Patient fx hip after family refused alarm - page 7

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... Read More

  1. by   nelcoy4
    At my hospital they have a form for the pt or POA to sign that is very detailed for alarm refusal. Also in the alarm refusal form it goes in depth about forfeiting rights to sue in a result of a fall (something like that, the form is very long and in small print). If I was a patient and saw that form I would say never mind turn the alarm on. Lol! After they sign the form we still have to document every shift about the alarm refusal on our fall flow sheets.

    Also the nurses and MD can import a video about it on patient's tvs. They can not watch whatever they want to watch on tv until this video is played. Once they watch the video, it is noted on the chart electronically that they watched the video.

    Kind of off topic, but there was a pt at my hospital that fell and he did not sue the hospital, but he sued the nurse only because she forgot to turn the bed alarm on. That scared me. I just follow the policies and teach the patients/families why they are in place. I make sure forms are signed and my documentation is detailed.
  2. by   slidster
    I hate that. Right to fall? Ok. Enjoy your right to bust a hip!!! GRRRR
  3. by   martymoose
    ^ yep, as we get to enjoy their right to sue us
  4. by   Maremma
    Well geeze! In our facility they have removed all bed and chair alarms. We are not allowed to have them! How do you like that? They said there are complaints (not sure from who, state maybe?) that they are being used as "babysitters" to negate our responsibility to keep them from falling!

    Yes then on top of that they decided to cut our staffing even further so we cannot have a staff member watching all our fall risks in an activity room while we scramble to do even more work from the staff cuts they said we no longer needed. It has definitely been a nightmare for us. These people are demanding to be put in bed but we can't put them there because they then try to get up by themselves and wind up on the floor. Our halls are lined up with all the "fall risk patients" 24-7.

    We are flirting with disaster. Pressure sores on all these people are going to be piling up around us. Pretty hard to change their positions at least every two hours when they are stuck in chairs all the time. Of course any legitimate concern that could in any way cost this multi billion dollar corp money is just ignored and brushed under the carpet.

    My facility made us believe the removal of the alarms was a universal thing that some government entity was forcing on us. EVERYONE had to remove them. I should have known better! It must REALLY be the cost of the alarms and replacement of batteries etc why we can't have them anymore.
  5. by   Emilyinsc
    Hello all, I have been out of work for 1 month since this incident. Apparently, alot has been happening on nightshift at the LTC/nursing home.
    Apparently the night after this guy broke his hip, they had two more falls, one requiring tx in the ED.
    the a day and 1/2 after that a woman on the same hall broke her femur from a fall.
    and most recently, someone fell (on the same hall/nightshift) and broke their pelvis.

    So in summary, all these falls are happening on night shift, bed alarm or not, and sustaining fx's.

    Maybe it was a blessing in disguise that I got fired. Now they'll have to find another scapegoat!
  6. by   Nismo
    I am figuring that the patient was confused and unable to make own choices. Family refused - alarm is a treatment. But is interupting with patient safety. You CAN put the alarm on even though the family refuses. Who is responsible, the hospital and the nurse. There is no reprecussions on the family. Any time the family is obstructing patient safety, I am sorry but I ask them to leave if they continue putting the patient in harms way. Its your as* and the patients health on the line.
  7. by   sharpeimom
    [QUOTE=tyvin;6974244]Why did the patient have a POA if they were so rightfully A&0x3?.QUOTE]

    Because you need to get a POA when you're still A&Ox3 because once the great decline begins, you're aren't considered competent enough to give the consent
    required to set one up. There are different kinds of POAs, including various medical POAs.

    Short OT here... There is also something called an AIF or Attorney In Fact which is largely archaic today, but can be very useful under certain circumstances. My husband and cousin have joint medical POA for me and my husband has an AIF for me. It allows him to sign documents for me by signing: my name/his name/AIF.
    Penmanship is nearly impossible for me now. I can sometimes manage a single signature, but no more. The AIF does not give him the same broad legal rights he would have with even a limited POA. Not because I don't trust him implicitly, because I do, but rather because I can still make financial decisions for myself.

    What able bodied persons need to remember is that those of us who are impaired physically (and occasionally cognitively) are still pretty much who we always were
    before and need to be treated as such. If I become mentally incapable of understanding the inherent risk to being unalarmed (I just made that a word!)
    then, new rules go ino effect.
  8. by   J.R.theR.N2b
    how restraining is a bed alarm? i consider myself to be the pickiest, anxious, most restless patient a poor nurse could ever have to endure. i am very severely claustrophobic and, as a result, am unable to tolerate restraint of any type. i cannot even lie still and toss and turn continually all night during sleep. i have been evaluated by professionals both for sleep apnea and for claustrophobia. the sleep test was continually interrupted by the therapist entering the room, imploring me to please keep the oxygen mask on, and was finally terminated because i was unable to comply. i was under the care of a psychologist while being treated for my claustrophobia, and he recommended a therapy he termed as "flooding", which came to an abrupt end, after i suffered such terrible anxiety attacks that even scared the psychologist, who stated he had never encountered claustrophobia as severe as mine. this is why i asked my original question. on research done on the internet it appears that all a bed alarm does is to sound an alarm alerting staff that patient is rising up in bed. if the patient is not restrained in any way, i fail to see why he nor his family would object.
  9. by   maelstrom143
    there should be a legal document to sign where if the patient and/or family responsible refuse safety protocols they relinquish their rights to sue if the patient should fall &/or injure himself/herself due to their choices. It is called taking responsibility for your actions and decisions. Used to be a very popular concept in the old days...jmho. Seems like our society prefers to blame everyone else except the ones really at fault for catastrophic failure.
  10. by   sharpeimom
    I wish there were such a document for those of us to sign. I would willingly sign one and I'm equally sure that my mom's 93 year-old twin sister would sign one too. My mother was also very independent and as long as she remained in control of her care until her last

    Some of us are reared to be most independent women (people) and giving up ANY control is almost impossible. I think if the subject of safety matters were broached with the patient's dignity in mind, we might be more receptive -- maybe. Good luck to the poor unfortunate who approaches any of my older relatives (especially the female ones) who are still competent despite their advancing years and frail bodies, and treats them as turnips or as though they were already senile.

    That's MY family.

    My husband's family tends to regard women as lesser citizens simply because they happen to have been born female. The elderly men are treated with the same respect as always. My poor mother-in-law, a bright and delightful woman, was treated as though she didn't have two brain cells close enough t make contact. I hope that will change as the generations change.

    His family.

    To sum up: I feel strongly that the wishes of the elderly (if A&O and understand the possible consequences of a fall) should be carried out and the member holding the MPOA required to sign a release of negligence and responsibility form, so they understand that they may not sue should an adverse event happen. If the patient is confused or even borderline confused, the above would not be in place.
  11. by   J.R.theR.N2b
    i am also from the old school and believing in assuming resposibilities for my actions. it is easy to determine from my post there are specific things i cannot tolerate, with any type of restraint heading the list, and i expect any and all medical staff to accept and honor my request. but, at the same time, i cannot and will not hold staff responsible for whatever bad outcome may result from these choices.
  12. by   Poochiewoochie
    Since my Mother recently passed away from complications from a hip fracture that happened at the nursing home she was in I have to say something about this.

    When she was admitted almost 3 years ago she was identified as a high fall risk and even though she was able to walk they put an alarm on her chair. When she moved or got up the alarm went off and the people at the nursing all but made her stay in her seat when she was awake. All that did was make my Mom mad so my Dad eventually told them to remove it. That was when the falls started and eventually she fell and broke her hip in December and a month later she fell again and broke her femur. That time she was alarmed. She passed away 2 weeks ago and according to the coroner it was due to complications from the hip fracture.

    Seeing as she was alarmed when she fell the second time I don't believe one would have helped the previous times. All alarms do is make it easier for the NH personal. I've seen them "force" residents to stay seated which IMO is a form of imprisonment which is illegal.

    Oh, and for the record, the NH did a great job with taking care of my Mom. In my heart I know they gave us extra years with her because the way she was going before we placed her she would have been dead in a short time. She was controlling and refused basic care from me-she needed to be in a controlled environment and for the most part the nurses in the NH were wonderful with her.
    Last edit by Poochiewoochie on Mar 9, '13
  13. by   drowningdaily
    Patients do and should have the right to fall. Patients can refuse ANY treatment. They still have the right to care and to stay in a facility. To force someone to leave AMA for refusal, as someone suggested, is beyond idiotic. We as nurses advocate for our patients. We need to explain to them why we use alarms and encourage compliance. But we need to respect their choices.

    And for those on this thread unfamiliar with bed alarms, they frequently get triggered with every little movement and keep people up all night.

    It really sucks that OP got fired for no reason. Only thing at fault in this case is gravity.