Incident at work.. what happens in this case?

[changeofpaceRN]

Some background first: I'm a new LPN still on orientation (only been there 1 week). The LTC place where I work doesn't require charting on every patient unless they have specific insurance ect, we don't do daily skin checks plus I work 11-7...

Anyway, a few days ago I charted on one who needs daily charting. Patient refused his 12am meds, he does on a regular basis and is on psych monitoring for his aggressiveness/combative nature.

So, I got the neb treatment ready and started talking to him. I told him I was going to put his neb treatment on. As I went to put it over his face (he has a face mask that delivers the treatment), he smacked it away, grabbed my arm and pushed me away as well. I didn't think anything of it so I charted something like "12am patient was aggressive and refused neb treatment. Advised will try again at 6am and patient agreed. Call light within reach" and that's it.

The next day, the day shift CNA found a type of reddened area/blister on his foot so that was charted as an "incident". Anyway, this blister ended up turning bluish so they had an x-ray done. Turns out patient has a fractured toe.

I get a phone this morning from risk management asking about the patient (since I was the last to chart the day before the toe was noticed). She asked about about him being "aggressive for his treatment" per my note. They asked if I had noticed him kicking his foot around and maybe kicking the siderail. I said no it was just with his arms from what I remember.. so then I get questioned some more- still don't know how it happened. The CNA caring for him on the night shift never reported anything abnormal when she went to get him dressed.

So now, since they don't know how he got the fracture, they are turning in the incident to the state for investigation. What the heck does THAT mean?? As a new nurse, I'm scared of this kind of crap and what can happen, is this something that can go as a strike against me? Is this something to freak out over? Of course, this is ALL I can think about and it's going to ruin my ONLY day off this week. Any words of encouragement are welcome :-):uhoh21:

[caliotter3]

Try to calm yourself down. Don't go off the deep end until you have reason. You have already done all you can do at this point. This is an argument for a 100% body check each time you work, but every LTC job I was at only "required" weekly body checks and sometimes these were recorded by the CNAs when they gave showers. It is impractical to do a thorough exam each time you start a shift, particularly when your patients are asleep. So just try to relax. I know this is hard to do at this point, but that is what you must do. Otherwise, your daily work will be affected.

[star2nite2000]

Should state step in and want to do a further investigation....all you have to do is tell the truth. Don't worry about it. State has so many things to investigate, nothing may ever come of this. What I usually chart when a resident is aggressive is go in to a little detail (flailing arms, hitting at nurse with arms, legs, etc. ). That just covers me should any 'injury' arise and the management tries to pin it on someone. You're a new nurse and all this will just come with experience, the good and the bad. Hang in there! It WILL be all right!

[TheCommuter, BSN, RN]

Try to be more subjective when writing nurses notes next time. Instead of writing that the patient was being aggressive, document that the patient smacked the nebulizer away, grabbed your arm, and pushed you away. "Aggressive" is a subjective opinion made by you, but you'll be better covered if you document the facts objectively next time.

By the way, this is nothing to worry over. The state comes into the facility for falls that require hospitalization, some fractures, and so forth. As long as this patient has psych issues and behavioral problems that have been clearly documented in the nurses notes over an ongoing period, you'll be fine.

[sassiebaz]

I think in this case you shouldn't worry but, this is the kind of thing I am afraid of when I become a nurse. Not this exact situation but in general. The elderly are fragile by nature(age) and I know when I was doing home care I had a patient compalining about her hand/wrist. I wasn't sure what to do and she insisted on a heating pad. Turns out she had a hairline fracture and I shouldn't have let her put heat on it. I didn't know that at the time but I still wonder how the fracture happened in the first place. The answer is...a million ways....

[pagandeva2000, LPN]

I wouldn't worry either, and as others have stated, next time, write a bit more detail about how the patient acted. This covers you. Easier said than done, but try not to worry about it. Patients act like this every day.

[Perfectms10]

Don't Worry; I'm a Nurse Case Manager and in Mass all fractures get reported to the state. It's routine.