Incident reports

jschut, BSN, RN · Jun 20, 2003

Wow!

We have one page to fill out and of course, need to chart on it in the nurses notes. We too are to ask to see if anyone knows what happened.

If injuries, we need to do a set of vitals q shift 24 hrs, or a head injury, initiate a neuro check...

But 15 pages? Wow!

Rnltc · Jun 20, 2003

I am from the state of WA and ours is the same as in about 15 pages. The nurse on the floor starts the I&A which is about 10 pages a lot of it front to back and the RCM and DNS has to finish. When a resident is a/o and knows what happens as in he bumped his hand when getting into his dresser which we all do, we still have to complete the whole thing, then look at what could we have done to prevent this as in pad his dresser and then look at each resident in the building and do the same thing for them as in prevention. I even had one survor tell me on a male who liked to sit on the toilet for about 20 minutes and was on comidan therapy got a 2cm bruise in the middle of his back from leaning on the back of the toilet I should have and need to pad the back of the toilet and look do that for all other 75 residents........Let's get real here....

I could just keep right on going with story after story, but there are just things that happen as part of every day life.......

nightingale, RN · Jun 20, 2003

Yuck 15 pages!

Ours is 1 sheet front and back.

Hang in there!

Talino · Jun 20, 2003

15 pages???

... must've been designed by a defense lawyer :lol2:

-- sorry :) , but you're absolutely right ... it's the extremes.

Unfortunately, to protect oneself from a litigious society, health care professionals and institutions often resort to a voluminous and thorough documentation.

Doing the extremes provide a sense of security.

.... and after you completed that 15 page report, you need to write a nurses note. Make sure you mention it in the 24-hour report, too. And, don't forget to update the care plan. Did you call the family? :devil:

Sharon · Jun 20, 2003

It sounds like your facility has combined the initial incident report with the safety investigative report. Maybe you could suggest that they separate the two. The individual assigned the duties of risk and safety manager should do the safety report. The safety report duties in small facilities can be divided between the Occupational Health/Employee Health Nurse and the manager responsible for the facility insurance. When the duties are divided, it is usually along occupational injuries/illness to the Occ Health Nurse and patient safety to the other manager.

CapeCodMermaid, RN · Jun 21, 2003

Thanks for all the replies. This form is supposedly an easier version of the long form. Just once I would like to submit an incident report with 2 words on it: SH** Happens!

2bPhD · Jun 21, 2003

I feel your pain. I know how those 15 page incident reports can be. I have some information that may actually help. Remember that the concern is that the bruise may have resulted from mistreatment, however I have found that many people refer to every purple spot on someone's skin a bruise. There is a difference. A bruise is a layman term often used for contusion which is swelling, discoloration, and pain that results from an injury. The edges of a contusions are usually smooth. Contusions can result from mistreatement and should be investigated. Ecchymoises is a blue/purple discoloration on the skin that is caused by extravasation of blood into the SQ tissue that occurs when vessel walls are fragile. Ecchymoises usually has irregular edges. Ecchymoises is common in the elderly because of thin skin, especially when they are taking anticoagulants or steroids and occurs with minimal trauma to the skin. Sometimes just a little bump will cause this. Purpura is a small blue/purple spot that occurs when there is a hemorrhage into the tissues. Older adults often have purpura (sometimes called senile purpura) due to fragile blood vessel walls that rupture without trauma. Differentiate between the three and tell the staff to avoid using the term bruise as it can be misleading. Investigate bruises but just document ecchymoises and purpura. If you have a patient who gets a lot of either of these, get a derm consult to confirm that it is a skin disorder and not from trauma. Hope this cuts down on the paper work.:)

gwenith, BSN, RN · Jun 21, 2003

Originally posted by Rnltc
I am from the state of WA and ours is the same as in about 15 pages. The nurse on the floor starts the I&A which is about 10 pages a lot of it front to back and the RCM and DNS has to finish. When a resident is a/o and knows what happens as in he bumped his hand when getting into his dresser which we all do, we still have to complete the whole thing, then look at what could we have done to prevent this as in pad his dresser and then look at each resident in the building and do the same thing for them as in prevention. I even had one survor tell me on a male who liked to sit on the toilet for about 20 minutes and was on comidan therapy got a 2cm bruise in the middle of his back from leaning on the back of the toilet I should have and need to pad the back of the toilet and look do that for all other 75 residents........Let's get real here....
I could just keep right on going with story after story, but there are just things that happen as part of every day life.......

Sorry just had a mental image of a patient in a straight jacket in a white padded room and the nurse saying "Well it is the only way we can guarantee that they will not get a bruise!!!"

You are right and investigating every incident as if it is abuse will not uncover true abuse and neglect - it will only foster a culture of "cover up". If the underlying intent of these 15 pages is to uncover abuse then there should be a method of determeining patterns of abuse that do not go overboard.

CapeCodMermaid, RN · Jun 21, 2003

2bPhD-I've talked myself blue in the face trying to explain to my DON and ADON that all purple/blue/dark spots are NOT bruises or contusions. They don't care. They are concerned someone will accuse of us not keeping our patients safe. There was one LTC in the next town which did not investigate reports of possible abuse and suspicious bruises and the DPH has swarmed all over them.

And the falls investigations are about at bad...we practically call in CSI to find out what happened.

2bPhD · Jun 21, 2003

Cape - I know what you mean. I have had the same thing happen to me. In one facility where I was working it seemed like there were 2 or 3 people who had the majority of the "skin discolorations". We were able to get the attending physician to document in her chart and diagnose her with senile purpura. This helped in our defense. Another person was sent to see a dermatologist who documented that the discolorations were not due to trauma and that they would be chronic. It is a shame that we spend so much time in LTC dealing with things that are really unimportant that we don't have the time that we need to address real issues.

CapeCodMermaid, RN · Jun 21, 2003

2b-Perhaps the REAL shame is that there are facilities and people who DO abuse elders. We are paying for their 'sins' and are guilty by association.