Fall in the ED!

I don't know your hospital policies.

At my place, a pt with confusion, elevated ammonia level, regardless of the fact that they tend to be elevated, would never be left alone in a bathroom. It's a fall risk, we can't leave fall risks alone in the bathroom.

The drunk seizure person, would have gotten 4 pt leathers and a security sitter, most people can get out of soft wrists, especially a drunk person. I know not every hospital has security, but what is the policy in your place for leathers?

What I'm learning is even though the ed is sep from the hospital, our #s contribute to the entire place. Falls are huge in our inpt setting, the head boss lady is getting yelled at from her boss, which trickles down. Falls are huge, reportable. You can also be cited and fined for falls.

Unfortunately, I don't think the 'we didn't have enough staff' line holds up in court, which is a reality for us. What is your back up? The doctor didn't want it? Wanna talk throw under the bus? Go to court, the doc will toss you.

IMO, even though you strive for a 'team'. You are floating solo. You need to make sure you're charting tactfully. Charting such things as medicated with Ativan for seizure activity per md, fall risk protocol initiated.

Pt begins to become agitated, chart it, notify md, chart provider aware, no new orders. Notify charge nurse, chart it ect ect you get the picture.

so the meeting with my supervisor went really well and he is chalking it up to making some policy changes in our department. Im not gonna get fired or even written up and he asked my suggestions on how we can change since apparently I wasn't the only incident. As far as leathers go sassy they are reserved only for extremely violent patients. That ammonia pt wasn't left alone in the bathroom he was in his room after I got done taking him to the bathroom. I understand the falls thing management wise. I know the doctor and he is not that type, he would back me cause he knows I practice well. We do work as a team we just handle our patients and chip in on difficult ones then go back to ours. We ask for help when we need it. As far as charting goes we are all electronic and all that is charted and I made a BUNCH of notes about everything that happened. on a separate note they are looking into not doing restraints on intoxicated pts because of an aspiration problem that occurred to someone else. I am worried about when our busy season kicks in how were are going to be having all these sitters etc when we have like 200 pts per day ><. the director really put my fears to rest and clued me in as what hes doing i have say was impressed. moral of story don bother with restraints on a seizure person just go straight sitter if they are intoxicated well. we will start putting drunk patients purple scrubs from now so stand out more. thanks for your input>

Glad that it turned out well THIS TIME.

It sounds like management is trying to make some positive/workable changes.

However, remember your first instinct was.. you were in trouble, going to be fired, etc.

Wouldn't hurt to keep your eye open for a better work environment.

By the sounds of things, you did everything that is correct. If someone wants to fall, they are going to fall. The ONLY thing I can see wrong is that initial patient you shouldn't have left alone (but lets face it, we all have to at some point occasionally). As long as you documented these interventions that you did, tehy actually don't have a leg to stand on. You were NOT negligent in your duties. Simple.