Unobserved fall and I feel awful!

I am a nurse of 2 yrs. and yesterday around shift change my little elderly lady was found on the floor. I had round on her about 1800ish and she was laying in bed with her book, didn't need anything. She had been ambulating with a walker to and from the bathroom by herself AND changing her own brief. Not only that, but she would ambulate the halls, often unassisted (however on my shift, I'd always walk with her).

She couldn't help herself up and I knew instantly a hip fx, which later a xray confirmed. The call bell was in reach, she had her footies on. According to her she was sitting on the edge of her bed, which she does during meals, went to reach for something and lost balance.

She had already been seen by PT and like I said, ambulating. Ortho has been consulted to decide surgery or no. I feel completely sick over this. She is AO and so sweet. I don't know why I'm posting. I don't know what else to do but I've already cried and now I'm back to doubting if nursing is for me. And I am to start a 2nd job PRN soon! I can't move forward. I'm scared for my patient and for myself. I can't even blame it on ratios because I had discharges before that.

I need a time machine... And maybe a Xanax.

You can't be present everywhere all the time. You cannot blame yourself for this. Accidents really do happen, even to the most alert and astute nurses. It's normal to feel guilty, especially if this is your first patient fall, but there is nothing you can do now--aside from finding that time machine, of course.

I had a patient fall on me a few years ago right between my hourly rounds. Myself and a corpsman found her on the floor with a pool of blood (IV had pulled out) nearby. I also struggled with blaming myself. I had a low patient load that night and I told myself I should've been rounding every half hour, fifteen minutes--what have you. I decided I should've somehow sensed that she was going to fall based on my assessment. You name it--I blamed myself.

You can think up a million excuses, but sometimes these things just happen. In the end, you must pick yourself up, firmly tell yourself that it really isn't your fault, and move on.

SoldierNurse22: Thank you. But I can't shake it. It's not my first fall, sad to say. But I round and make sure the call bell is in place, bed alarm, etc, and still falls happen. And I ALWAYS blame myself. Even though my Charge RN and other nurses say I've done everything I should. But it doesn't matter. I still think something could have been different. And when I have a fall, I feel like I'm having too many and I'm a bad nurse. It's so early in my career and I'm afraid of losing my license and not being to handle things.

[LadyFree28, BSN, RN]

Probably a Xanax...

Like SoldierNurse has explained, you can't we everywhere...things happen, even to the most highly functional AO person; it has NO bearing on our nursing practice.

Decompress and move on; the pt is still ok, despite the fracture. Today is a new day. :)

Edited Aug 28, 2014 by LadyFree28

[doctorwhofan]

Look at it this way-you did round on her, you did answer her call for help, you didn't ignore her hip pain, you got the ortho team involved, and truthfully she could have fallen at home and not been found for hours. Unfortunately patients fall in the hospital. The important thing to remember is that you took appropriate action after the fact. You'll be fine!

Sent from my overpriced Apple device

[HappyWife77, BSN, RN]

It is not your fault. No one wants to see an injury or accident to our patients.

It's ok to grieve about it....but try to feel what you feel, and move on with Peace my friend. Iam sure your sweet lil lady would tell you as well its not your fault.

I've seen lil o ladies recover from many things. I pray she is ok and you are not too hard on yourself. God bless.

(((Hugs)))

[anh06005, MSN, APRN, NP]

The only way you could have prevented it was to be in the room the one second that she decided to reach over for whatever she was reaching to grab. She may have asked you to get it instead. Maybe not. Statistically that's a very small window of preventing the incident.

It is known that all of the stuff you DID do will decrease the risk of falls (non skid socks, frequent rounding, etc.). Notice the word is DECREASE and not ELIMINATE. Things are going to happen unfortunately. My first patient death was a sweet little lady I had rounded on within the last hour and the cardiologist had seen within the last 30-40 minutes and I had actually given lasix a few minutes after cardio saw per his order. She was a DNR but a family member asked if I could check on her. When I walked in family was around the bed crying. I was dumbfounded and started crying with the family. They didn't blame me or anything. Actually gave ME a hug. Things happen for no obvious reason.

Go by whatever room she is in now and check on her. I do home health now and do that often when a special patient of mine winds up in the hospital. They really appreciate it and don't blame you for their misfortune. They appreciate your kindness and care.

The only way you could have prevented it was to be in the room the one second that she decided to reach over for whatever she was reaching to grab. She may have asked you to get it instead. Maybe not. Statistically that's a very small window of preventing the incident.

It is known that all of the stuff you DID do will decrease the risk of falls (non skid socks, frequent rounding, etc.). Notice the word is DECREASE and not ELIMINATE. Things are going to happen unfortunately. My first patient death was a sweet little lady I had rounded on within the last hour and the cardiologist had seen within the last 30-40 minutes and I had actually given lasix a few minutes after cardio saw per his order. She was a DNR but a family member asked if I could check on her. When I walked in family was around the bed crying. I was dumbfounded and started crying with the family. They didn't blame me or anything. Actually gave ME a hug. Things happen for no obvious reason.

Go by whatever room she is in now and check on her. I do home health now and do that often when a special patient of mine winds up in the hospital. They really appreciate it and don't blame you for their misfortune. They appreciate your kindness and care.

It is a comfort to know I'm not alone. I'm trying to breathe easy but I'm still having trouble. Thanks all. This is helping me blame myself a little bit less.

[anh06005, MSN, APRN, NP]

As with any sort if "traumatic experience" it will take a little time to work through it mentally. You were following the best practice but unfortunately it can't eliminate every event.

Your head knows you did what you could. It's that dang heart that's getting in the way. But our hearts are why many of us went into nursing anyway.

So, as you have beaten yourself up over this I wonder what you have determined you might have done differently to prevent this fall?

I am asking because from your post it would seem that the AO elderly lady is responsible, not you.

People fall, people die, people get even sicker... no matter what we do.

You instituted and followed the correct precautions. Accidents happen.

Your reaction.. to now doubt your career choice is way out of line.

Please consult your EAP and get assistance regarding this reaction.

As other have said, it was not your fault. Unless we place our pts in a bubble, they will fall.

Please don't beat yourself up over this.

Thank you. And I know my reaction is way over the top. It isn't productive or practical but I have always been hard in myself like that. Maybe I will find some help with that sometime per your suggestion. Again, thank you all for your input. I do appreciate your time.

Emery, I think this might help your perspective. A friend was recently hospitalized, quite weak from a critical event. No one answered his call light.. he had to void. went to the BR by himself.. fell... hit his head requiring staples. His room mate also fell... breaking his hip.

This occurred in a well respected hospital! Hmmm.. could be an interesting thread

I hope they are both ok. But that does make me feel better.

My little old lady was to have an Ortho consult to determine if surgery is needed. The attending consulted one while one of her other MDs changed to another. So no Ortho consult today! Frustrating! But vitals are good and she is sleeping tonight. And yes, thankfully if she had to fall, it wasn't home and we were able to take action quickly.

And this may need to be another thread, but mechanical dvt prophylactics are a fall risk. Even if a pt is AO. I've heard mixed reviews of whether AT pumps, for example, are effective and worth the fall risk.

[Step_981]

I agree with SoldierNurse22, I think that it is normal that you feel guilty but it is also true that you can't be everywhere in the same moment.

Unfortunately those things happen, you has done all you can for avoid it but accident happens, therefore, in my opinion, you shouldn't blame yourself.

PS: sorry for my english, i'm italian and i try to learn it :)

As the others have said, don't be so hard on yourself. It does not sound like you could have done anything to prevent it. Even if you were in the room she could have reached for something and fallen. My husband's grandmother broke her hip in her 80's while standing at the sink washing dishes. She had surgery, healed and went on to live many more very productive years. I work on a floor that receives post-op ortho pt.s and many hip fracture pt.s. While it can be the catalyst for an elderly person's demise, many do recover very well. The elderly are oftentimes tougher and willing to do the rehab more than younger folks. Point is, even if she does need surgery, it is possible she will do just fine. And when she returns, you'll be there to cheer her on and encourage her in her recovery. You sound like a wonderful, caring nurse.