Nursing Home- Patient falls?

[anonymous1919, LPN]

Scenario:

70 year old resident is ambulating in the hall and falls on his R side. You assess him and he appears to be able to move in R shoulder and R hip with out any pain. You follow protocol and document the fall, call the residents wife, and notify the house manager and doctor. All is well, right?

Or would you also request the doctor order an Xray for his R shoulder and hip? I have seen some LPN's request this and others determine it is not needed. Isn't it risky to not order an Xray? And what if the doctor says based on given information he/she does not deem it neccessary? Would you chart that you requested for an Xray and the doctor denied?

[RNGrammie]

in our facility, an rn does the assessment and based on that assessment relays the info to the md and it is then decided whether an xray is warranted or not.

not always is an xray necessary, especially if rom is wnl for the individual and the resident denies pain.

[anonymous1919, LPN]

in our facility, an rn does the assessment and based on that assessment relays the info to the md and it is then decided whether an xray is warranted or not.

not always is an xray necessary, especially if rom is wnl for the individual and the resident denies pain.

ok. where i worked it was the lpn who did the assessment. so if you chart rom is wnl and resident denies pain... and 3 weeks later for whatever reason the resident is found to have a fracture... are you introuble? or ok?

[proudtobeRN777]

never forget to order the Xray , it will take 5-10 minutes but u save yourself doing this.......

[ktwlpn, LPN]

No one should be in trouble-even an x ray may not pick up a fracture especially if it is non-displaced. That may be the case herei.It was non- displaced and some movement 3 weeks later displaced it. Does not matter who may have assessed it.Did the resident complain of pain during the 3 weeks since the incident? If that is the case then everyone involved in his care is neglectful but your post does not say that he did so. NO x ray needed if the resident does not appear to have pain during ROM-if you xrayed everyone every time they fell they would all glow .Unneccessary and cost prohibitive,IMHO.

[proudtobeRN777]

in my facility policy is to send the resident to the hospital for every unwitnessed fall even if the patient falls twice in 1 shift u have to send them to the hospital ...and i have done it no matter what the ambulance think, what the hospital think..... u have to do it....

[ktwlpn, LPN]

in my facility policy is to send the resident to the hospital for every unwitnessed fall even if the patient falls twice in 1 shift u have to send them to the hospital ...and i have done it no matter what the ambulance think, what the hospital think..... u have to do it....

That's just ridiculous.How many times have you had a confused resident tell you they fell and found no evidence of same and sent them out? I would have a fit if it was my mother or father being put through that.Obviously the powers that be at your facility have no respect for the skills of the nursing staff.Either that or sometime in the past they were found neglectful by the DOH for not following through with a fall with injury and had to come up with this stupid policy. This is another problem with the health care system.

[Bug Out, BSN]

My facilty the LPN observes and reports to the RN per SoP, the RN assesses and determines along with MD if Xray or other diagnostic measures are necessary.

For the most part if there is no assessed injury then no Xray is ordered.

[Bug Out, BSN]

That's just ridiculous.How many times have you had a confused resident tell you they fell and found no evidence of same and sent them out? I would have a fit if it was my mother or father being put through that.Obviously the powers that be at your facility have no respect for the skills of the nursing staff.Either that or sometime in the past they were found neglectful by the DOH for not following through with a fall with injury and had to come up with this stupid policy. This is another problem with the health care system.

Not a problem with healthcare, a problem with Tort Reform.

Look at the NSO webiste and all the fall related torts. Multi million dollar lawsuits by family, sometimes family that had not visited for years, on the behalf of fall victims.

[Nascar nurse, ASN, RN]

in my facility policy is to send the resident to the hospital for every unwitnessed fall even if the patient falls twice in 1 shift u have to send them to the hospital ...and i have done it no matter what the ambulance think, what the hospital think..... u have to do it....

That is not our policy and seems a ridiculous abuse of resources! If they have usual ROM and deny any pain... exactly what is the hospital going to x-ray - the entire body to r/o an injury.

We monitor our residents every shift for 72 hours post fall to determine if there are any injuries or concerns that aren't evident at initial assessment. We do get X-rays if there is any doubt of possibility of injury but that is all.

[NotFlo]

in my facility policy is to send the resident to the hospital for every unwitnessed fall even if the patient falls twice in 1 shift u have to send them to the hospital ...and i have done it no matter what the ambulance think, what the hospital think..... u have to do it....

I have never heard of such a policy and honestly I think that's a bit of overkill. Who ends up paying for the ambulance and ER visits for someone who fell and is back up again without any injury whatsoever?

[NotFlo]

That is not our policy and seems a ridiculous abuse of resources! If they have usual ROM and deny any pain... exactly what is the hospital going to x-ray - the entire body to r/o an injury.

We monitor our residents every shift for 72 hours post fall to determine if there are any injuries or concerns that aren't evident at initial assessment. We do get X-rays if there is any doubt of possibility of injury but that is all.

This is exactly what we do at our facility.