Patient fx hip after family refused alarm

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  1. Whose at fault?

    • 9
      the admission nurse
    • 27
      the nurse on duty night of fall
    • 14
      the nursing home
    • 112
      no one since the family refused

162 members have participated

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.

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Specializes in Home Health/PD.

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.

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Specializes in LTC, Rehab, Gerontology.

There is not enough information to make a choice. If the family members were not POA, then the patient is the only one that could refuse any care. However, if it is determined that the patient is a fall risk, then the nurse should be sure that all safety measures are taken, including an alarm in wheel chair and on bed.

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Specializes in geriatrics, home care, wound care.

If the patient is identified as a fall risk, a chair alarm is just one measure to prevent a fall. There are other interventions that can be utilized to prevent a patient fall.

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Regardless of whether or not the family members were the POA, it is the responsibility of the nursing home to ensure the patient's safety so the alarm should have been placed. If the nurse cannot explain to the family the necessity of the alarm, then the DON should have been called to do so and if the DON can't, then the administrator. I am an ADON and have been dealing with this issue recently. If the family does not want an alarm, then they can take their loved one to a place that is negligent and allows refusal of safety measures.

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We have had almost the same thing happen. Family refused the alarm. (And, fyi, not all families who refuse are uninformed or uneducated, some are simply very aware of what their loved one will be like WITH the alarm on.) Anyway, the night he was admitted, he got up and fell. Broke his arm. We did have a motion sensor alarm in the room, which enabled us to discover his injury right away. No-one was at fault. Refusal of the TABs monitor and education was very well documented and care-planned.

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Specializes in Trauma Surgical ICU.

The admission nurse as well as all the other nurses that came behind him/her. It is everyone's responsibility to insure safety, the family needed to be educated on the risk and the importance of the alarm as well as this is not a negotiated item. Was the pt AAOX3, what did he/she say about the alarm..If the family/pt refused it should have went up the chain.... An alarm is such a small thing, why on earth would they refuse??

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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?

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Specializes in Emergency Room.

If the admitting nurse documented that the family refused (and they had POA) and that he/she explained the reasoning, I don't think I'd necessarily blame the admitting nurse. I would think it's the nursing home's fault for not having any type of protocol in place for a situation like that. I'd at least implement fall precautions (low bed, floor mats, etc). I probably would have also let the supervisor know and left a message for the ADON or DON as well. I don't know if I'd put the alarm on the patient anyway simply because I worked at a nursing home where an alarm was placed on a patient against the family's wishes and it turned into a bit of a mess.

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Specializes in Gerontology, Med surg, Home Health.

Read the studies. Alarms DO NOT prevent falls. If the family or resident refused an alarm, the nurse should have documented her teaching on whatever safety measures were in place.There is a huge risk of falling shortly after being admitted and other safety measures such as frequent monitoring should be in place.We have no alarms at all in my building and the numbers of falls have not gone up.

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I would rather have the family be upset over something as small as a bed alarm than deal with a potential death of the pt.

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Specializes in Gerontology, Med surg, Home Health.
Regardless of whether or not the family members were the POA, it is the responsibility of the nursing home to ensure the patient's safety so the alarm should have been placed. If the nurse cannot explain to the family the necessity of the alarm, then the DON should have been called to do so and if the DON can't, then the administrator. I am an ADON and have been dealing with this issue recently. If the family does not want an alarm, then they can take their loved one to a place that is negligent and allows refusal of safety measures.
If I am alert and oriented, I can refuse ANY and ALL treatment or medication. As long as I am not putting someone else at risk, you have no right to force me to do anythi g and if you did this to me, I would be on the phone to the Department of Public Health.
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