Physical Therapy drops pt and doesn't tell RN??

[squatmunkie_RN]

I'm a new nurse, just graduated in May. I had a pt who was very big 400lbs. The only people who get her out of bed is PT. They were moved her from her Big Boy Bed which has an air mattress to the chair to eat lunch, around 1230 (ALL went ok). They come to move her back to the bed a few hrs later.

Now, around 1600 my pt tells me PT let her knee hit the ground when moving her back from the chair to the bed. She says that she slid off the chair and fell on her knee. Now her knee and ankle hurt. For some reason I didnt think this was HUGE deal at the time, the pt is in minor pain...theres no bruise or swelling. I give her a PRN Vicodin. I didn't mention it to the charge nurse...still not thinking its a huge deal. I'm kinda ****** PT didn't come tell me what happened though..

Now I am giving report to night shift. I tell them the story...and the night nurse was OMG did you tell the charge nurse? Then I had to fill out an incident report, call her Dr.....ugh.

Physical therapy should have told me what happened ASAP, right? They know what they did was wrong. I think people see me as a new nurse and try to "get one over" on me. I wasn't there when she fell. It wasn't my fault.

[morte, LPN, LVN]

yup, the most likely reason that PT didnt write it up is, it didnt happen!

[wooh, BSN, RN]

Shocked it took until page 3 for what should have been the immediate action to come up. CALL PT! Find out if it really happened. Because either it did, and when a 400 pound person hits the floor, there's always a chance of injury (for both the patient and the people picking the patient up), or it didn't happen, and you've now got a patient making up stuff, which is probably even worse of a situation.

I know "pain is what the patient says it is" and we're all here for the love of the sweet innocent patients that are always so compliant unless there's a valid reason to not be, and when we pick up our paychecks it's all puppies and kittens and cuddly little babies. But in reality, patients lie all the time. You need to know sooner rather than later if you're dealing with an injury or you're dealing with a liar.

[Scrubby]

You need to CYA at all times. Even if it's not 'your fault' as such, it is still an incident and needs to be documented. I think most of use here can agree that PT did the wrong thing by not informing nursing staff about the incident. But you are just as in the wrong for not following up on it as well.

We've all been new nurses at some stage and understand how frustrating it can be when other staff members make mistakes and you have to pick up the pieces. But at the end of the day we're the patients advocate and that involves making sure our patients are safe.

[TakeOne]

(this post has been changed and or remove since some folks here are easily offended).

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Is this somehow better than what was there before you changed it?

[wishiwereanurse, BSN, RN]

i think the new nurse can't fill out an incident report because she was not there to witness the alleged fall. Nobody can fill out an incident report based on pure hearsay. Patients can tell you anything, and although we are there to advocate the patient, we need to follow up with the witness to find out what really happened. The patient's complaint when the nurse walked in was pain, the best thing that could've been done was assess the pt, address that problem and notify the md of patient's complaint. Stay objective and stop pointing fingers...

[OttawaRPN]

We can't assume our patients are liars and cheats, management in no way will back you up on this. The person who either witnesses the fall or finds the patient on the floor is the one who fills out the incident report. In the case described, document "pt states knee hit the floor while being transferred by PT, assessment completed, pt in minor pain no bruise or swelling, analgesia given for discomfort, md notified at xx hours." should be sufficient. It is not my job to go after PT to make sure they're following protocol, the manager can fully investigate if necessary, meanwhile I've covered my orifice.

[heron, ASN, RN]

i think the new nurse can't fill out an incident report because she was not there to witness the alleged fall. Nobody can fill out an incident report based on pure hearsay. Patients can tell you anything, and although we are there to advocate the patient, we need to follow up with the witness to find out what really happened. The patient's complaint when the nurse walked in was pain, the best thing that could've been done was assess the pt, address that problem and notify the md of patient's complaint. Stay objective and stop pointing fingers...

I disagree with this ... an incident report is a way of notifying risk management of issues and can be filled out by anyone having knowledge of an event. It is not, in itself, a disciplinary action, although it may lead to one. An incident report in this case lets higher ups know of the patient's allegations so they can investigate further.

While it would be nice for the staff nurse to investigate, it's really outside her authority to decide whether the complaint is warranted or not. To avoid filling one out on the basis that she did not witness the actual event could be construed as a cover-up and create more problems for everyone involved. The wording could go something like "Patient c/o knee pain and reports that ... Upon assessment knee appears ... Pt medicated for pain ... "

Actually, I think the OP would be advised to ask her question of risk management ... they're the folks who can clarify who writes what up.

[wooh, BSN, RN]

I'd call PT. "Ms. Patient says her knee hit the floor during the transfer back to bed, what happened?"

PT will say,

A) "Oh, yes, we got busy and forgot to tell you, it was just a little bump though."

B) "That didn't happen, what are you talking about?"

C) "Oh yes, it was a bad fall, we got busy and forgot to tell you, sorry."

Any response that doesn't include after it, "But we did do an occurrence report," would lead me to write an occurrence report with what I can objectively write. Any response that doesn't include after it, "We did notify the attending physician," would lead me to call the attending to make sure he/she is aware.*

It may take a few minutes to get PT on the phone, but it's important info to know. And risk needs to be notified by SOMEONE of what's going on.

*Assuming it's daytime when I find out about this.