My patient had a fall.

[regerterb]

Hi guys,

I am a new grad 4 months in , have done 3 months on acute surgical and have now moved to ortho rehab…had a 85yr old male today have a fall. He had had his shower in the AM, was sat in a chair and was told by numerous nurses to call the bell if he needed to get up..GCS 15-understoood everything we were saying and agreed. I would walk past his room every 0.5 hours to check him and ask. As I am sitting at the desk 2 hours later, the cleaner calls out that he has had a fall, he is found R lateral, with a small pool of blood to a head lac. Assessment done, neuro obs completed, GCS 15, remembers event, nil other injuries. Obs repeated once sat up, all fine. LAC to head attended to, bleeding stopped, helped back into bed, no pain. Dr is notified (both rehab dr and attending on call dr-its a public holiday today). The rehab Dr states to do obs 1/24 and neuro obs 0.5/24. The CMO on call comes and assesses him…just says to pop some steri strips to the wound and monitor. Around 1430….3 hours after fall, i do my neuro obs..and patient isn't orientated to time or place GCS 14. CMO notified and goes into a rant saying I should have transported him to ED earlier….ambulance called and transported to ED. CMO on call asks if I am ok with this decision?? I put in an incident form as soon as it happened….I just feel so bad…the Dr just made me feel like an idiot..even though I did everything as he said..if he wanted him transported earlier..he should have said….I notified him of any changes. Have I done everything I should have…I just feel incompetent that I didn't push for transport earlier..but then he had no signs of head injury at that time. The nurse coming onto shift then mentions that last Friday he had a similar episode of confusion when given Tramadol…he had had Panadeine Forte this morning (as per the same CMO)….ugh. rant over.

[Lev, MSN, RN, NP]

As long as you documented your a$$ off you should be fine legal wise. Yes, you didn't everything you should have. It is a provider decision to send a patient out in a non emergent situation. Don't beat yourself up over this.

[regerterb]

I did dont you worry! Plus the delay it took the CMO to get there whilst on call…stating he would wait til 6pm to assess him… -.- I will beat myself up over it….or maybe until I know he is ok..isn't it an emergency situation if the patient suddenly has a GCS 14.?

[K+MgSO4, BSN]

Going to assume your in oz from your terminology and the public holiday :) where the heck was you ANUM or in charge? They need to be supporting you in this situation, I say this as a former ANUM, former NUM and now the person who looks at these incidents, it will be one of the first questions I'd ask.....

[K+MgSO4, BSN]

GCS drop of 1 point is not going to panic me if he has had panadine forte recently. Im young and healthy and that stuff knocks me about. CMO probably should of got their backside in earlier, if you are in tne public system this time of year is when the interns think they know it all 5 months in.

[thenightnurse456]

I'm assuming you're from Oz. yay!

You'll soon realise that Drs often lash out at nurses when they know they potentially made the wrong call. I believe they teach that in med school 😉.

Seeing as there was a known head injury and the fact that you weren't in an acute setting, the Dr should probably have ordered a transfer to ED so the patient could get a head CT and proper assessment.

The lesson to learn is the importance of proper documentation and incident reporting (which you did, so well done). Also whenever a Dr. gets an ego, go to your team leader or NUM asap, that's why they get paid more.

Chin up.

[Here.I.Stand, BSN, RN]

I personally think an immediate transfer in light of an obvious blow to the head would have been reasonable. If an elder has any brain atrophy, s/sx of a brain injury can take longer to show, because with the extra space in the skull, the ICP doesn't rise right away. I also would be more concerned that this was the cause of confusion, vs a little codeine. I mean, it's codeine.

That said, you notified that MD immediately, and were instructed to monitor. You monitored accordingly, and notified the MD at the first sign of a neuro change. (And yes, a one-point drop in the GCS is significant. The first sign of elevated ICP--if increasing slowly; not talking about an unhelmeted biker crashing his head into pavement at 55 mph--is confusion. Confusion takes one point off of the GCS.)

This dr. threw a hissy fit for following his instructions. He should have been mad at himself.

[regerterb]

So an update he was sent back to us post assessment from emergency...then this morning has been sent back as the rn noticed his speech wasn't right this morning....

[regerterb]

Last Friday the rn also noticed this and called for an immediate CT and MSU which came back unremarkable

[K+MgSO4, BSN]

I'm assuming you're from Oz. yay!

You'll soon realise that Drs often lash out at nurses when they know they potentially made the wrong call. I believe they teach that in med school 😉.

Seeing as there was a known head injury and the fact that you weren't in an acute setting, the Dr should probably have ordered a transfer to ED so the patient could get a head CT and proper assessment.

The lesson to learn is the importance of proper documentation and incident reporting (which you did, so well done). Also whenever a Dr. gets an ego, go to your team leader or NUM asap, that's why they get paid more.

Chin up.

No no no. Drs will only act like that if they are allowed to. My surgeons would not dare treat my nurses like that, I do not atand for it as the NUM. First tme, my office for a conversation, second time head of unit gets a call, never been a third. ......

[thenightnurse456]

No no no. Drs will only act like that if they are allowed to. My surgeons would not dare treat my nurses like that, I do not atand for it as the NUM. First tme, my office for a conversation, second time head of unit gets a call, never been a third. ......

Can I work for you? Haha.