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Freaking out over a patient fall!!

Safety   (1,531 Views 24 Comments)
by Zara9897 Zara9897 (Member)

17 Likes; 846 Visitors; 26 Posts

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Hi guys, it's been a while. I've just been sweating buckets about something and wanted to get some opinions.

So, I was at clinical this morning from 0630 to 1400. I had a patient with renal/hepatic problems. He was a stand by assist 1. I answered his call light & he said he wanted to go to the bathroom. I looked around for a gait belt & couldn't locate one. He said that he is fine with just a walker. Now, we're told to always use a gait belt. I messed up and took him to the bathroom without one. Once he was done with his business, I went in to get him off the toilet (he had his walker in front of him & I was helping him to stand up. We locked arms and he was getting up when his right knee buckled and he fell to the side. I held on to him and tried to lower him as far as I could until gravity took over. He fell on his butt and later stated that he had some back pain (he normally has chronic back pain & I guess this aggravated it). I assessed him at the time and called in his primary nurse right away. She told me I should have probably used a gait belt (turns out it was behind the open door, tucked away on top of a table). She did say that it probably wouldn't have mattered anyway considering his knee buckled under him. They called in the doc and he said the same thing & suggested that he be more mobile to strengthen his muscles. 

My instructor on the other hand said that she would have to write me up anyway (which I completely understand). The thing is, she told me to meet her tomorrow after our exam to talk it over with the dean of nursing.

I am freaking out about this soooooo much and I can't afford to because of my exam but I can't help it. I'm worried this might cause me to fail my clinical portion (and in turn, the entire semester -- this is my last semester before my NCLEX btw). Thoughts? I feel like I'm overthinking things but its just how I am. I can't get this whole day off my mind. . .

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bsyrn has 18 years experience and works as a School Nurse.

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You know you messed up so you certainly don't need anyone harping on that. Unfortunately, patient safety is taken extremely seriously so there could be some dire consequences. I would go in totally prepared with what you learned and how this will never happen again. It really doesn't matter what the doctor or nurse said, bottom line is the gait belt should have been used. I am hoping for the best outcome for you!

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Persephone Paige has 15 years experience as a ADN and works as a Med-Surg.

293 Likes; 3 Followers; 1 Article; 3,102 Visitors; 558 Posts

Don't know what to say about this situation except, 'sorry.' I no longer 'get someone up' to the bathroom alone anymore unless I know them. I'll call the aide and we can do it together. I used to let the patient's urgency to not have an accident cause me to feel compelled to get them up, 'right now!' Not anymore, I'll get help. If he has an accident, we'll clean him up. I'm old too. I didn't sign up to blow out my back either.

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8 Likes; 316 Visitors; 16 Posts

I was so anxious about having this happen to me, that I actually bought a gait belt off of amazon. - I know how busy things can get and things might not be where I think they are or where I need them to be.... unless I have it right in my pocket. *  maybe when you meet with the dean, tell them as part of your plan to make sure this never happens again- that you’re going to buy your own so you always have it on hand. 

a lot of times folks don’t know their own limitations- (i mean don’t we all?!) I’d rather use a belt and it not be necessary than something bad happen 

 

good luck tomorrow. I hope it’s just a “let’s talk about this CI and how to prevent it” 

 

* ok it’s not just the gait belt, I literally have an entire arsenal of stuff , pulse ox, bp cuff.... planning on getting a temporal thermometer too at some point heh.....

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51 Likes; 4,697 Visitors; 278 Posts

Take a few minutes and write down (really, write em down) a few things you can think of that may have contributed to this fall. From the beginning of the situation to the end, both your own errors and other factors present that might have contributed. 

- Was there a common place to put gait belts so that staff would know where to find them? Was the toilet seat the right height for him? Were there bars on the wall of the bathroom the patient could use to assist himself? Should you have asked for a second RN/student to assist you? Was a second RN/student available if you had? Is using a gait belt the policy at this institution? Would a gait belt have kept him from falling or simply pulled you down with him? What medications was he on?

Go in to the interview with a thoughtful analysis of the situation and without trying to avoid blame personally. Having a list will let you feel (and be) prepared. And once you're prepared, do your best to forget about it until the interview happens, and focus on other things.

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17 Likes; 846 Visitors; 26 Posts

Thank you guys soooooo much. I have probably released enough tears to fill a bathtub. The meeting was actually not a meeting. They just told me that I needed to recognize what happened and that they had to kick me out of the program. I got kicked out today and I have an appeal set for tomorrow. My instructor told me that i have a very clean record and that I know what I did wrong and what I will never repeat again. She told me to use this. I was also told that there is a possibility that the school can get sued and (me in turn). These posts have really helped me clear my head and prepare myself.

Honestly though, I’m so thankful for your guys’ input bc you guys don’t know me and I tried to give all the facts — I’m killing myself thinking how much I should’ve just stepped out of the room and asked for a gait belt (one was hidden in the room and yes it’s supposed to be hanging by the door). I just wanted people who would give it to me straight. 

Anyway, I can’t change what’s happened but I just REALLY can’t imagine not being a nurse or even restarting the semester. I’ve alreafy prepared for graduation and even reached out to a couple of job positions. God willing, it’ll go well and I’ll be able to continue. Thanks again xx I’m going to go prepare and pray for the best

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17 Likes; 846 Visitors; 26 Posts

3 hours ago, Persephone Paige said:

Don't know what to say about this situation except, 'sorry.' I no longer 'get someone up' to the bathroom alone anymore unless I know them. I'll call the aide and we can do it together. I used to let the patient's urgency to not have an accident cause me to feel compelled to get them up, 'right now!' Not anymore, I'll get help. If he has an accident, we'll clean him up. I'm old too. I didn't sign up to blow out my back either.

This was exactly the situation. He was on lactulose and was 50 so he really didn’t want to “go” on the bed. I slipped his grip socks on first and complied when he said he was fine with the walker. It says in the hospital report/documentation that his right knee tends to buckle. My instructor included that in her report too (it was not in his chart). It was all just a mess from the beginning but I felt cornered and felt that it was emergent. It’s true though, I would have rather just cleaned him up. I will definitely take that into account from now on though. If i don’t know the patient, i will get an aide or someone to help me

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Sour Lemon has 9 years experience.

653 Likes; 2 Followers; 28,767 Visitors; 4,047 Posts

44 minutes ago, Zara9897 said:

Thank you guys soooooo much. I have probably released enough tears to fill a bathtub. The meeting was actually not a meeting. They just told me that I needed to recognize what happened and that they had to kick me out of the program. I got kicked out today and I have an appeal set for tomorrow.

 

You have got to be kidding??? Good luck with your appeal. I can't believe they kicked you out for this with no prior issues.

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Persephone Paige has 15 years experience as a ADN and works as a Med-Surg.

293 Likes; 3 Followers; 1 Article; 3,102 Visitors; 558 Posts

3 hours ago, Zara9897 said:

This was exactly the situation. He was on lactulose and was 50 so he really didn’t want to “go” on the bed. I slipped his grip socks on first and complied when he said he was fine with the walker. It says in the hospital report/documentation that his right knee tends to buckle. My instructor included that in her report too (it was not in his chart). It was all just a mess from the beginning but I felt cornered and felt that it was emergent. It’s true though, I would have rather just cleaned him up. I will definitely take that into account from now on though. If i don’t know the patient, i will get an aide or someone to help me

It happens often on our floor. Almost everyone is on Lactulose and they all want to make it to the bathroom with their dignity in tact. We are a 1:6 nurse/patient and a 1:12 aide/patient ratio, I tell 'em to sit tight. If we have to clean up, we will. We simply cannot be everywhere AND be safe. Also, a bedside commode. Put it right next to his bed... Then it's just a pivot transfer.

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TriciaJ has 35 years experience as a RN and works as a Retired.

1,084 Likes; 5 Followers; 30,716 Visitors; 2,770 Posts

Hopefully by now you've had your talk with the dean of nursing and it went ok.  (I think that was a bit of overkill for a typical rookie mistake.)  The big reason everyone gets in a tizzy over a fall is because if the patient is injured enough to require additional hospitalization, Medicare won't pay and the hospital eats it.  It's a money thing.

Not that falls should be taken lightly.  They can cause serious injuries regardless who is paying the tab.  I think the doctor and primary nurse were probably right:  a deconditioned patient with a bum knee probably wouldn't have been saved by a gait belt.  It's just better CYA on the incident form when you can say one was in use.

Please stop freaking out.  The patient is as fine as he was going to be and your school just wants to put the Fear of God into you.  Which you obviously already have.  Do something nice for yourself when you get the chance and try to put this behind you.

 

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TriciaJ has 35 years experience as a RN and works as a Retired.

1,084 Likes; 5 Followers; 30,716 Visitors; 2,770 Posts

1 hour ago by TriciaJ, RN

TriciaJ has 35 years experience as a RN and works as a Retired.

 786 Likes; 6 Followers; 30,335 Visitors; 2,685 Posts

Hopefully by now you've had your talk with the dean of nursing and it went ok.  (I think that was a bit of overkill for a typical rookie mistake.)  The big reason everyone gets in a tizzy over a fall is because if the patient is injured enough to require additional hospitalization, Medicare won't pay and the hospital eats it.  It's a money thing.

Not that falls should be taken lightly.  They can cause serious injuries regardless who is paying the tab.  I think the doctor and primary nurse were probably right:  a deconditioned patient with a bum knee probably wouldn't have been saved by a gait belt.  It's just better CYA on the incident form when you can say one was in use.

Reposted from original thread.

Edited to add:  I can't believe they kicked you out of the program for that.  Sending you good thoughts for your appeal.

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KJoRN81 has 4 years experience as a RN and works as a Med Psych RN.

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Update?

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