Cna incident investigation

[Nnb07]

I need some advice on what will happen to me. I am a cna and recently I was involved with an incident that resulted in the resident falling from the stand up lift and breaking her hip. I was helping an aide transfer a resident from the chair to the bed and when the resident was standing up in the lift, I asked the aide if it was ok for me to go on break and she said yes. I left before the resident was transferred in bed and she was still standing. When I came back from break she told me the resident fell from the lift when I wasn't there.

The facility sent the information to the attorney general and department of health for nys.

I was suspended from work and I understand I am in big trouble but does anyone know the process or what will happen? Will I lose my certification and can I continue nursing school?

I know now I shouldnt have left and I really regret it and I'm so upset that the patient fell I feel so bad. But I don't know what to do and I can't stop thinking about this. Does anyone have any advice or information on what will happen?

[MunoRN, RN]

Sorry to spam-post, but I didn't feel like this question was properly addressed. The first person operates the lift controls and pushes the patient. The second person spots. This may seem like a silly waste of personnel, but at my facility, we used a hoyer that really let those patients swing! The second person held the patient steady, and made sure their head did not bang the large metal bar as they were positioned. You also made sure a fidgety patient didn't reach up to mess with straps that could pinch them as they were being lifted of lowered. On an assist-to-stand, the second person again watched the straps, and the feet to make sure the patient kept their feet flat and on the platform.

Basically, the first person watches the lift, the second person watches the patient.

"Spots"? Yes, that does seem like a silly waste of personnel.

[psu_213, BSN, RN]

Some people have posted that "most" facilities require 2 aides for all mechanical lifts. What if those was not one of those facilities? Also, how does someone know what "most" facilities require? Even if you have 30 years of LTC experience and have worked in 10 different facilities, all of which require 2 people, how can this be representative of "most" LTC facilities in the US?

I'm not questioning anyone's integrity and I'm not calling them dishonest, but in the absence of actual, large scale research on this, I don't think anyone is in the position to say what "most" facilities require.

[Possum_RN]

Getting back to the topic the OP presented, It was implied (but, true, not outright stated) that her facility required two, as this seems to be what she's worried about in the investigation - if her facility required only one, she 's much more likely to be off the hook.

OP, I think it's time to gather materials - your facility's AND school's policy manuals. Sit down, take a look, and decide if an attorney is in order. Sucks to have to pay them, but you've got too much on the line to wait and be thrown under the bus. As stated in a previous post, an attorney can often track down other documentation (or lack thereof) that can save your butt. Since you do not currently have access to the patient's Plan of Care (documenting their transfer status) an attorney may be needed for you to get this information for your defense. At least, they can tell you more of what to expect than we can.

And again on the topic of two-vs-one: I worked in a facility that dealt with patients who were neurologically and physically risky to transfer, all of whom required several transfers a day. I can easily see how a patient who is mentally able to "spot themselves" and alert the caregiver to a problem on their end may require only one caregiver to transfer....but that was not the case in the circumstances I worked in. With so many transfers concentrated at certain times a day, even a competent caregiver gets careless watching both the patient and the machine. I notice that the "one to transfer" crowd usually lists their speciality as acute care - this may very well be a key difference in how our opinions on the matter are formed.

[Ambersmom, BSN, RN]

I need some advice on what will happen to me. I am a cna and recently I was involved with an incident that resulted in the resident falling from the stand up lift and breaking her hip. I was helping an aide transfer a resident from the chair to the bed and when the resident was standing up in the lift, I asked the aide if it was ok for me to go on break and she said yes. I left before the resident was transferred in bed and she was still standing. When I came back from break she told me the resident fell from the lift when I wasn't there.

The facility sent the information to the attorney general and department of health for nys.

I was suspended from work and I understand I am in big trouble but does anyone know the process or what will happen? Will I lose my certification and can I continue nursing school?

I know now I shouldnt have left and I really regret it and I'm so upset that the patient fell I feel so bad. But I don't know what to do and I can't stop thinking about this. Does anyone have any advice or information on what will happen?

OP strongly suggest you contact a lawyer.

[Ambersmom, BSN, RN]

Sorry to spam-post, but I didn't feel like this question was properly addressed. The first person operates the lift controls and pushes the patient. The second person spots. This may seem like a silly waste of personnel, but at my facility, we used a hoyer that really let those patients swing! The second person held the patient steady, and made sure their head did not bang the large metal bar as they were positioned. You also made sure a fidgety patient didn't reach up to mess with straps that could pinch them as they were being lifted of lowered. On an assist-to-stand, the second person again watched the straps, and the feet to make sure the patient kept their feet flat and on the platform.

Basically, the first person watches the lift, the second person watches the patient.

everywhere I worked required 2 people, one to operate the lift, the other to prevent the person being lifted from swinging, grabbing, and to help position, and to ensure they were properly harnessed in. I've never heard of anywhere that allowed 1 person for a lift-not safe- and where I worked 1 person using a lift alone was a firing offense.

[MunoRN, RN]

everywhere I worked required 2 people, one to operate the lift, the other to prevent the person being lifted from swinging, grabbing, and to help position, and to ensure they were properly harnessed in. I've never heard of anywhere that allowed 1 person for a lift-not safe- and where I worked 1 person using a lift alone was a firing offense.

My experience is the opposite, I've worked at any facility or for any organization that required to 2 people to operate a lift, not even the manufacturers who tend to err on the side of caution recommend a 2 person requirement, I have actually worked at one facility that specifically discouraged 2 person lift use because there was too much temptation to just not use the lift at all.

I've never found there is any reason why the person doing the things you claim a second person is required for can't also press a button.

[Possum_RN]

Alriiight, Muno....I looked at the first two manuals Google provided me with.

Manual #1 - Joerns HPL700, page 15: "Have someone assist you when attempting to transfer a patient."

Manual #2 - Invacare models 9805 and 9805P, page 10: "Although Invacare recommends that two assistants be used for all lifting preparation, transferring from and transferring to procedures, our equipment will permit proper operation by one assistant. The use of one assistant is based on the evaluation of the healthcare professional for each individual case."

(note that wording - they recommend two assistants - if the facility poilicy specified one, it's on that facility. If the healthcare professional makes a bad call, it's on that individual.)

So, I'm not sure what manuals you consulted. In addition, the CDC offers this handy graphic:

But hey, you got me on the stand-assist-lift! Guess the facilities I worked at pulled that policy out of their tushes. OSHA has a similar graphic. Both can be found at:

https://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf (page 16)

https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.pdf (page 13)

Whelp. That's enough of that. Hopefully we can get back on-track here. Sorry to contribute to the off-topic convo - it's just upsetting to see someone advocating AGAINST patient safety. By your reasoning, having two nurses check off on certain medications and blood transfusions is a waste too - silly, to involve another caregiver when one should do, right?

But in any case, it's irreverent to the OP - it's going to come down to what was in her facility's policy, on the patient's care plan, ithe employee training documentation for lifts, etc. She needs to have access to those documents for her defense...not our opinions. A new thread for this debate might be nice though?

[MunoRN, RN]

Alriiight, Muno....I looked at the first two manuals Google provided me with.

Manual #1 - Joerns HPL700, page 15: "Have someone assist you when attempting to transfer a patient."

Manual #2 - Invacare models 9805 and 9805P, page 10: "Although Invacare recommends that two assistants be used for all lifting preparation, transferring from and transferring to procedures, our equipment will permit proper operation by one assistant. The use of one assistant is based on the evaluation of the healthcare professional for each individual case."

(note that wording - they recommend two assistants - if the facility poilicy specified one, it's on that facility. If the healthcare professional makes a bad call, it's on that individual.)

So, I'm not sure what manuals you consulted. In addition, the CDC offers this handy graphic:

But hey, you got me on the stand-assist-lift! Guess the facilities I worked at pulled that policy out of their tushes. OSHA has a similar graphic. Both can be found at:

https://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf (page 16)

https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.pdf (page 13)

Whelp. That's enough of that. Hopefully we can get back on-track here. Sorry to contribute to the off-topic convo - it's just upsetting to see someone advocating AGAINST patient safety. By your reasoning, having two nurses check off on certain medications and blood transfusions is a waste too - silly, to involve another caregiver when one should do, right?

But in any case, it's irreverent to the OP - it's going to come down to what was in her facility's policy, on the patient's care plan, ithe employee training documentation for lifts, etc. She needs to have access to those documents for her defense...not our opinions. A new thread for this debate might be nice though?

The HPL 700 is a driven lift, which is where there is a logical reason to have a second person, Hoyer's sit to stand lift is the HPL 500, which states in it's user manual that a second person is only needed when "negotiating a slope".

https://www.joerns.com/user_area/spec_sheets/HPL%20500%20Manual.pdf

The Invacare sit to stand manual states: The stand up life may be operated by one healthcare professional for all preparation, transferring from, and transferring to procedures with a cooperative patient...

http://www.invacare.com/doc_files/1145811.pdf

Whelp. That's enough of that. Hopefully we can get back on-track here. Sorry to contribute to the off-topic convo - it's just upsetting to see someone advocating AGAINST patient safety. By your reasoning, having two nurses check off on certain medications and blood transfusions is a waste too - silly, to involve another caregiver when one should do, right?

But in any case, it's irreverent to the OP - it's going to come down to what was in her facility's policy, on the patient's care plan, ithe employee training documentation for lifts, etc. She needs to have access to those documents for her defense...not our opinions. A new thread for this debate might be nice though?

Proper utilization of resources doesn't harm patient safety, it's actually an important part of patient safety. I'm all for medication double checks when they improve safety, rather than being detrimental, this isn't just my view, I tend to agree with safety groups such as ISMP when they discourage unsupported double checks that don't have any rationale support and only take the focus off of situations where a second check/helper/etc actually serves a beneficial purpose.

I'm open what the reasoning is behind this, but so far there doesn't seem to be an actual purpose to the second person.

[NurseBlaq]

Alriiight, Muno....I looked at the first two manuals Google provided me with.

Manual #1 - Joerns HPL700, page 15: "Have someone assist you when attempting to transfer a patient."

Manual #2 - Invacare models 9805 and 9805P, page 10: "Although Invacare recommends that two assistants be used for all lifting preparation, transferring from and transferring to procedures, our equipment will permit proper operation by one assistant. The use of one assistant is based on the evaluation of the healthcare professional for each individual case."

(note that wording - they recommend two assistants - if the facility poilicy specified one, it's on that facility. If the healthcare professional makes a bad call, it's on that individual.)

So, I'm not sure what manuals you consulted. In addition, the CDC offers this handy graphic:

But hey, you got me on the stand-assist-lift! Guess the facilities I worked at pulled that policy out of their tushes. OSHA has a similar graphic. Both can be found at:

https://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf (page 16)

https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.pdf (page 13)

Whelp. That's enough of that. Hopefully we can get back on-track here. Sorry to contribute to the off-topic convo - it's just upsetting to see someone advocating AGAINST patient safety. By your reasoning, having two nurses check off on certain medications and blood transfusions is a waste too - silly, to involve another caregiver when one should do, right?

But in any case, it's irreverent to the OP - it's going to come down to what was in her facility's policy, on the patient's care plan, ithe employee training documentation for lifts, etc. She needs to have access to those documents for her defense...not our opinions. A new thread for this debate might be nice though?

I tried to explain that but you're wasting time. This rabbit hole of how many people it requires for a lift is a never ending rabbit hole meant to distract from OP's situation. I suggest you leave it alone or you'll be harassed all over AN site until no end. I ended up having to add certain people to my ignore list and I had never done so until then. Difference of opinion is fine but the e-stalking and group disrespect and condescension game is not. You have been warned. LMAO

So back to OP, what's the update?

[nehneh14]

I'll throw my 2 cents in here too and report that in my experience lifts are commonly used by one trained caregiver, both in inpt. facilities and by caregivers at home. Particularly, sit to stand lifts are designed for one user. If more than one operator is needed in order to keep a person safe in a sit to stand, then that is a glaring red flag that the sit to stand is an inappropriate piece of DME for that patient. In the typically understaffed med surg unit in which I worked years ago, we commonly lifted patients with a Hoyer by ourselves. No one would ever get lifted if we had to wait. Having an extra hand was great and more efficient, but if the patient wasn't a "flailer" and not oversized for the lift, we did it alone. And now that extra capacity Hoyers are more common, the weight issue is not as much of a determining factor. As with every patient activity, however, you have to use your brain and size up the situation before you decide how to go about your transfer. One size never fits all. As for the OP, it's confusing to me that a sit to stand was being used and yet 2 people were assumed to be needed. It's horrible that the pt. fell, but I wouldn't have expected to be using a sit to stand if the pt. was so weak or unsteady that she couldn't reliably support her weight. I can't beat up on the OP for this. Sometimes crappy things happen without intentional negligence.

[Gooday]

Are you in trouble for changing the patient in the lift? I know that is not supposed to be done. Some of the lifts now days only require one person to transfer so leaving would not be an issue, but allowing a patient to stand in a lift is a big no no. I am thinking maybe the issue is leaving while a patient is standing or being changed in the lift, both no no's. Hope it works out for you. Everyone makes mistakes, I have learned that if I feel uncomfortable about something it's probably not a good idea.

[MunoRN, RN]

Are you in trouble for changing the patient in the lift? I know that is not supposed to be done. Some of the lifts now days only require one person to transfer so leaving would not be an issue, but allowing a patient to stand in a lift is a big no no. I am thinking maybe the issue is leaving while a patient is standing or being changed in the lift, both no no's. Hope it works out for you. Everyone makes mistakes, I have learned that if I feel uncomfortable about something it's probably not a good idea.

To clarify, the OP was referring to a sit-to-stand lift, having the patient stand in the lift is it's main purpose.