Fall risk

[zeppzepp2009]

Just wanted some opinions....what are your policies on toileting patients/residents that are alert and oriented, need assistance and not deemed a fall risk by the facility? Do you stay with the pt while toileting or leave and give them privacy and come back for them?

[SuesquatchRN, BSN, RN]

If they are truly independent we leave them alone.

:)

[fuzzywuzzy, CNA]

We only have to stay with them if they have a chair alarm. Otherwise they know to ring when they're done and we'll help them get off the toilet.

[Ev1987]

I would assist them to the toilet, and give them some privacy. There is a call light in the restroom, so they would ring when they're finished.

[zeppzepp2009]

Here's the deal...I am doing nursing clinicals @ a facility....the call light was on outside the residents room and not a CNA to be found. I go in and ask if I can help...resident needs to use the bathroom. I assist resident to the wc and she rolls herself to the bathroom. I make sure resident is safe on the toilet hand the call cord and say pull it as soon as your done, I'll be out in the hall. Resident falls...I get a lashing from supervisor that resident should not be left alone! Supervisor told my clinical instructor to write me up. I checked the chart, was present @ report and not anywhere was there a mention of fall risk...no chair or bed alarms etc. Resident even acknowledged that they knew they should of called. I am beating myself up over this....I feel awful that the resident fell, how am I going to be a good nurse if I can make a stupid mistake like this??

[SuesquatchRN, BSN, RN]

What did your CI say?

It was not your fault if you followed the care plan - which you did. You did not make an error. However, to be on the safe side, don't do that again.

:)

[zeppzepp2009]

My CI stood behind me but said don't ever leave a patient/resident alone on the toilet. I definately learned that the hard way!

[Ev1987]

Oh, I'm sorry to hear that. I know you must feel really bad. I have a status report on my residents, so I know who is stable and unstable on their feet. Of course, if someone has a problem keeping their balance, it's best for their safety to keep an eye on them. Only if a resident is capable to move on their own, at least to their wheelchair or walker, would I leave them alone in the bathroom. Again, sorry you had to go through this, hope everything turns out alright.

[NM nurse to be]

Ouch, sorry to hear that! This is another one of those situations where policy/class and the real world don't quite coincide with each other. Policy at my facility is that NO one is left alone in the toilet. That's the stated policy and if there is an incident, you are at fault.

What happens in reality is that you have to use your judgement. On the skilled hall at night, it's me vs 30 residents. Many of whom are continent (mostly) and mobile enough to get there with help. This is where the dilema comes in. WIth that many, they often want to go at the same time. And there are always those who get tired of waiting and just take themselves. If you stay with every one of them, start to finish, you won't get them all. Some will fall because they tried on their own, you won't get any of the incontinent residents changed, you will spend your night watching people pee. That's the stated policy.

What really happens is you have to use your judgement. With a new resident, I always go and stay either with them or just outside the door, the first time I take them. Once you know them a little bit, you have an idea of what they are like. If it's one I have to stay close to, I plan it so I can do a brief change of a neighboring room (they share a bathroom) or get out someone's clothes for morning. Reality is you WON"T be able to stay with every single bathroom trip.

Management knows this but turn a blind eye *UNLESS* something happens, then it is your fault. This seems to be an unfortunate reality of the job. During the day, you won't have as many residents but it can still get crazy if they all toilet. So you have to learn your residents (I know you are in clinicals, this is a skill you will acquire :) ) and know who you can trust to wait for you to come back.

Good luck with clinicals. You will be a pro in no time :)

[zeppzepp2009]

Thanks guys......all week I answered call lights from residents that were left on the toilet alone. I know in the real world that's what goes on, it's impossible for the CNA's to stay with all their residents. Unfortunately I didn't think twice about leaving her, I learned a lesson from it and thankfully she was fine.

[JDZ344]

If they can walk themselves to and from the toilet, they can be left. They know to pull the alarm if they need help.

If they need help to stand, I leave them alone, and instruct them to pull the alarm when they are done and I will come help. I then (if I can) hover around the bathroom, or at least within that bay.

[smtriemstra]

In the place I work residents can be left by themselves on the toilet if they can get around on their own and are not a fall risk or have alarms. (Chair sensors, tabs etc.) I will leave them on the toilet if I know they will be okay, but if im in doubt as to wether or not they will fall I stay in the room, but give them their privacy by stepping away from the doorway. I've never had anyone fall on me...yet, and Im bound to try and stick by that. I've found people on the floor before, but none of my residents have ever fallen. If its not in the careplan that you need to stay by them, then I wouldn't worry a lot about it. Accidents happen. Just try to go on with life.