State reportables

[Nascar nurse, ASN, RN]

My facility seems to have gone crazy with state reportables recently. Enough to make you want to pull your hair out & I think it's gotten way out of hand. I will give you some examples (sorry that I have to keep it so generic) and I would like you honest opinions if you would have reported. Please be honest - don't just tell me what you think I want to hear. Maybe there's something I'm not understanding

1. Family reheated food & resident took a bite. Result of less than 0.5 x 0.5 blister to lip - blister gone before end of same shift. Reportable?

2. Resident reports a staff for being hurried and rough. Closer 1:1 with resident = aide was in a hurry, going faster than resident wanted to be rushed - but absolutely no physical abuse and resident easily agrees that perfectly OK with aide continuing to provide her care. Reportable?

3. Sudden acute change of resident condition right at shift change BEFORE report has occurred. Off going nurse casually tells aides "she's been fine all night" & never gets off her rump to go check res. On coming nurse (punched in but who has not had report) is concerned w/ resident and goes to check, follows appropriate care and sends res to ER. Reportable as neglect by off going nurse (even tho resident received timely and appropriate care)?

This is just some examples. We average 2-4 reportables of this kind/week. And of course, we are suspending/terminating staff left and right over every little thing. After 25 years, I'm almost afraid to even speak to a resident in fear they may complain. Needless to say, I'm spending hours upon hours investigating complaints.

Thoughts?

[noc4senuf]

For number 1&2, I would not report. As for #3, if you are going to report to the health dept, then I would also report the nurse to the Board of Nsg.

[CapeCodMermaid, RN]

Number 1,,,I'd report it. It was an injury no matter how small.

The others I wouldn't report and I have been told I over report. When in doubt, report it. If the DPH doesn't want it that's up to them.

[southernbeegirl, BSN, RN]

Number 1,,,I'd report it. It was an injury no matter how small.

The others I wouldn't report and I have been told I over report. When in doubt, report it. If the DPH doesn't want it that's up to them.

i agree.

[noc4senuf]

The reason my choice was not to report it was, it was not an injury of unknown source

[Talino]

State laws vary. In New York, only #3 is a probability, even a toss-up. Since this is an acute change, the outgoing nurse's statement and witnesses' accounts will determine if negligence really took place.

[CapeCodMermaid, RN]

The reason my choice was not to report it was, it was not an injury of unknown source

With that reasoning, you wouldn't have to report a witnessed fall with a fracture. I didn't report a burn once to the DPH...I was the assistant at the time and the DNS said not to. Corporate came in and picked that chart for mock survey....they hit the roof.

[noc4senuf]

No I wouldn't as it was witnessed and there is not an unknown.

[CapeCodMermaid, RN]

No I wouldn't as it was witnessed and there is not an unknown.

Wow..in Massachusetts if we didn't report a significant injury---fracture---we'd get cited for sure.

[Nascar nurse, ASN, RN]

With that reasoning, you wouldn't have to report a witnessed fall with a fracture. I didn't report a burn once to the DPH...I was the assistant at the time and the DNS said not to. Corporate came in and picked that chart for mock survey....they hit the roof.

CCM.. that is exactly what happened with the burn I referred to. Mock survey hit the roof (luckily, I guess, the burn occurred only 2 days before they came in).

But.. I see a fracture as a significant injury. I DO NOT see a 2nd degree burn that resolves itself in less than an 8 hour shift as a significant injury...but I don't get to be the boss either.

[debRN0417]

According to the regulatory language a second degree burn could be harm for the resident. Fortunately the family did it and not the staff, but it could be harm none-the-less. This is something that definately should have been reported. Even though the area resolved quickly and it did not "change the person's life" (short-term or long term) there could be some potential problems. You should be concerned about the possibility of this happening to other residents in a more serious way. Although you have no control over the family, the resident is under your care and you are responsible for what happens to them while they are there. I would be investigating how all this happened and what could be done to prevent such occurrences in the future. If something like this is reported and you have all the documentation of the investigation, and how you are going to keep this from happening again, and how you are going to protect not only this resident but others as well, then I can't see where you have failed. However, if you try to "sweep this under the rug" ( and please don't take offense to my verbage) you could set yourself up for problems- not only with the regulatory agency, but with the potential for future events as well. I am not just talking about this instance but think about it: an incident occurs, you know about it, you took care of your resident, however, you did not investigate if this could also affect others and how could you prevent anything like this from happening again to all residents. Okay, then some family member comes in and does the same thing, but this time it is much worse. There is a real problem there. I am not criticising anyting that you have done. I just want you to explore and thing about the whole picture.

2. Not reportable, UNLESS the report taken from the resident is considered an allegation of abuse. Then it is reportable definately and investigation MUST happen.

3. The off-going nurse needs to be counselled, disciplined, or whatever, and education done regarding job duties and monitoring of residents, unless she is a habitual offrender and this is documented, then if terminated for neglect, this is reportable to the board of nursing and to the state agency because she was neglectful to the residents needs.

I hope this helps.

[noc4senuf]

#1 does not meet the criteria of which we report. We report for abuse, neglect, mistreatment, misappropriation of resident property, and injuries of unknown origin per regs. We do always document what our action is for insuring something does not repoet itself. Since documentation is there, surveyors can & do read it when they are in. No problem. Nothing is swept under the rug.