pt dies after fall, who's to blame?

[sueannRN]

This is a true story. One RN asked another RN to watch her pts so she could go off the unit and left with giving little to no report: "will you watch rooms 34 and 36?" The RN covering was busy while a third RN answered the pt's call bell and allegedly helped the pt out of bed to use the bedside commode, drew the curtain closed 'for privacy' and left the room. The pt fell and a STAT CT showed a massive cranial hemorrhage. Among other complications, the pt needed to be intubated and was having a difficult time ventilating. The pt's family decided to make him comfort care. Who do you think is responsible and how relevant is it that this pt had Stage IV CA?

[Biffbradford]

IMO, that's WAY to complex to analyze on-line. :)

[NCRNMDM, ASN, RN]

I feel that there is more than one person to blame. The first nurse who was leaving the unit should've given a detailed report to the nurse who agreed to watch her patients. If the first nurse didn't give the second nurse a detailed enough report, or if the second nurse felt that she needed a more detailed report, then the second nurse should have clarified any unclear details with the first nurse before the first nurse left the unit. If the second nurse who agreed to take the patients thought that she would become too busy to care for the patients while the first nurse was gone, she should have told the first nurse so, and declined the report on the patients. If the nurse who was covering the patients suddenly became busy, she shouldn't have let another nurse who knew nothing about the patient go into the room and help the patient with anything. At the least, she should've given a quick run-down of the facts before asking the third nurse to assist the patient. Next, the third nurse should have NEVER left the patient alone on the bedside commode with the curtain drawn. If the nurse was going to draw the curtain, she should've stood with the patient in the room. If the patient didn't want the nurse standing in the room, I say tough luck; you need to consider patient safety first, and you need to do everything you can to protect your license. If the nurse felt that she absolutely HAD to leave the room, she should've given the patient the call light and stood directly outside the curtain, preferably with a slight view of the patient. After the patient fell, the third nurse should have called for help, assessed the patient for broken bones, neuro deficits, skin tears, cuts, or bruises, and anything else that could have resulted from the fall. The nurses should have worked as a team to assess the patient, notify the physician, carefully monitor the patient's vitals while waiting on orders from the MD, ensure that all IV lines, catheters, and other devices were still in place and functional, and put together an incident report. If any neuro deficits were present on the initial exam after the fall, the nurses should have notified the physician of this and suggested a head CT.

[ProgressiveActivist, BSN, RN]

Not enough info. Was the pt a high fall risk?

How long was the primary nurse gone?

How long did the pt lie on the floor?

When found was appropriate action taken?

Did an acute bleed cause the pt to fall?

This could happen to any one of us. Try to support each other instead of assigning blame.

[ckh23, BSN, RN]

Who knows? What came first the fall or the bleed? If the patient had a bedside commode I'm going to assume this was not the first time out of bed. I'm not saying the situation is flawed with lack of communication, but there is no way to determine which came first.

To many possibilities. Did the patient bear down while on the commode and have a syncopal episode? Did he fall? Did he bear down and that caused a spontaneous bleed? Did he just happen to have a spontaneous bleed at that time?

[wanderlust99]

Don't leave someone unattended unless you are certain that they are steady on their feet, A&O, cooperative & will use the call light first before getting up.

[CCRNDiva, BSN, RN]

This is why I never get another nurse's patient out of bed without checking with their nurse first.