Patient rights an privacy bathroom

[Mqnurse13]

Im wondering if anyone else at other facilities is crossing this issue. Fall risk patients insisting on privacy in the bathroom and falling in the process. If a patient insists we cannot enter the bathroom and they fall where is the liability and can we insist we have to come in no matter what. Even when the door is cracked and we are right there it doesn't guarantee they won't fall. My patient insisted I leave the bathroom I instructed him to not get up I'd be at the door and I was with the door cracked open he kept telling me he needed privacy and didn't want me to look at him while in the bathroom even though I explained the policy and risk. Of course he ended up falling but luckily didn't get hurt. My manager told me in the future I can't leave the bathroom even if they insist. My question is where is the line with patient rights and what is the policy at your facility. Thanks!

[applewhitern, BSN, RN]

If they are unstable enough and have potential to fall, we insist that they use the bedside commode, and we stay with them. We don't give them the option of using the bathroom. However, that said, I am not an attorney but I would think patient's rights to privacy would outweigh the facility's policy. Always document, document, document.

[Davey Do]

My manager told me in the future I can't leave the bathroom even if they insist.

Yep, Mqnurse23. I apologize profusely, but bottom line, their safety supersedes modesty. I've never had to do this, have informed the patients that it is an option, but if push came to shove, I'd get a physician's order and serve them with a restriction of rights.

we let them go in and they have to sing a song while they are in there. Let's see Davey do one with that?

Hppy

Thank you for that introduction, Hppy.

Back in 1979, I wrote a song called "My Toilet".

I'd like to sing it for you now.

Perhaps your girls can join in?

It goes like this:

[ATTACH=CONFIG]27731[/ATTACH]

Thank you! Thank you very much!

[blondy2061h, MSN, RN]

I struggle with this too. I tell people to do the same we do in every AMA situation- establish competence, educate and document. More so than the fall risk patients, I struggle with patients I suspect are doing drugs or self harming in the bathroom.

[Accolay]

I don't struggle with this. I apologize but tell them why I'm there and explain that the floor is very hard. But my personal policy is to assess each patient. There are lots of patients who are fall risk but there are fall risk shades of grey as in, are they at the top or the bottom of the scoring tool?

For the patients I know, have walked them before etc. and are not a complete fall risk, I'll give them a little more room to take care of business, for patients I don't know, I'll stand really close. Either way the door is never closed. I've have been known keep the door shutish using my foot as a door stop and holding the handle to keep the door where I want it. Much easier in our ICUs that only have a vinyl curtain.

[Kooky Korky, BSN, RN]

"My manager told me in the future I can't leave the bathroom even if they insist." You have been directed by management. Review the facility policy for yourself.

I sure would get that policy in writing and make sure the family is brought in on this immediately. So typical to leave the nurse out of the loop and out to take the hit when someone cracks he old noggin open or busts their hip.

[Kooky Korky, BSN, RN]

Yep, Mqnurse23. I apologize profusely, but bottom line, their safety supersedes modesty. I've never had to do this, have informed the patients that it is an option, but if push came to shove, I'd get a physician's order and serve them with a restriction of rights.

Thank you for that introduction, Hppy.

Back in 1979, I wrote a song called "My Toilet".

I'd like to sing it for you now.

Perhaps your girls can join in?

It goes like this:

[ATTACH=CONFIG]27731[/ATTACH]

Thank you! Thank you very much!

A brief addemdum:

Sometimes I am by myself,

Sometimes folks like to hang about,

What their thrill is, I don't know,

But sometimes I really give them a show.

They get to see my bootie,

They even see my wee wee,

I'd hand out noseplugs if I had some,

Cuz the grand finale can be a real stinker.

Yeah, I know it needs some work. Best I could do at the last second. And I don't know how you do that picture template, DD.

[canoehead, BSN, RN]

I sure would get that policy in writing and make sure the family is brought in on this immediately. So typical to leave the nurse out of the loop and out to take the hit when someone cracks he old noggin open or busts their hip.

Oh yes! Send your boss an email saying "I wanted to confirm with you that your instructions were...and I will be changing my practice as you've instructed." Get a read receipt on it, and save it.

[Delia37, MSN]

Our neuro step down unit does EEG and seizure assessment/monitoring; which mean seizures patient would come in for 48hrs to be monitored via EEG. Since this is a scheduled admission done in clinic, they are told and provided written material indicating that they will not be left alone in the bathroom. Very rarely they have any issues with anyone not being compliant.

[psu_213, BSN, RN]

I worked at a hospital where the policy was for direct bathroom supervision for all fall risks. Among management it was almost a zero tolerance policy. However, I would imagine that if an A&O pt steadfastly refuses a staff member in the bathroom with them, pt rights are going to win out. In this case, document the heck out of it. Document the pt's refusal to have staff in the bathroom. Document your education of why staff need to be there. Document the pt's continued refusal. Document that you educated the pt on the call bell, document that you gave him/her the call bell string, document that you told the pt not to get up without assistance....find other things to document!

Unless the pt specifically signs something that says that they will have a staff member with them in the BR, then I would think they could refuse having said staff member in there, just like they can refuse other safety interventions, meds, etc.

[jaderook01, BSN, RN]

It's rare when I have patients that can walk without assistance to the bathroom. Most of ours either use bedside commodes, bedpans, or are incontinent. If they are a falls risk (and can actually walk), then they are escorted to the bathroom, the door remains open and someone is hovering around in the room, waiting for them to finish. The types I get usually need help being cleaned up after anyway. After having a patient code in the bathroom (one that was being discharged), I don't take chances.