first patient fall

[baby.nurse123]

I am a new RN, still within my first year of practice. The other day, one of my patients had a fall and this is the first patient fall I've had to deal with. We set the patient up in a chair with his table over the chair, call button/personal items in reach, nonskid socks on etc.... One of the therapists working with the patient earlier offered to move his chair closer to the doorway so he could be seen by staff passing by, but I told her he would be okay, he was watching tv at the time and had been using the call button all day if we weren't in his room at that moment. Then I had about a thousand things going on with my other patients at the same time. When the aide came to round on him 20 minutes later, she found him in the bathroom sitting on the floor. I assessed him--the vitals were fine, he hadn't hit is head, orientation was at his baseline, and had only a small bruise on his knee with no pain. We assisted him back to his chair and moved him to the closest room to the nurses station that was available. We did apply a bed alarm, though my experience has been that you can't always rely on it (because sometimes it doesn't always go off or the patient just moves so fast). I notified the doctor, did my documentation to address all the formalities that come with it.

I just feel so bad about this and honestly very stupid :smackingf because thinking back on it, I know this probably could have been prevented if I had just let her move his chair closer to the doorway. And maybe this sounds silly, but can I get fired for stuff like this? I'm so afraid to lose my job and/or license because this was such a huge lapse in my judgement and totally my fault...

[Palliative Care, DNP]

Accept the learning experience and move on. Luckily, he is ok and without serious injury.

[MN-Nurse, ASN, RN]

Moving his chair closer to the door may or may not have made a difference.

Unless everyone is under constant watch (and even then), there will be falls. As long as you did what you could and handled the situation properly after the fall happened, there's not much you can do.

[CVmursenary]

you shouldn't be disciplined; its not your fault. There is only so much you can do to prevent someone else from hurting themselves.

[decembergrad2011, BSN, RN]

I recently had a patient fall that scared me and I felt like I had made a huge lapse in judgment. If you followed all protocols after discovering him, I think you acted professionally and competently. Apparently a lot of patients fall. As far as moving on - Fall risk assessments might be something to add into morning report? Some charting systems require it as part of the physical assessment.

[SweetseRN]

Realistically, I have no idea how you could have prevented this accident. Most falls do happen in the bathroom. I am sure you are really upset but I really do not think you are at fault. I would love to hear ideas for how this could have been prevented but I honestly do not know what you could have done differently.

[honeykrown, MSN, NP]

I had my dirst pt fall last week and i have just been on the floor 3wks. Everyone told me there was nothing i could do about it since she was non compliant all of a sudden. we moved her room xtra closer to the nurses station and even had to move the bed down so they could see her feet. Some patients need sitter but if your hospital does not utilize them, there's so much you could do.

You can be with one pt and ignore all your pts because they are fall risks

[pumpkin455]

It happens to the best of us...I have had 3 people fall in the 2 years I have been a nurse, and I beat myself up every time! Sometimes there is just nothing you can do...pts are fast getting OOB and some are so confused that you just cannot make them stay in the bed!! We recently got cameras that we put in the pts rooms that we can watch at the desk so we catch them when they are starting to move...best invention ever!

[nightengalegoddess]

Since you are new it will probably be ok. A singular fall is no reason to be fired; especially since no harm came to the patient. But if you have had any 'enemies', a fall can be the beginning of harrassment. In fact, anything can be the beginning of harrassment when you have an enemy. But it sounds like you did everything right afterwards, and next time, you will be moving the patient closer to the door; as well as documenting that the patient is a fall risk before they fall. Also, I found it helpful to notice my fall risks right away on walking rounds and document right away that I had discussed fall prevention with all the details listed...and that the patient either verbalized understanding or needed reinforcement..(more documenting of reinforcement throughtout shift)...and then religeiously using the bed alarms when someone is at risk..etc. Just making your communications and documentations crystal clear that you have done everything available to prevent a fall on a person you assesss at risk...whether or not your hospital has a formal fall risk assessment.

I had a patient fall once..she was physically and verbally brutal with me, insisting on leaving her alone in the bathroom. I foolishly allowed her to be alone while I stood out the cracked door, and then...THUMP. Thankfully no harm came to her...but harm came to me from my employers! Tied between the "customer is always right/satisfaction score stress"...and the responsibility of providing safety it is difficult at moments to make the right decision.

My new employer and I discussed this event at my interview when I was asked about a learning experience. I was told in this hospital, safety comes before patient satisfaction. What a relief. Now, if I had had this patient again....it would simply be the bed pan for her. That way, I wouldn't have gotten bruised and scratched as she was screaming at me to leave her alone. Frankly, this particular patient was going to fall somehow. It was part of her attention seeking behavior. She didn't like me to begin with, and I should have known I would be some kind of target for her. Ugh. Never again.

[canigraduate]

I work on a floor that has a lot of elderly patients, therefore a lot of fall risks. I have a lot of experience with this kind of thing.

When reading your post, what I immediately noticed is that 1) You did everything you were supposed to do and 2) Nobody witnessed the fall so you don't actually know if he fell or just sat down.

In this case, I don't think you should be worried. However, since you sound totally freaked out, here are some suggestions about how to prevent falls.

1) Push for chair alarms. At my facility, if we get a fall risk out of bed we have to place them on a pressure sensitive alarm. This works wonders.

2) Put patients in a recliner with the feet up and under a table. Most of the ones who are fall risks aren't physically and/or cognitively able to get around these obstacles. You can always use pillows to make them more comfortable and help keep them in place, too.

3) If you have someone who is persistent about trying to get up alone and you can't get a sitter or a bed net, put them at the nurses' station temporarily. I've had to do this for some of my Alzheimer pts until their sundowning phase passes. (Obviously, this only works for patients that can sit in a chair.)

4) Never leave a fall risk patient alone in area that is not in a clear line-of-sight. I've had to put patients in doorways many times.

5) Use the walls as much as you can. Put a fall risk patient's chair or bed right up against the wall if you can. It is a lot harder to get around than rails or elevated recliner feet.

Hope this helps some!