Chasing after alarms. What do you do?

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I work at a LTC. The facility uses alarms on fall risk residents. The hall I work on has 26 residents. 8 of those resident have alarms. I had a lady with an alarm in the bathroom. We are not supposed to leave these people unattented, but the lady across the hall has demientia and was getting out of bed and her alarm was ringing. She is very unsteady and would have surely fell if I didn't get to her in time. So, I hooked the lady who was on the toilet to the rail with her alarm and told her not too move (she is alert and oriented, she just needs assistance to the bathroom) while I ran to get the other lady.

While taking care of the demintia woman the nurse bust into the room and tells me I needed to go pick other lady off of the floor. The first lady had wiped and tried to stand to pull her pants up and slide down on her bottom. She wasn't hurt at all. But when she slide down on her bottom it casued her alarm to go off. I didn't hear it across the hall. The nurse said she heard the alarm from the employee bathroom (which is right by my hall) and when no one got it right away she came down the hall.

Long story short I got wrote up by the nurse.

What would you have done differently? Its not uncommon to have 2 or 3 alrms going off at once at any given time. We have one aide on a hall for 26 people, so its just me. Our nurses station is not on the hall. Its up front at a large desk. Once they are done passing meds they generally don't come back done the hall unless they have to.

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There wasn't a great deal you could do. It sounds like the first lady was a greater fall risk than the one in the bathroom. I probably would have done the same as you, but either way, sounds like you would have got wrote up :(

PS- the nurse who left lady #2 on the floor to come yell at you to pick her up? Why couldn't she have got her off the floor?

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I would have probably have done the same thing as you did. Im with pp on why in the heck would the nurse leave the fallen resident alone?

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Its pretty common on the nurse's part to leave a fallen resident and look for the aide to pick them at our facility. I am not kidding at all. We have a group of nurses at are way above and beyond any type of aide work and they are not afraid to let you know it either.

When I did go to the room to pick the lady up the nurse was behind me saying "Now let's get her up" moving her thumb upward while I did the lifting and she stood there. That particular nurse is not a nice person at all.

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We have one aide on a hall for 26 people, so its just me.

That seems illegal.

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You're alone on a wing with 26 residents, with no nurse's station in sight? It not only sounds illegal, but it's an obvious safety hazard.

And the nurse that came to write you up couldn't help the other fallen resident...why again? Ugh.

I think in this situation, you really did the best you could.

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Yeah, I believe it is probably illegal. I was told they get by with the ratio because they count the nurses. Also most of the other employees such as the receptionist are aides that never do aide work but are counted as aides. Sometimes we have to care for even more than the normal 26. We have four halls each holding up to 26 residents with one aide on each hall. There are times when one of the aides will call off or not show or quit and we have to work with only two or three aides for the whole shift. So that's about 35 roughly to one aide or 52 to one aide. Believe me it sucks!

Actually the nurses station is insight, but just not on the hall. Our building is shaped like the letter "X". In the center of the "X" is where the nurses have their station and there is also an "aide" receptionist there as well. The nurses are understaffed as well. We have two LPN nurses per shift, so they have about 52 people under their care. I realize the nurse wasn't happy with me because she had to do all the paper work on the fall and it just added to her work load.

Our facility has a rule that states you can't not leave a resident with an alarm unattended unless they are in bed or sitting in chair. I knew I wasn't supposed to leave the lady on the toilet alone, but I was sure if I didn't get to the other woman in time she'd fall.

I just felt bad because the lady on the toilet could have been seriously hurt. Thankfully she wasn't though. I just feel so guilty because I do try really hard to take care of these people and when something like this happens it makes me feel like I am a terrible aide.

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Vc01ca:

First, you're not a terrible aide - you are REALLY under the gun! 26:1 ratio? Yow! I feel overloaded at 17:1! Of course, in my case I've been employed for 3 weeks now, with a week and a half on the floor as an on-call CNA. One week, if you exclude my floor orientation (3 days).

Second, as with everyone else - sounds like you did what you could to prioritize a no-win situation, and you did the best you could. Kudos to you for trying to pull that one off! :hug:

Third - sounds like you need to look for another LTC, if you can. This place sounds like a potential bomb just waiting to explode; props to you for toughing it out for your patients sake, but it sounds like you could be the next one injured (professionally, or worse...physically). Prayers going out to you & your patients - neither you nor they deserve this.

----- Dave

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Any employee within earshot of an alarm should run for it as soon as they hear it and not wait for someone else to get it; at least they may be able to stop someone from falling and just let them know the aide will be with them shortly. You should never leave one fall risk alone to try and help another one. That way if someone falls while you are helping an alarmed resident, you have an obvious valid excuse for not running after another alarm. Anyone who hears an alarm and does not respond immediately, seeing that the aide on duty is busy helping someone, they're the ones who should get written up. When are LTC facilities going to learn that alarms make very poor babysitters for confused dementia residents?? And that's another thing I find really bizarre about that facility -- they count receptionists as aides even though they don't do any aide work? Sounds like they're trying to stack the numbers so that their aide-to-patient ratio looks good. I agree with IEDave, this sounds like a no-win situation. I'd be saying 'adios' right about now....

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"Sounds like you need to look for another LTC, if you can. This place sounds like a potential bomb just waiting to explode"

I've been there over a year and it keeps getting worse and worse. I have been job hunting, but so far no luck. As crappy as this place is they do work my school schedule, which helps me out so much.

"And that's another thing I find really bizarre about that facility -- they count receptionists as aides even though they don't do any aide work? Sounds like they're trying to stack the numbers so that their aide-to-patient ratio looks good."

That's exactly what they are doing. Almost all the staff has an aide or nurse title behind their name to make the ratios look better. Several office people such as HR, billing, activities, medical records, some housekeepers, and the people who order supplies are either LPNs or aides. The majority of these people never do any actual bedside care.

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You can only be in one place at one time, so find out exactly what you are expected to do when these situations come up, because they WILL come up, all the time.

If the care plan states a particular resident is not to be left unattended in the bathroom, then leaving them unattended, regardless of the situation, puts you at risk. Make sure you know who is and isnt allowed to be left unattended in that situation, for your own protection.

The reality is that even though it makes sense for you to leave the person who at that moment is not about to fall, to help someone who IS, you are going to be the one held responsible if the person you just left tries to get up and falls. Had you stayed with the person you were in the bathroom with, and the other resident fell and broke their hip, it would have been a tragedy, but you wouldnt have been held responsible as long as they had their alarm on.

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It's a horrible situation to be in, and there's probably no one correct answer that's going to be right every time, much as we'd like there to be. What I have always done is to make sure the one I am with is safe before leaving to respond to an alarm - sometimes that only takes a couple of seconds, sometimes it takes a lot longer.

You think you can leave one and run to prevent the other one falling but it's just as likely that the one you left too quickly will fall while you're gone, and the one you're running too will fall before you get there so what you end up with is two falls, and that's never a good outcome.

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