Did I jump the gun?

estrogen · Aug 14, 2005

I think you made a very good decision. I work in an ER and have seen falls go bad lots of times. I can see you look out for the best of the pt. Where I work the medics would have done full C-spine immoblization and brought the pt in. especially since it was a un-witnessed fall.

I agree... I'm actually starting to think that they should have taken her. How they knew that she doesn't have a fracture anywhere in her body, I don't know...

chadash · Aug 14, 2005

Here is a question from a plain old nursing assistant: how 'bout that bruise at the temple? Did she hit her head?

estrogen · Aug 14, 2005

Here is a question from a plain old nursing assistant: how 'bout that bruise at the temple? Did she hit her head?

Thanks for that question chadash. I keep thinking about that bruise too ...I don't know if she hit her head. Matter of fact is, that I did find a small, pale bruise on her temple. Like I said earlier, I assessed her head, her neuros and vitals were fine... I informed the doc about the bruise and the paramedics.... The doc ordered neuro checks x 24h (which would have been done anyway as part of the protocol) and that was it...

annlet · Aug 14, 2005

Not at all. Our facility we call 911 for all suspected head injuries especially in those that are non-verbal. Was her family aware of the fall? Could they have insisted she be transported to the hospital for eval????

Annlet

estrogen · Aug 14, 2005

Not at all. Our facility we call 911 for all suspected head injuries especially in those that are non-verbal. Was her family aware of the fall? Could they have insisted she be transported to the hospital for eval????
Annlet

As I allready stated somewhere, husband was called, but didn't pick up the phone right away. Called back a couple hours later and didn't insist on transportations since she seemed stable and w/o pain at that time.

CapeCodMermaid, RN · Aug 14, 2005

Estogen. . .I have been a charge nurse and supervisor in long term care, so I am going to say this as gently as possible, but I suspect someone has already told you this or something similar or you wouldn't have posted. When a resident has fallen, after you have assessed them you don't leave them lying on the floor. A "little bit of a painful response when [you] moved her hip" is not enough to justify that. You suspect a hip injury and then get three or four people into the room and coordinate the moving of this patient off the floor and back into a comfortable bed. You could have slid the patient onto a people mover or coordinated the staff to splint her hip and leg while she was being lifted. The paramedics did what you and your staff should have done. Your first call should have been to the patient's doctor, or whoever was on call for him and you should have spoken with them personally, not by leaving a message with an answering service. Your second call should have been to the patient's family. The third call should have been to the DON to inform her what happened. If the doctor had ordered transfer to the hospital you would have followed your facility's protocol and contacted the appropriate ambulance service and not called 911.
The paramedics are going to talk about this one back at the firehouse for some time. (I'm sorry, but it's true.) Suck it up as a learning experience. Now, you need to look up the symptoms of a traumatic broken hip. You've left out something in your description of your assessment of the patient that you should have looked for with a broken hip. There are two very specific signs of a broken hip that you don't mention assessing for. Decide on what you should have done differently after discussing this with your manager. Have a plan for what you will do the next time something like this happens.
All is not lost. . .we learn from our mistakes. In the end, you did no harm to the patient, but I am concerned that you could have made her more comfortable.

We would have left the resident ON THE FLOOR until rescue came. You can do more damage trying to move an injured elder than leaving them where they are. If possible, we put a pillow under their head and sit with them till rescue arrives.And we all know those s/s of a fx hip....don't always happen in everyone.

I usually call rescue before I call the doc. It's my call whether to send them or not. We got a Gtag once because the doc said "don't send them" ...it was the middle of the night....the man stayed at the facility until I came in at 7, took one look at him, called rescue and sent him to the ER. His hip was fractured. Now all the nurses are more assertive (read bossy) with the docs because we've learned we have to be.

estrogen · Aug 18, 2005

So guess what, everyone. I finally went back to work last night after four days off. The lady DID have a fractured hip and she is still in the hospital. I learned one thing besides trusting my nursing judgment. Next time I won't feel intimidated by paramedics or anyone else and will insist on them taking the patient when I feel like she should be checked out.

boopchick · Aug 19, 2005

It's always better to err on the side of doing more rather than less. You did fine!!!

aandersonrn · Aug 27, 2005

I agree you should send her out if you get her back without anything what a relief, we have a problem with EMT's trying to argue with nurses whether to send a resident to the hospital or not and just stand your ground and stand by your assessment. We have a patient like that he has Lewy Bodies and will be stiff most of the time and mostly unresponsive but I have seen him stand out of his wheelchair and fall before I could run to him.