Nursing Home- Patient falls?

[anonymous1919]

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?

[Dixiecup]

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.

Most nursing homes only have an RN on day shift. This is how it is at our facility, so the LPN does the assessment.

[JenniferSews]

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?

No kidding! Does the facility pick up the tab when insurance says 911 wasn't warranted?

I would have sent 6 of our 39 pts to the hospital this week if this was our policy. Plus 1 more that was questionable since she swears she was on the floor but the staff found her square in her bed. Instead I sent 1 pt to the hospital who genuinely needed to go and the others were all assessed, skin tears dressed as applicable, family and MD notified, and vitals checked and assessed frequently. Sliding out of a low bed onto the floor mat is not a good use of the ER or EMT's time and resources.

We assess vitals and neuro status on falls q15x 8, q30x4, q8x72. We use our individual judgment regarding pt status and whether they need to be xrayed, sent out, etc. All with the consult of our on call docs of course. Bruises and skin tears are assessed q shift until they are resolved. If the patient complained of pain after the fact or showed a ROM deficit then we'd order an xray at that time even if they had no symptoms right away. ETA- no one would be in trouble providing the frequent neuros, incident reports, and charting after the fact was all completed.

[proudtobeRN777]

even if the resident has been sent out to hospital ..and nothing found out...even then the resident is on neurochecks Q shift for 14 days and on charting Q shift for 14 days ... yesterday 15 of the 30 residents on my wing were on alert charting.:rolleyes:

[Nascar nurse, ASN, RN]

even if the resident has been sent out to hospital ..and nothing found out...even then the resident is on neurochecks Q shift for 14 days and on charting Q shift for 14 days ... yesterday 15 of the 30 residents on my wing were on alert charting.:rolleyes:

14 DAYS! That's crazy. Another waste of resources - the nurses time.

[CT Pixie, BSN, RN]

Our RN super assesses the resident after a fall, if the residents denies any pain or discomfort, are showing no non-verbal cues to pain, have WNL ROM, no obvious injuries, we call the family in charge, do an incident report, notify the doc. If the doc wants an x-ray etc he gives us a verbal order for one..otherwise, we monitor for any injury that may appear later on.

We do qshift vs for 9 shifts from the time of the fall, neuros for any unwitnessed fall. If the resident shows any s/s of injury after the fall (from a shift to days later) we inform the doc and may get orders for x-rays, or to send the resident to hosp for evaluation, etc.

[Danielsonrg]

LOL he fell!