patient pretending to fall?

[LibraNurse27, BSN, RN]

Today I was caring for a patient admitted for hernia repair and alcohol withdrawal. He had minimal withdrawal symptoms and was alert and oriented x 4, talking with me and making sense, using the call light appropriately all morning. He asked to get up to use the bathroom so I stood by as he transferred to the commode and he did well with the walker without assistance. He asked for some privacy so I stepped out but instructed him to call me for assistance back to bed and gave him the call light; he agreed.

He called so I returned to the room and saw he was already sitting on the bed. The commode was still next to the bed and full of stool. The patient then stated that the commode had tipped over onto the ground when he stood up and caused him to fall and hit his head, hip and back. I notified MD and initiated the protocol for unwitnessed fall but was so confused about how the commode could have tipped over but then be in the same place I left it with nothing spilled on the ground. The MD said the patient comes in often for withdrawal and always wants pain meds and ativan, stating he was punched or beat up etc. After the fall he did keep requesting pain meds and he frequently requested ativan although he had no withdrawal symptoms. I am wondering if I was wrong to leave the room and ask him to call because he was A and O 4 and if I was right to do the falls protocol although I am not sure if the patient truly fell. Pt examined by MD without evidence of injury. Any input is appreciated! So stressful

[111th, ADN, LPN]

People are nuts. í ½í¹„í ½í¹„ You did the right thing though. You have to report facts, which include the patient stating he fell and hit his head.

If the patient is AOx4, steady on their feet, etc. I would have allowed him privacy as well. I usually stand next to the door or behind the curtain though so I probably would have questioned the patient, "you fell? I was right here and didn't hear a thing. Wow, how did you manage not to spill that full commode?" and maybe prompted him to be truthful. If he maintained that he fell, then of course I'd have no choice but to follow protocol.

[adnrnstudent, ASN, RN]

I deal with fake falls all the time. When they do it, we discontinue all narcs. Narcotics are fall risk drugs and we don't want them to fall again.

[JKL33]

TBH I have handled it the way you did at times, and other times I have said something like, "that's too bad" and gone about my day. Usually somewhere in the middle, such as gently challenging the claim as described by previous poster.

You can't control what other people do/say, and you didn't do anything wrong here. Just document factually. Also, resist the urge to focus on self when describing, documenting, or reporting - leave that drama out of it so you don't end up looking like you actually need to defend your own actions. That's about all there is to it. Stay calm, be factual. Wait...there is one more thing: Always investigate a patient's claims. This incident was pretty easy to investigate, but the next one may not be. Don't blow people off based on things like their reason for admission or difficult behaviors. Be prudent and act in their best interest.

Everything's okay! No need to stress about it any more. :)

[Been there,done that, ASN, RN]

The patient is an expert at manipulation. He was seeking drugs for the "pain" from the so called fall.

You followed fall protocol and surely you documented the scene of the fall. You did nothing wrong.

It was a good lesson, now you know what addicts are capable of.

[Marija1]

I want to ask a question here but don’t know how?

[Orion81RN]

24 minutes ago, Marija1 said:

I want to ask a question here but don’t know how?

A question in regards to this post on a fake fall? Or a question in general that you want to create a thread for? To start a new thread with a question, click the green "Add new topic" button.

[LovingLife123]

I would not have left a withdrawing pt alone. They are automatically and fall and seizure risk. I just tell them, sorry, no privacy when you are a fall risk. In the icu, I have very few that are not a fall risk. But a pt who is actively withdrawing and getting Ativan is a fall risk.

You did the right thing though. I had a person fake fall one time. I had all of the precautions in place. He was wanting Ativan and faking seizures. He actually got out over 4 side rails up. The part I hated most was I had to cancel his transfer order and then complete all the paperwork and CT.

I was like, really, dude???

[VivaLasViejas, ASN, RN]

In LTC, I had a resident who "fell" several times a day, until one evening when I caught her putting herself on the floor and then yelling "Help!" We had to care plan this because she was A&O and, unfortunately, very needy. The "falls" were obviously a cry for attention. We had a psych eval done which revealed a previously undiagnosed anxiety disorder, and once she was put on Buspar and given counseling for a few sessions, the behavior became less frequent, although it didn't stop entirely. At least we didn't have to keep running a tab on incident reports...I half-expected the Sierra Club to file a lawsuit against the facility because we were killing so many trees in keeping up with her!