Choose your words wisely....

[Jo Dirt]

It is believed the nursing home where I work will be likely facing a possible lawsuit over a patient who has had a lot of falls lately. She is in her 90's and is not able to ambulate, though she can stand for transfers. She will try to either get out of bed by herself or put herself to bed and end up in the floor. The POA (who is not a relative) has become increasingly frustrated over the facility "allowing" her to fall. I have actgually had to fill out two of the incident reports on her in the last few months. I really do not believe it was the facility's fault, there are simply not enough people to hover over her every minute. We have taken every precaution we can (bed and chair alarms, low mattress with cushioned pad next to the bed, frequent reminders not to attempt to get up without assistance) but in spite of it she still has been falling. And it's nothing personal against this patient but she is as big as a cow and very clumsy.

Anyway, the most recent incident involved a minor bump to the head which resulted in a small inter (or intra) cranial bleed. She actually seems more alert and with it than she was before. We had a meeting about it. Apparently the nurse who called to report this to the POA said "the CNA dropped her." This was not what happened, but the administrator said when you have people looking to zero in on a lawsuit every word you say can and will be used against you. He went on to mention that another nurse in another report told her the reason the patient fell because we were "short" and since the patient wasn't put to bed when she was used to going she tried to put herself to bed.

Well, he didn't mention any names but this was me. I don't specifically remember telling the POA we were "short" but apparently I gave her the impression we were short staffed. The administrator said NEVER tell anyone you are short staffed, which we were not. I just wonder if this is going to come back to haunt me. I do not think this patient has suffered irreversible damage for this, but knowing how sue happy people are it just kind of eats at me.

BTW, it was the truth when I told the POA there was a call in which left us with not as much help as we usually had.

[Jo Dirt]

I work in a 220 bed non-profit county run LTC -very few private pay residents. We implement strict 1 to 1 for residents like this. It makes more sense then allowing a resident to fall 27 times in a month (the family were NOT pleased-the DOH even less so. Most of the incidents happened because the fellow was left in the dining room alone after dinner-night after night after night.Or he had climbed out of bed and fallen in the doorway of the room-and then was put back to bed and left to climb out and stagger to the doorway TO FALL AGAIN. HELLO-leave hime up with a drink and a snack for a while....BUT-people have to understand that falls will happen and we can;t tie these people down...not with duct tape,velcro or bed sheets...darnit

Another thing is, you are dealing with people at the end of their lives when they are at their worst. We're dealing with ailing people who are in their 80's and 90's, some very large (like this woman) and who are demented. Falls and accidents are going to happen. What happened the last time, the CNA was actually holding onto the patient and they fell together--the CNA had ahold of her the whole time. She wasn't dropped. But this nurse flipped out and put her foot in her mouth, I guess. She should have calmed down before she called the POA.

I think people need to be educated about the nature of nursing homes and what they can expect. Then, give them the choice to take it or leave it. The nursing homes are just shooting themselves in the foot with their advertising "the best care" and "top quality service." This gives outsiders the wrong impression of what they can expect, realistically and just sets the NH up for failure.

This patient is up as usual, doing excellent BTW.

[nerdtonurse?, BSN, RN]

We had a local facility go to a "no restraints" rule -- and their fall rate skyrocketed. We've been getting a LOT of broken hips, 2 subdural hematomas that I've looked after, plus others I haven't. I would never want to see my parents in restraints, but I'd rather see that than see them with spiral fractures of the femur, getting their hip replaced, having clots evacuated off their brain, etc....

[Xbox Live Addict]

One day someone will get it I am sure...

This arrangement will change only when the State mandates tougher standards for staffing. LTC does not have the same enforcement for staffing ratios as acute care, and Oklahoma has among the lowest standards for nurse staffing in the US. A nurse coming from California, where staffing for health care facilities is tightly regulated, would be absolutely horrified at the patient load they would receive here.