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.
In all of my years of nursing I have never allowed myself to be held responsible for something that happens AFTER report/narc count.
I completely agree. After report you are no longer legally responsible for that patient. If the on coming nurse had any issues with the situation they should have been addressed in bedside report. That's the point of report. You don't let the other nurse leave until you are ok with everything. If repot is accepted then so is all the responsibility.
Lots of ICUs and ERs don't like new grads. That is, the nurses don't want new grads in the unit. I wonder if this is what is going on. I worked in one ICU where we took and loved new grads, in the other one sadly, a new grad would have been bullied off the unit. I'm not like that but I've seen it several times.
And in my opinion, if the other nurse was in the room with the pt then it is her problem, not yours.
Document when there are safety shortfalls. No chair alarms? Document it. I had to document a "system" problem when the phones were apparently down and my trauma patient decided to de-recruit a lung. Not my fault, not the physician's fault.
Tell the doctors you can't follow their orders for up to chair and explain why. Document if you cannot get a patient up due to the above reasons.
Tell patients and families when they're frustrated about things like this that they should mention it on their survey.
My hospital's been really into arbitrary rules made up on a whim, and this has been my strategy to address it and safeguard myself.
To add:
If there is a lack of equipment; ALWAYS ALWAYS and I do mean ALWAYS file an incident report; that is a safety issue and it is not punitive, but it supports a paper trail for potential and actual unfavorable outcomes.
My facility has one that can be filled out on the computer, providing an electronic trail, if something were to happen.
I completely agree. After report you are no longer legally responsible for that patient. If the on coming nurse had any issues with the situation they should have been addressed in bedside report. That's the point of report. You don't let the other nurse leave until you are ok with everything. If report is accepted then so is all the responsibility.
But she violated known policy in the first place. She tried to follow it but necessary equipment was not available. Still, she should not have left pt up in chair without alarm.
I don't want her to be at fault and I still don't know all the details of why this fall occurred, but she should have left pt in bed and notified MD that alarm was not available and gotten him to talk to nurse boss about providing alarms or given an alternative order to just ambulate in the room a little .
Specializes in OR, Nursing Professional Development.
To add:
If there is a lack of equipment; ALWAYS ALWAYS and I do mean ALWAYS file an incident report; that is a safety issue and it is not punitive, but it supports a paper trail for potential and actual unfavorable outcomes.
My facility has one that can be filled out on the computer, providing an electronic trail, if something were to happen.
Absolutely do the incident report or whatever your facility calls it. Risk management may be on your side and pressuring the powers that be to spend the money on the necessary equipment. I'm sure my risk management department is sick of seeing incident reports from me. Anytime an IV pump doesn't have enough battery life to transport from OR to ICU despite being plugged in up until the second we leave the room, I fill one out. It's amazing how those pumps disappear. How do I know they disappear? Those of us in the OR who were sick of dealing with them got out our bright red sharpies. That way, we knew when one of those blasted pumps found its way back to us.
Excuse my ignorance on the "big people" ICU, but if the OP stated that they only have chair alarms for the 2 "most confused" patients. For those that say that all ICU patients are at a risk for falls, do you have chair alarms for every patient that is up in a chair?
If the only 2 chair alarms were being used for the 2 most confused patients, does that mean that there are no other patients in their chair except for those two patients or does that mean that those nurses remain at the patient's chairside in case they try to get up? She advised the oncoming nurse that the patient did not have a chair alarm. That nurse accepted the hand-off and assumed responsibility for the patient. If she did not approve of the patient out of bed without the alarm, she should have had the OP put the patient back to bed. If the policy (from the previous fall) was that she needed someone to watch a patient when they are out of bed, the oncoming nurse was IN THE ROOM. How can this be pinned on the OP?
But she violated known policy in the first place. She tried to follow it but necessary equipment was not available. Still, she should not have left pt up in chair without alarm.
She was advised when her other patient had fallen to "have someone else watch your patient when you need to leave the room". The oncoming nurse was in the room. How was she violating policy?
If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.
My hospital also has it that if the pts, knees or buttocks touches the floor it is considered a fall. Even if the pt is assisted to the floor gently, its called an assisted fall. Sounds like you work for the same organization as I do.... the wording is identical. I do not understand though how if you had already given handoff to the oncoming nurse and she was in the room with the patient how this was your fault. And sometimes things just happen even when we are standing right there and all precautions are in place properly. Don't beat yourself up. Hold your head up and politely and professionally stand your ground.... you asked for the proper equipment. You cant restrain a pt to bed just because they don't have equipment to let them up to the chair... that encourages bed sores.
not.done.yet ,BSN, RN When I worked in 2 Extended Care Facilities , lowering a patient to the floor was still considered a fall and we had to fill out an Incident Report.
TootsieJ
6 Posts
I completely agree. After report you are no longer legally responsible for that patient. If the on coming nurse had any issues with the situation they should have been addressed in bedside report. That's the point of report. You don't let the other nurse leave until you are ok with everything. If repot is accepted then so is all the responsibility.