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Discussion

Being blamed for fall after shift

Hello all,

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.

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    • Featured Replies

    alarms on A&O patients was the norm on the unit I worked on. The unit manager insisted that EVERY patient have their alarm on, or sign a form refusing it...it was ridiculous putting a 22 year old on the unit on obs for cellulitis on an alarm...

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    In my opinion you are in no way at fault.

    1.) You triend to get the bed alarm but it was not available

    2.) You were not even in the the room or on shift when the patient stood up

    3.) Its really the other nurses word of what happened; so who knows what happened

    4.) If the patient was instructed to not get up without assistance and was AOx3 then the fall is the patients fault in my opinion.

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    @boomer thank you very much for your thoughtful and kind reply

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    • Author

    To all thank you so much for the input. I really have been questioning it and feeling bad but you are correct and the input solidifies my position to take this up the ranks if need be. At this point only the night shift has documented the fall and I have done no paperwork etc because I had already handed off the patient. I'll keep you updated on the results. Thank you again

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    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.

    And here is a definition of a non sequitur.

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    @boomer thank you very much for your thoughtful and kind reply

    You're welcome, and it's gratifying to see all the support you are getting here. Wondering too if you have a union. Maybe this will all turn out OK for you. Hopefully sensible minds will reign.

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    A patient lowered to the ground by a nurse is not counted as a fall.

    Actually it is because it is an unanticipated change of plane.

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    A patient lowered to the ground by a nurse is not counted as a fall.

    The last place I worked it was indeed counted as a fall.

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    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. Having said that - there are system errors as well contributing to the fall like not having a chair alarm. The lesson to be learned (and I am not saying that they were right to ding you for that) is that if the pat is a fall risk (and they all are in ICU) make sure they are supervised when OOB and have chair alarm. If you do not have chair alarm just have them sit on the bedside with you or stand up to shake out legs and go back to bed with bed alarm on.

    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...).

    I respectfully disagree with you. Mobility is extremely important, getting the pt OOB was the right thing to do. Had they been confused, I would agree that they should not have been left up without a chair alarm. But that was not the case. Not every ICU patient needs an alarm. Going forward, we now know that this patient does.

    OP, I am so mad for you. Please make sure you stand up for yourself here. The real issue is not whether or not the patient needed a chair alarm. The issue is that this happened A) after you gave report, so the patient was the oncoming nurse's responsibility, and B) while the other nurse was IN THE ROOM! An alarm would not have prevented the patient from standing. This is craziness.

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    A patient lowered to the ground by a nurse is not counted as a fall.

    This is considered an "assisted fall"

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    • Experts
    A patient lowered to the ground by a nurse is not counted as a fall.

    It is where I work and probably at many other places.

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    • Experts
    Hello all,

    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.

    Do not agree to help put her back to bed. In a way, doing so makes you voluntarily still on duty. New nurse can get her coworker on shift to help.

    Boss is at fault for not making sure you had a chair alarm available to use.

    Being in ICU, IMHO, makes a pt confused, not fully "with it' mentally. So even if she was A&O x3 doesn't mean she knew not to get up alone. Why was she getting up anyway? Toilet? Stretch? Other reason?

    You yourself say that "the 2 most confused Patients" got what two alarms you did find. Pts in hospital, whether ICU or not, are there due to sickness, injury, are medicated, are not fully responsible for themselves. Your boss is remiss for not making necessary equipment was available.

    Why didn't the other nurse lower the person into a chair or onto the bed? Where exactly in the room were the two of them?

    Don't argue or blame. Just truthfully write your statement, including having asked for alarms earlier from boss and having endorsed pt to oncoming nurse.

    In future - no alarm, no up to chair. But do inform MD that you can't carry out the order to get up, and why you can't, who you've approached and when to get alarm - like Charge Nurse, Manager, Central Supply, Nursing House Supervisor, etc.. Don't just drop the matter. Where do the alarms come from?

    In a way you are responsible, I guess, as much as I don't want you to be, and you are not the only one at fault.

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