Patient fx hip after family refused alarm

[Emilyinsc]

Ok, the family for a short term rehab patient did not place an alarm due to family's refusal (this happened on a wed). He fell a day & a half later, breaking his hip and nose. The NH is coming down hard on the admission nurse since she didn't place the alarm on wed (but remember the family refused). Who is responsible? the admission nurse who wasn't present on the night of the fall? the nurse on duty? or the NH? or no one since the family since refused the alarm & it was documented.

LET ME KNOW.

[artsmom, BSN, LPN]

You were terminated over a fall? Even a bad fall shouldn't be cause for termination. I had someone fall yesterday- her head broke her fall. It happens. Alarms, documentation, and education are nothing against someone's will (or dementia). Being terminated is a bit harsh, unless there were more incidents before this one?

[martymoose, BSN, RN]

Don't forget - the hospitals are getting sued for this- and they also are not getting paid because of medicare for hospital acquired incidences . Of course the nurse is the scapegoat in this. Of course they are going to can someone over this.

I have compropmised care of other pts when ive had pts who , despite having a bed alarm on ,insist on getting up and setting it off every 2 minutes.I take my chair and sit my butt where the pt is in direct view and tell them to sit down. Repeatedly.

I know in this day and age of nursing , I will lose my job over things out of my control, and its just a matter of when.

[BuckyBadgerRN, ASN, RN]

How do we know that the admitting RN DIDN'T do her best to educate the family? We all know it can be like talking til you're blue in the face to brick wall!

I think the nurse is to blame in my opinion. The nurse should've explained the safety issues and why an alarm was needed. Although alarms don't always prevent falls, it does help. Seems like the family was uneducated. I would've put the alarm on. They could be mad at me but I'm there for the pt and the Pts safety.

[martymoose, BSN, RN]

This happens often. "Mom doesn't need an alarm". As long as each nurse is documenting that mom is non-compliant with wearing Person alarm, staff is not responsible when mom falls and breaks her hip. Yes of course family will blame you, but as long as each shift is documenting they can't do anything. No personal alarm, sensor pad, or self- release lap belt is gonna keep a resident from falling if they are determined to get up and walk.

at my facility, we were told that we still have to have the alarm on, it doesnt matter if we document that they dont want it. supposedly the facility is still responsible even if they refuse.

[SNB1014, RN]

our nurses automatically plug in the bed checks and explain them and do their teaching. refusing the bed check isn't brought up as an option. sometimes the patient will refuse it after our song and dance.

i feel bad for some of the pts with the bed check on who are aXo because all it does is drive them crazy and make them mad. if they wiggle or reposition in bed, BAM it goes off. i think the alarm sounding always magnifies x10 how long it takes to get a nurse in the room. even if she comes in 5 mins, those are a long long long 5 mins with those horrible bells and beeps.

[imintrouble, BSN, RN]

Well thank u for your responses. The patient was a&ox3. His daughter who was his poa happened to be an RN. He fell broke his hip and nose & went unchecked for a undetermined amt of time. The fall happened on night shift.

I was the admitting nurse, and I documented the refusal. I wasn't the night nurse (the one he fell on).

He fell 48 hrs after I had him. However, the NH did not see eye to eye with me.

If we check our patients properly, there shouldn't be a need for alarms. An alarm doesn't stop someone from falling.

It isn't a fix all. A patient has the RIGHT to refuse! Every one keeps forgetting that.

I can't put into words how bad I feel for that patient right now.

Doesn't matter anymore, I was terminated today. All I can do is the best I can. Sometimes we fall short, sometimes we f&*^% up, but we gotta keep trying and move on.

I am so sorry. Nurses are at the bottom of the food chain. Always.

If you'd placed the alarm against the pt/family wishes you'd have been reprimanded. Since you left it off you were fired. This is a situation where there is no right response. It's so unjust.

I've been in your shoes, and this incident will color the way you look at pt safety for the rest of your career.

[SwansonRN]

I agree. Having an alarm will not prevent someone from falling. Increased supervision, hourly rounding, toileting schedule, more pt education, maybe even a sitter if the situaton called for it could have prevented the fall. I think this is a failure for nursing staff. I think every nurse that had this pt had the ability to stop this from happening. If there was no alarm there should have been more interventions in place. I'm not criticizing because I don't know the situation...and many of us have been there...just my 2 cents. I'm so sorry that you had to go through this.

[jadelpn, LPN, EMT-B]

Well thank u for your responses. The patient was a&ox3. His daughter who was his poa happened to be an RN. He fell broke his hip and nose & went unchecked for a undetermined amt of time. The fall happened on night shift.

I was the admitting nurse, and I documented the refusal. I wasn't the night nurse (the one he fell on).

He fell 48 hrs after I had him. However, the NH did not see eye to eye with me.

If we check our patients properly, there shouldn't be a need for alarms. An alarm doesn't stop someone from falling.

It isn't a fix all. A patient has the RIGHT to refuse! Every one keeps forgetting that.

I can't put into words how bad I feel for that patient right now.

Doesn't matter anymore, I was terminated today. All I can do is the best I can. Sometimes we fall short, sometimes we f&*^% up, but we gotta keep trying and move on.

I am sorry that you were terminated. Especially if this happend long after you admitted him, or was even his care nurse. A POA usually doesn't have too much to do with much unless the patient is incompetent. And in your post, it was not the patient that refused, it was the daughter. Who should know better being an RN. Sometimes, if a patient such as this needs a 1:1 sitter. Needless to say, it is a policy in most facilities that alarms be used. If the patient refuses, back it up with an order.

Again, sorry that this happend to you.

[malestunurse]

As long as you documented everything you probably have a case for unfair dismissal.

[Carlos1]

I dont see how you can be blamed, after I read the latest. I would have insisted and documented the refusal also. I'm not a nurse (yet). The NH should have rules to protect their employees. I think the NH failed both the patient and their employees.

[Jory, MSN, APRN, CNM]

I think the nurse is to blame in my opinion. The nurse should've explained the safety issues and why an alarm was needed. Although alarms don't always prevent falls, it does help. Seems like the family was uneducated. I would've put the alarm on. They could be mad at me but I'm there for the pt and the Pts safety.

Don't think for a second that a family or patient will automatically pick the most reasonable choice after the risks and benefits are explained.

Scenerio clearly states that the family was offered the choice/refused and that this was documented. Doesn't take two seconds to say, "your father could fall and break a hip if he gets up without assistance."

The nurse cannot stay in the room 24/7, that is not reasonable nor expected. She has other patients.

Our facility will not remove an alarm from a patient unless the family agrees to stay with the patient at ALL times, therefore, assuming responsibility. They sign a paper stating such.

[Jory, MSN, APRN, CNM]

I would have put a bed alarm on anyway. Safety trumps pretty much everything. We are required to place an alarm on fall risk patients. I honestly don't understand why a family would refuse a bed alarm on their family member. Makes no sense to me. Was the pt A&O?

Some states, such as mine, a bed alarm is treated very similar to a restraint. You have to have a doctor's order unless it's emergent and then orders have to be re-signed with necessity documented.

A nurse can make the decision short-term (as in hours) but long term (over 24 hours), if the family refuses, she cannot go ahead and do it anyway any more than she can force anything else on the patient.