Patient Fell and Got up?

allnurses Guide · Jun 8, 2017

I work in LTC as a CNA, an ambulatory resident with some dementia (or other means of forgetfullness) self toilets and was recently moved to a different room across the hall. It appears she's been increasingly dizzy and confused of her new surroundings and we've (myself and my nurse) discovered the BIGGEST bruise on her bottom a few days ago and that's now spread throughout her entire hip region. Nobody from previous shift had reported off to me about the bruise or any other shift before them. Nobody knows where it came from or what happened to her
and the resident can't remember and denies any pain. We have assumed that she fell and just got up since nobody knows what happened. She's scheduled for x-ray sometime soon but we are worried that she's broken her hip. Will us aides be in trouble for this since nobody knows what Happened to her?

If she is still able to ambulate the likelihood of a hip FX is slim. Still why is the X-ray not ordered STAT? In the LTC where I worked an unknown bruise of that severity would have been an immediate trip to the ER. Does the resident have family and have they been informed. Regulatory agencies will be all over your facility. If you are in the US and Medicare is footing any part of the bill you must bear in mind that Medicare will not pay for any care subsequent to a fall in the facility. Document everything. You should have a documented Change of Condition with and SBAR noted the circumstances of the discovery as well as who was notified and what treatment orders were given and how they were carried out.

Peace and Namaste

Hppy

princesspunch · Jun 8, 2017

I think the nurse I reported to did that since at our facility CNAs aren't allowed to document those. I just reported to her of my findings and she took pictures of the injuries and did all of her wound measurements. Since then the bruising has spread through the the hip area.

allnurses Guide · Jun 9, 2017

I think the nurse I reported to did that since at our facility CNAs aren't allowed to document those. I just reported to her of my findings and she took pictures of the injuries and did all of her wound measurements. Since then the bruising has spread through the the hip area.

I still do not understand why this person did not get a STAT x-ray of the hip as soon as the bruising was discovered. If the injury turns out to be significant your facility could be cited for a delay in treatment.

Such a citation could be deemed to put all your residents in imminent jeopardy. You facility could fall under investigation and lose it's Medicare status not to mention pain and suffering of the patient.

Hppy

notanumber · Jun 17, 2017

I still do not understand why this person did not get a STAT x-ray of the hip as soon as the bruising was discovered. If the injury turns out to be significant your facility could be cited for a delay in treatment.
Such a citation could be deemed to put all your residents in imminent jeopardy. You facility could fall under investigation and lose it's Medicare status not to mention pain and suffering of the patient.
Hppy

At our facility, transfer to acute care is dependent on approval of a physician (with some judgment-based exceptions, e.g. traumatic amputation or code on someone who is not a DNR), and the decision to send or not depends on their level of intervention as well as family wishes. I would not be surprised to only receive orders to monitor and give PRN analgesia for certain residents. No STAT xray does not necessarily mean no treatment plan. It sounds like the physician and family decided they did not want to put the confused patient through a stressful ER trip involving hours of hallway time if it could be done by appointment in the company of a familiar face. Any significant change in status between now and the appointment may change the plan.

Cruella de ville · Jun 17, 2017

If her care plan had her independent for mobility and you were following the care plan, then there should be no reason anyone should get in trouble.

Here.I.Stand, BSN, RN · Jun 21, 2017

From what you said, I don't see any culpability on your part.

I too wonder why the xray is not prioritised higher though. Another thing I would be concerned about though, is her increasing confusion. If she self transfers and falls, without needing to call for help or any other indicator besides the bruising... I'd be concerned that she had also hit her head.

Is she on anticoagulants? Such a huge, increasing bruise makes me wonder. (This past fall, my 94 yr old grandma was on Coumadin, and her INR had gone way up. They didn't know at the time, as she was down to checks only monthly. Well after getting a flu shot, I kid you not her arm turned black from her shoulder to her fingertips!) Prolonged clotting can certainly increase the risk of a brain bleed if she does hit her head.

allnurses Guide · Jun 22, 2017

At our facility, transfer to acute care is dependent on approval of a physician (with some judgment-based exceptions, e.g. traumatic amputation or code on someone who is not a DNR), and the decision to send or not depends on their level of intervention as well as family wishes. I would not be surprised to only receive orders to monitor and give PRN analgesia for certain residents. No STAT xray does not necessarily mean no treatment plan. It sounds like the physician and family decided they did not want to put the confused patient through a stressful ER trip involving hours of hallway time if it could be done by appointment in the company of a familiar face. Any significant change in status between now and the appointment may change the plan.

When I worked skilled an incident like this would have required a stat e-ray with the X-ray coming to the facility to avoid an uncomfortable and frightening trip to ER. We had a lab and x-ray on-cal service for our facility. Also in most cases if the patient showed new confusion we could order standard labs and UA under standing orders from the physician. All stat then we could call the results to the physician within 4 hours.

Hppy