PT fell... Now I'm paralyzed with fear

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I'm in my final semester of school doing my preceptorship/capstone. I'm on an ortho floor and really enjoying it. I received report on a PT who was not a risk for fall... Later in my shift I went in to check on him and he was getting up. He got up slowly and stumbled to the side and fell. I couldn't do much it all happened so fast, I got to his head and protected it as best as I could. I couldn't stop the fall though my hand was crushed into the wall forcefully. I went to the ED they splinted it, met with an ortho 2 days later and it wasn't broken just a bad crushing injury.

Tonight will be my first day back and I'm paralyzed with fear. I'd do anything before going to my floor tonight... I feel hopeless and extremely fearful.

Both my instructor and preceptor think that I did the right thing, and that it wasn't my fault but I just can't get beyond this. I almost feel like I have PTSD I keep reliving it in my head.

How do I get beyond this?

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Specializes in Emergency.

What kind of ortho was it? I'm shocked they would not be risk for fall unless it was upper extremity.

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Specializes in Clinical Research, Outpt Women's Health.

It happens. Let it go.

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I phrased that wrong, he was a risk for fall... Almost all ortho PTs are a risk for fall, the only ones that aren't a risk are the overflow med surg patients. He wasn't on a 1 to 1 assist for ambulation on he was up and out of bed ambulating well without assistance all day.

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If I were to get a penny for every patient I've had that's fallen...well I would have maybe 10 cents lol.

Brush it off. It's not your fault, you didn't push him or forget to plug his alarm in. Relax. Absolutely no one will blame you.

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Specializes in Psychiatric Nursing.

No worries things like that happen. Next time just lower bed, make sure side rails are down unless it is stated or ordered (it is a form of restraint after all and can increase the risk for fall since theyd climb that stuff). Assess mental stats, sedation and determin which requires more frequent watch and reindtructions.

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No worries things like that happen. Next time just lower bed, make sure side rails are down unless it is stated or ordered (it is a form of restraint after all and can increase the risk for fall since theyd climb that stuff). Assess mental stats, sedation and determin which requires more frequent watch and reindtructions.

Only one of the siderails needs to be down so that it's not a restraint. Leaving them all down is way too dangerous.

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Specializes in Psychiatric Nursing.

CrazyGoonRN thank you for the clarification.

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Let me tell you a story.

It was Christmas night several years ago in a big military hospital. Yours truly had a minimal patient load. I spent the night caring for a LOL with cancer of the throat. She was hunched severely at her upper back, which was further occluding her airway in addition to the cancer that was pressing on her trachea. She was also very restless and wanted to get out of bed. She had moments of clarity, but as the night progressed, her O2 sats dropped and she became less and less "with it".

I was keeping a close eye on this lady. I had nothing else to do, so I'd sit across from her room and chart, take a walk, come back, and repeat. It was in the wee hours of the morning that I was rounding on the floor on behalf of a few other nurses and came across my own patient's room.

Imagine my horror when I saw my patient on the floor, blood all around her. I don't think I've ever moved so fast before--that includes PT tests and all my military training. I had a corpsman with me who quickly helped me get this poor lady off the floor and into her dreaded bed. To our relief, the blood was from the IV site that had come out when she fell. On assessment, she was clearly altered, had no memory of what had happened, and was starting to look like she was circling the drain. We cleaned her up, put her in bed, re-started her IV, and I left my corpsman at her side in a 1:1 as I called the on-call doc looking for a CT scan.

For 3 hours, I called the on-call service, trying to get a CT order. In the meantime, we moved the patient from her room to a room that was line-of-sight from the nurses' station. We spent the rest of the shift keeping her in bed between my corpsmen and the charge nurse. I was starting to page other services when I finally got a call back from the doc. By then, she was on a nonrebreather O2 mask, restless as all get-out, and trying to get out of bed. She was on her way to CT when I gave report to the AM shift and took off.

The next night, I came back and found out my patient had coded. They trached her at the bedside (which really geeked the nerds among the day shifters) and transferred her to the ICU, where she died several days after Christmas. The irony in all of this was that her CT had come back completely normal.

Fast-forward several months. I was out one Friday night with friends from work and came across the on-call doc who I had been trying to get ahold of that night. Several pitchers into the Sangria, this young intern began spilling his guts to me, told me he had fallen asleep on-call and hadn't heard my numerous pages, and felt absolutely awful about what had happened with my patient.

Y'know what I told him? It's OK. Well, not that it's OK that he fell asleep and missed my pages, but he didn't need to kill himself with guilt over our patient's fate. I told him that what happened with that patient was not preventable. Falls happen. Accidents happen. It's a fact of life and a matter of time before they happen on your shift to your patients. What matters is that you take steps to prevent them where you can and respond appropriately afterward.

I can tell you in all honesty that I have often pitied this patient, wished I had been there to see the fall and respond sooner, but I've never for a second kidded myself into thinking I could've prevented it. I've never felt guilty or responsible for her death and I have refused to do so, mostly because my closest friend, who was also on shift that night, insisted upon it. She could see the conflict between my emotional response to the situation as a human being (guilt) and my rational response as a professional and she guided me in how to handle the situation--to care for my patient and move on.

Hopefully, this post does for you what my friend did for me all those years ago. Chin up, mevsmom. This isn't on you.

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Specializes in Intake, Home Care.

I would tread lightly with stating PTSD. It's one thing to dwell on something, but PTSD is nothing to dwell lightly.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

breathe...these things happen! ((HUGS)) he patient was fine you are fine. It's ok.

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Specializes in L&D, infusion, urology.

Learn from it, and move forward. Assess what went wrong. There are usually multiple factors at play. If he was a fall risk, even though he'd been getting up and moving okay all day, why was he up out of bed alone? What could have been done differently? It sounds like you did the right thing under the circumstances, which is good!! I'm glad to hear both you and the patient are ultimately okay.

Patients will fall. Hopefully not often, but it does happen. We had one go down when she didn't realize that her epidural hadn't worn off as much as she thought it had. My preceptor and I were holding on to her, so it was like a "guided" fall, but she went down nonetheless. We, like our patients, are human. Again, learn from it and move forward.

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