Incident Reports: Who deals with this situation?

[jigi888]

Hi,

I work in the community setting and prior to each home visit we need to attend a home visit risk assessment with the patient over the phone and once again in the home to make sure that the home will be safe.

Nurse X attended to a home assessment and marked down that there were no pets. When I attended the home I was attacked by a dog, and a further subsequent 2 nurses were attacked despite my escalation to the NUM, whom discussed this with Nurse X (Nurse X is also the case manager of that patient). Nurse X failed to implement adequate follow up to ensure it did not happen again. I suspect that Nurse X did not actually attend the home risk assessment with the patient and just completed it for the sake of completing it because if she completed it with the patient, the patient would have told her that there was a dog on the premises.

This could be considered falsification of documentation. Anyhow, so I was assigned this patient again and found out that there were still no safeguards put into place in regards to this dog and how to manage it, I escalated it to the NUM. The NUM spoke to Nurse X and nurse X then sent me an email advising that I should have consulted her first about the matter. This is actually the second patient of hers whom has had a dog which I have been attacked by.

What are your thoughts on this? Is this a management issue to deal with due to the falsification of documentation and repeated occurences or is it something which I am meant to approach her about?

[RiskManager]

The RiskManager, who deals with this sort of thing daily, thinks you should fill out an incident report as provided by your facility/agency policy. As I like to say, if I don't know about the problem, I cannot work on it.

[TriciaJ, RN]

If you were attacked by a dog, you need to complete an incident report according to your agency policy. You do not have to run this by anyone, nor should you. According to your post, it sounds as if Nurse X is covering her butt for some lapse in protocol. I don't know what the situation is; you shouldn't worry about it either.

You just report the incident and refuse to return to that home until you have been notified that the dog is no longer an issue. If you have been given the proper assurances, and get attacked again, then you submit another report and not return to that home.

[jigi888]

Hi, yes I did complete and incident report and escalated to my NUM immediately.

This time when I returned (several months after the initial attack) I noticed that the nurse had not implemented anything to ensure the safety of other nurses who visit and dont know the patient so I escalated to my NUM again. The nurse was upset that I had escalated it to the NUM and said that I should have discussed this with her first (this was already the 4th incident by now of the same nature). I advised her that this was not my job to approach her about the issue because she was falsifying documentation by completing the risk assessment when she actually did not.

I raised this with my NUM also and my NUM said that I should raise this issue with the nurse first in the future prior to completing an incident report.

What are your thoughts on that?

[VANurse2010]

Hi, yes I did complete and incident report and escalated to my NUM immediately.

This time when I returned (several months after the initial attack) I noticed that the nurse had not implemented anything to ensure the safety of other nurses who visit and dont know the patient so I escalated to my NUM again. The nurse was upset that I had escalated it to the NUM and said that I should have discussed this with her first (this was already the 4th incident by now of the same nature). I advised her that this was not my job to approach her about the issue because she was falsifying documentation by completing the risk assessment when she actually did not.

I raised this with my NUM also and my NUM said that I should raise this issue with the nurse first in the future prior to completing an incident report.

What are your thoughts on that?

Your manager is full of s. This isn't some interpersonal conflict over a minor policy. This is a major health and safety issue that involves documentation and BON issues - not something you "work out" with the coworker. Manager needs to do her damn job.

[jigi888]

Thank you. I was just wanting to see other peoples opinions on this issue to see if they correlated with mine.

That is a WH&S, performance management issue, not mine to deal with and something that I need to inform the nurse of as it is EXACTLY as you say, its not something i need to 'work out' with my co worker.

[TriciaJ, RN]

Here is the problem: if someone becomes injured it could become a Worker's Comp issue. Then your agency will be in hot water for not addressing a known problem. Is your agency a small or struggling one? If you don't think they're taking safety issues seriously you can try reporting them to the labour board. Might be time to look for a new job.

[jigi888]

Hi, its a large organisation. There has been lots of reshuffling, lots of people in acting roles which may not be the most suitable.

I have been considering looking for another job because I have seen that the standards here compared to my previous roles as quite low, inadequate handling of situations etc. And at the same time I think to myself, why should I have to leave because someone else is not doing their job properly? I do think I will probably leave before the end of the year though, this role is causing a major moral conflict.

[jigi888]

Riskmanager, would you have an expectation that the nurse who had been attacked to bring this up with the nurse who made the breach?

[RiskManager]

Riskmanager, would you have an expectation that the nurse who had been attacked to bring this up with the nurse who made the breach?

I would not necessarily have that expectation. Having said that, and having managed people for a long time, it is usually a good thing when staff are empowered to discuss and resolve these issues on their own and are able to do so. This is not always feasible, though.

[jigi888]

So it's been a few months since this has occurred. Here is what has happened since...

Another nurse has been bitten by the dog, had to present to ED as a result of it. Management finally decide that the patient needs to come into our clinic to be seen however this is short lived as the patient complains that it is too hard for him to get in there. My manager then says 'this is your last chance, make sure the dog is locked away when the nurse visits' (note that the dog has already bitten 4 nurses previously).

Another nurse visits and gets bitten again last Thursday (management had implemented a risk mgt plan of contacting patient 30 minutes prior to Lock the dog away after the initial incidents, obviously it isn't working as patient locks the dog away but then still will let the dog out when the nurse is there). The acting manager then says, call 30 mins prior, make sure the dog is locked in the garage and if it isn't then leave. My question is "why the hell are we still even going to this patients home, they are obviously non compliant with what we put in place, how many nurses need to get bitten before this madness ends? Why is management not managing this properly? ARGHhHHHh.

So I have contacted the next manager up to tell her of the WH&S risk and inadequate management of the situation and detailed every incident which has occurred, her reply seemed somewhat defensive and I suspect that she may have played a role in the some of that decision making process. Finally got the result which should have been implemented from the start - no more home visits for that patient but... Let's see how long it lasts for this time.... Rant over