any phone call to a doctor saying that I cannot follow your order because I cannot find the equipment would have the same result. They MIGHT call my charge nurse and go off on her which is no better for me. I don't get stepped on because as I said previously, I would never allow myself to be blamed for something that occured after report/narc count.
Saddly this is another example of the "nurses eating their young" sydrome. Once you gave report and the new nurse took over, she...not you... is responsible for that patient, especially if she was in the room at the time of the incident. You notified all persons--the charge nurse, the oncoming nurse etc... plus the patient was a non compliant A & O person. You can't be held responsible if the proper equipment was not available...
I've been a nurse for 39 years... I have many through and through knife wounds in my back.... watch your back, my Dear, watch yours.......
), he just slides right on out... luckily he isn't strong enough to get his chest up, but if we didn't have side rails, he could have easily slide all the way to the floor.. the bed was low yay...
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Conqueror+, BSN, RN
1,457 Posts
I don't know where you guys work but if I called one of our doctors about a missing chair alarm I might be looking for a new job.