I had a really nice patient today, who naturally was on fall precautions, since if you score 6 or more on the checklist, you get a yellow bracelet, yellow rectangle on the chart, yellow fall precaution sign outside the door, plus a round yellow sticker on the Kardex.
Of course, filling out the fall precaution checklist is another 'important' bit of charting done each shift that really makes a difference for our patients!!! Thanks to documentation like this, America is a better, safer place. Busy nurses really find the fall assessment worksheet an invaluable tool that they don't know how they ever got through the day without!
My patient, however, thought it was ridiculous that she was being told to call a nurse to go to the bathroom. She felt like having a sign outside her door, for all the world to see, was embarrassing. :imbar She told us, and she told her doctor, that we should use some common sense here. She told me that she has her cane, and she is perfectly capable of being careful in going to the bathroom, and she demanded that that sign be taken down!
Do ya think we should have gotten a mental health eval???
So, it's all or nothing? Either patients accept, without question, everything the doctors and nurses say to them, or else they stay home and die? You are saying that patients don't have a right to refuse any aspect of their treatment plan, I see.
So, it's all or nothing? Either patients accept, without question, everything the doctors and nurses say to them, or else they stay home and die? You are saying that patients don't have a right to refuse any aspect of their treatment plan, I see.
I have fallen at work a couple of times. I have fallen away from work more times than I can recall. Bipedal locomotion is inherently risky, yet we continue to do it.
I think I'm with you, on this one. In fact, I have advocated (not very enthusiastically, I must admit) for a patient's right to fall, if they so choose.
I've never quite had the nerve, though, to chart "patient elected to sit/lie on floor." Been tempted, though.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
we just took the sign down and documented her request. she agreed to keep the bracelet on, but said she planned to use the br independently.
in that case, perhaps risk management or a team of hospital lawyers should visit her and explain to her that she's assuming the risk of falling and refusing the level of care that would protect her safety. therefore if she falls, she has no right to sue to hospital, and must actually pay for all the tests/care required after the fall. or she can leave ama in which case the bill is her responsibility.
Specializes in Med/Surg, Tele, IM, OB/GYN, neuro, GI.
There have been pts that have complained about the signs and usually when it's explained while it's there they accept it. For pts that are a fall risk I've seen some hospitals use a fall leaf with a magnet that they place on the door. It doesn't say what it's for but everyone that works at the hospitals knows what it means.
What was triggering the fall risk? Had she fallen before? Or was is simply because she walked with a cane? I think we need to use a little nsg judegement because labeling someone a 'fall risk'.
Many people walk with canes - some are at risk for falls because of it, but some aren't. Sounds like this lady knew what her risks were.
i have often wondered about hipaa and those signs. it does not take a mental genius to know what they mean.
i'm confused - how much 'personal information' can you give away by a sign that says "fall precautions" ???
i guess i'm trying to understand your argument regarding hipaa violation here - since i don't see any
cheers,
in that case, perhaps risk management or a team of hospital lawyers should visit her and explain to her that she's assuming the risk of falling and refusing the level of care that would protect her safety. therefore if she falls, she has no right to sue to hospital, and must actually pay for all the tests/care required after the fall. or she can leave ama in which case the bill is her responsibility.
which is now all that more important since cms has, in their infinite stupidi.... er... "wisdom" deemed that "falls" are a "never event" in hospitals... and that they won't compensate for falls suffered in hospitals.
nurse: can we tie everyone down to their beds? that will ensure a 100% no-fall stay.
cms: of course not!
nurse: well, how else can we ensure 100% no-fall numbers?
cms: that's your problem... not mine!
nurse: you do know that many of the patients we treat are the elderly? that they are prone to falling just because of their age? it's part and parcel of "growing old" ?
cms: that's your problem... not mine!
nurse: so... you won't pay me if a patient has a fall on my unit but you'll pay me if i accept a transfer pt. who has had a previous fall/history of a fall?
cms: that is correct.
nurse: so what's to stop hospitals from forming cartels and shipping patients around just because they are a 'cms risk'? doesn't this ultimately work toward the detriment of patients and their care?
cms: silence! what the hell do you know about cms?
nurse: *muttering under breath* i know enough that you sleaze bags want to continue to pay less and less as compared to what you're supposed to reenumerate...
cms: such insolence! you're just a nurse! wipe that bottom there....
Ok,..if the sign comes down,.yes the staff on the floor can still watch her,.but what about lab, radiology, RT, PT etc? What about the staff that was off the first three days of her admit? AND if she falls, with our new rules,.Medicare won't pay to fix the broken hip, the resulting pneumonia, DVT etc! Does administration want us to be ultra sensitive, politically correct and do everything to make the pt happy or do they want us to keep our pts safe?
They force us to do the fall risk assessment, they make the rules for the signs, they teach us what precautions to take for those at high risk for falls, but if the pt doesn't' like it, it isn't so important anymore? When did the pt become better at managing their own health than the professionals who are highly trained to do it? Why even place people in the hospital if they are only going to agree to part of their care? Why don't we just skip the docs all together and let the pts decide which labs to draw, which meds they want to take and which CT/MRI/Xray etc they want?
I'm all for pts being involved in their health care. They should be able to make informed decisions and understand the "why's and what for's" but if you don't trust your health care provider enough to do what he/she recommends then get a new doc or stay at home!
I say this all the time... if patients really knew how to manage their own health most of them wouldn't wind up in the hospital. How many taxpayer/insurance dollars would we save if all patients were 100% compliant with their diabetes, or heart disease, or name your diagnosis. We see patients all the time who want to do it their way and fail. One of our toughest jobs as nurses is to prevent patients from causing harm to themselves through education. Even still some patients go on over eating, smoking, drinking etc... because they want to. Most of the time those are the most difficult patients because they get admitted to the hospital thinking its Burger King... and everything will be happen their way, when they want it to. Management usually caters to this patient because they are more concerned about the HCAPS score than if the patients get proper care.
Specializes in A little of this & a little of that.
I have seen a "fall" leaf on the nameplate for patients that are fall risks, in LTC it sort fo blends with other decorations. Also it is no longer allowed to post the the type or reason for precautions publicly. A sign saying "please see nurse before visiting" is allowed. If charts are in publc view, no stickers or other information such as DNR can be on the outside of them. It is difficult but not impossible to protect PHI/patient rights and care for/protect the patient.
We use "falling stars" as well. We know what they mean, but a visitor doesn't. Occasionally one will ask, but it's surprisingly rare.
Couple thoughts here....I think the BIGGER problem is her insistence on getting up herself. She's going to do it whether or not there's a sign on her door! The more important thing is to do your best to make sure this doesn't happen. Did you say, ok, if you insist on getting up yourself, we will put a personal alarm on you so that we're alerted when you try to get up? Or tell her that she will need to be in a room right across from the nurses' station so that you are better able to monitor her activity? There is more than one way to skin a cat! In the face of these other interventions, perhaps she'll change her mind.
I also question the validity of her "HIPPA" violation complaint. If her name is not visible outside of the room, etc, a visitor for someone else will not know who she is. HER visitors obviously will know, but since she is continuing to wear the bracelet, they will know anyway (I'm not sure about yours, but our falls bracelets say "FALLS RISK" on them~by law).
Does your facility practice hourly rounding? At mine, since it's implementation, we have seen a reduction in the number of overall falls. Checking on this lady hourly, and offering to bring her to the bathroom, may help.
If it were me. I would explain to the patient that the reason she has a yellow arm band on and a sign outside her doorway is because we value her. Our goal is to return her to home as soon as possible without the mishap of accidentally missing a step and risking breaking a hip. I have used this explanation with success. I have also gone to say of a patient once upon a time who accidentally fell sustaining a severe injury to her head which ended up causing death.
If that doesn't work, then I document teaching, call the doctor and get an order stating patient does not have to be on fall precautions, or if the doctor feels they do, I have them sign AMA papers if they are still insistent.
Most people are reasonable if you explain, give worse case scenarios. For the ones who reason doesn't work, Well, not much you can do to convince them.
Thanks to documentation like this, America is a better, safer place. Busy nurses really find the fall assessment worksheet an invaluable tool that they don't know how they ever got through the day without! 
FireStarterRN, BSN, RN
3,824 Posts
So, it's all or nothing? Either patients accept, without question, everything the doctors and nurses say to them, or else they stay home and die? You are saying that patients don't have a right to refuse any aspect of their treatment plan, I see.