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.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
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.
Yeah, this does make sense. I did fill out an incident report when a very large lady fell onto me as I transferred her (I'm very small), and I eased her to the floor. She was on top of me at that point. And no, I wasn't hurt. It was in such SLOOOOOOOW motion. She was fine too. The resident was annoyed, as well as the attending, that I had to call them to notify them. The previous OP who used the term a "change in plane" clarifies quite well what is and isn't a fall.
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.
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 buy that OP is responsible for a fall that happened after transfer of pt care. Her choices were violate an order or violate policy, and she chose the option that provided better patient care. If she had not told the oncoming nurse there wasn't an alarm, she could be held responsible because the new nurse might assume there was one. If being up to a chair without an alarm was unacceptable per unit standards, the oncoming nurse should have said "Let's get the patient back to bed before we finish rounding report, so that they will be safe while they are in my care."
I do agree that for OP the reasonable choice here is not to get a patient up without an alarm again. If someone protests, all you have to do do is point out that disciplinary action was taken against you for not following protocol, and that once equipment is provided for you to carry out the mobility order in alignment with fall protocol, you will gladly do it.
I agree that the circumstance of the fall is highly suspect, since the pt was safe during the day and the noc nurse was present, but there will be no proving what happened there. Did anyone ask the patient how it happened? The patient's version of events should be part of the documentation.
Sadly, in the hospital system that I work for, even an assisted fall is considered a fall and it counts against our unit. Any time that a patient's body physically touches the floor, it's seen as a fall, no matter the circumstances behind it.
You're definitely being thrown under the bus. I'm currently in a similar situation, and I recommend you to communicate through e-mail, and to never go into meetings alone. And document all of it. I'm an ICU-grad, like you, and the amount of superiors who cover eachother is rediculous.
Even if it did count as a fall, it wasn't in your shift any more, and you did everything possible to make sure the patient was left in a safe environment. It's not your fault the hospital wasn't able to provide more equipment you needed. Even though I highly doubt al call button would have made a difference in this case.
All I'm saying is, expect the worst, but I sincerely do hope it will turn out way better for you than it did for me...
If you're not supposed to leave confused patient #1 without having someone else watch them, you should not have been given a second patient. That's a safety issue. sounds like a staffing problem. You can't be there for the whole shift. Regarding patient #2, your charge nurse should have gone to other departments to find a chair alarm (mine do that). Not having any in stock is not an excuse. Since you had already done shift report and the night nurse was in the room, why couldn't or wouldn't she get the patient back in bed? She was a/o x 3. The night nurse was clocked in, so the patient is now hers. This doesn't make sense. At my hospital, lowering patients to the floor is a fall. Document everything. Not cool that they're blaming you, a new nurse who is still learning. And a chair alarm would not have made a difference with keeping the patient from standing up, except when the UOR is completed.
Hearing about situations like this make it all more clear to me that I should not invest anymore time and money into getting a BS in a profession as awful and unfair as nursing.
So, this happened after you reported off to the night nurse? I thought it would have been the night nurse's responsibility? I would think if the policy is that ever pt, no matter how oriented they may be, needs a chair alarm then the facility should provide a chair alarm for each room. Right? Am I in fantasy land?
Plus, it's not fair since they don't have enough equipment then that could prevent some pts from getting proper care. Like if you didn't do it and the doctor comes in and finds out you haven't carry out his treatment plan because of a darn chair alarm...how is he going to react.
There are a lot of complications with pts having to stay in the bed 24/7.
Then again I'm just a student and I like reading these type of post for future scenarios
I think the biggest thing we have tackled in nursing school is documentation and it's funny that it seems that we have to make sure a documentation is perfect to protect us from our fellow nurses from throwing us under the bus.
I think it's important, too, to consider those patients who are AAOx3 but are impulsive whether from a concept of wanting to move their inpatient stay along by doing more, trying to do more because they feel better, or impulse control issues related to a disease state or other condition. I've had patients on the inpatient rehab unit where I work who are exactly that. They answer all of the questions perfectly throughout the entire shift but dink around when it comes to impulsivity. Good luck with this issue. I wonder if printing all of these responses out and taking it to HR would help at all?
My understanding (from where I work) is that staff lowering a patient to the ground is not a fall and does not require an incident report. About the bed and chair alarms - it's crazy, you tried.. But make sure you DOCUMENT everything. Write a note as soon as you can't locate an alarm that there is no alarm available and what you did to try to get the alarm.. And make sure whatever fall preventative measures in place are also documented as well (nonslip socks applied, rounds made, etc). I don't think this is truly your fault but I can SEE how they can try to put the blame on you, and I'm not surprised. Hopefully you can fight it ! It is disheartening to us, as nurses, to be blamed for incidents like this when we are truly trying our best to keep our heads above water each shift. Good luck!
I do not understand the need for a chair alarm for an alert and oriented patient. I never worked ICU so pardon my ignorance. She had access and instruction in use of call light? How is it the nurse's fault if she did not call for assist?
Next time file an incident report re: the lack of alarms for the pts. immediately. This should have a date and time on it. Be sure to detail your attempts to find one. Ultimately, maybe a short ambulation and back to bed would have been safer, but it still should be noted in the chart or incident report that the pt's exercise needs were not being met due to a lack of equipment.
You may have been able to call the supervisor re: alarms available on a different floor/unit. You are a scapegoat for a system-wide problem. Your immediate supervisor should be more pro-active for her staff as well as the patients assigned there, but good luck with that! Good luck to you, dear.
Boomer MS, RN
511 Posts
Yeah, this does make sense. I did fill out an incident report when a very large lady fell onto me as I transferred her (I'm very small), and I eased her to the floor. She was on top of me at that point. And no, I wasn't hurt. It was in such SLOOOOOOOW motion. She was fine too. The resident was annoyed, as well as the attending, that I had to call them to notify them. The previous OP who used the term a "change in plane" clarifies quite well what is and isn't a fall.