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.
You have orders to get the A/O x 3 pt. OOB, but there are no chair alarms, but you have orders, but there are no chair alarms, but you have orders, but there are no...
.
Right!! I am so sorry OP. I was set up like that at my first job. I had NPO orders for a patient EXCEPT MEDICATIONS. I gave the medications crushed and with pudding just like the night nurse told me to do. The charge nurse said it was okay, and my preceptor said it was okay. I even called the doctor and he approved. ( I charted all phone calls and communications with the charge nurse and my preceptor).That was how the patient took her medications at home. She was NPO because family wanted a swallow eval because they thought she had a stroke. Stroke had already been ruled out. She was actually on observation for hypokalemia. Anywayssss..... I got put on unpaid administrative leave for 9 days so the manager could "investigate". I got fired for "Unsafe patient care."
You covered all of your bases and I think that one of the hardest things to accept is that when we DO cover all of our bases, we cannot control what our patients do. I think that the circumstances are all bad :/
Perfect example of why you should fill out an incident report or patient safety report every single time you don't have the needed equipment available and documenting what you said to the patient and what they replied to you.
If if they want alarms on all these patients then they have to provide them. Enough incident reports of missing equipment will get noticed pretty fast by legal.
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?
Don't print anything or take it anywhere!!! That will get you in hot water if they feel there is enough identifying info to figure out this is about your place of employment!!
If you were not allowed to leave the confused patient alone then perhaps it would have been more prudent to make him a 1:1, otherwise you cannot be in two places at once. Was there a bed alarm on him that no one responded to? And how do you keep intubated patients from grabbing the tubes if you're not allowed restraints? I'm confused. I have a new appreciation for my ICU. As for the fall post shift change, you should not be solely responsible for that one. Even with a chair alarm, the nurse was at the bedside. How would the scenario have changed with a chair alarm? Would it have enabled an invisible force field preventing the standing of a patient. No.
I def feel that you should not be blamed, no nurse in fact. However it is the oncoming nurses responsibility to chart what she saw happen & how she assisted the fall, & any or all interventions she performed on the patient because she assumed care of the patient and witnessed the fall. Now she/they may say you didn't have a chair alarm but so long as you tried to get one and made the charge nurse aware then you did your part. In addition, your charting (hopefully) reflects any patient teaching you performed to your alert and oriented patient regarding getting up without assistance and that you had the call within reach. Even still I wouldn't stress, no injuries, so you will be fine. You can use this experience as a teaching lesson- be sure to document any teaching done to patient and that maybe next time before change of shift, have patient put back to bed safely with your assistance so you know that your patients are safe.
A patient lowered to the ground by a nurse is not counted as a fall.
According to NDNQI a patient lowered to the floor as in this case is considered an assisted fall. There is no one person to be blamed for this patient's fall. A thorough review of the circumstances surrounding the fall has to be done. And no you should not have kept the patient in bed all day. Did he have OOB / activity orders? What is the policy on using bed alarms and chair alarms? Is there a falls prevention and management policy? Is it a good policy and was it followed?
The problem is that the pat "fell" while in the critical care area/ICU. Granted it would be a problem on a regular floor but even more so in an ICU. In the ICU literally every pat is a "high risk for falls" and safety comes first.
When a pat in ICU falls it is a huge "thing"because no pat is supposed to fall in a critical care area (like nobody is to fall off the stretcher when they transfer from the table to bed in the OR...).
In every department I've worked in since I became a nurse, all patients are considered, and labeled, as high risk for falls (2 EDs, 2 ORs). Let me guess, all your patients in that ICU have a colored band on their wrist, and a sign on the door? The hospital can buy all that crap, but not an adequate number of bed alarms to follow their own policies. This sounds about right. Signs, wrist bands, and additional charting are proven to prevent falls
As a nurse of 44 yrs others might disagree but I have different advise. I feel the best action would be to let your supervisor know that you have learned a lot from the experience and will be able to give better care for patients in the future. You are really not saying it was your fault but it will maybe defuse the situation. If you fight it they will fight back. Maybe not in this instance but they will find other things to use against you. If it truly is their practice that caused the accident then quietly look for a better place to work. It can really backfire when you take it "up the chain " so to speak. Life is to short to let this get to you. Stress is what kills us. You will come across lots of issues in your nursing practice that can cause lots of stress. Let it go!!
GSDlvrRN, MSN
100 Posts
Right!! I am so sorry OP. I was set up like that at my first job. I had NPO orders for a patient EXCEPT MEDICATIONS. I gave the medications crushed and with pudding just like the night nurse told me to do. The charge nurse said it was okay, and my preceptor said it was okay. I even called the doctor and he approved. ( I charted all phone calls and communications with the charge nurse and my preceptor).That was how the patient took her medications at home. She was NPO because family wanted a swallow eval because they thought she had a stroke. Stroke had already been ruled out. She was actually on observation for hypokalemia. Anywayssss..... I got put on unpaid administrative leave for 9 days so the manager could "investigate". I got fired for "Unsafe patient care."
You covered all of your bases and I think that one of the hardest things to accept is that when we DO cover all of our bases, we cannot control what our patients do. I think that the circumstances are all bad :/