When to call the Doctor regarding a fall?

[LStar]

Hello, I am a new RN with a bit of LPN experience. I had a quick question. I was working at a nursing home at the time as a LPN on second shift, when a patient was found on the floor. The patient was alert, no harm, vitals were stable and was able to get back up. After assessing the patient I charted and filled out a incident report. I was about to call the doctor and the RN said since the patient is not hurt it's okay to just fax the incident report to him. I was just wondering if I should have called the doctor still anyways even though there were no injuries or was it okay to fax the incident report without calling? Thank for any advice :)

[horrorxgirl]

At the facility that I work at we have two ways to contact the doctor on shifts that he's not in office. We can either page him (which is what we almost always do) or we can call his telephone service to leave a message or to have them page him. So if a patient shows any sign of injury I immediately page the doc. If the patient shows no sign of injury I call the telephone service to have them leave a message for the doctor but a callback isn't needed.

Then we write a nursing order and fill out a paper to do neurochecks on the patient every four hours for 24 hours to cover our butts more. POA is still notified for every fall, and at our facility even if it happens on midnight shift and there are no injuries we are still required to call then, so I try to wait until after 6am, but still the phone is often answered by startled, concerned people...and I feel bad doing that.

[ohgoodnessgracious]

Really? Wow.. I've only worked in a big university hospital so I'm really not all that familiar with LTC protocols. Any patient that falls here get seen STAT, get STAT scans and we have all the annoying gizmos and gadgets to alert us if even patients shift over on the bed. It seems scary that no one sees a fallen patient by the MD until a couple of days later. Do the patients get sent for any scans right away? I guess this would depend on the severity of the fall. I understand where and how excellent nursing assesment comes into play but bleeds and all sorts of brain trauma could be very silent - I mean look at what happened with Liam Neeson's wife. In any case, kudos to you life-savers!

[horrorxgirl]

I would say the biggest reason it's different in longterm care is because falls are extremely commonplace. And because of this we go through other measures too, like chair/bed alarms, keep beds in the lowest possible position for certain residents, and using padded fall mats on the floor beside the bed to lessen the possibility of injury. You can have some residents who are very confused and will fall several times in one day. Several times in one shift, even. If we had to send them out for every fall, the ER would be getting certain patients every single day and for no reason. So thats why we initiate 4 hour neurochecks instead.

A fall happening to an alert patient who is walking to the bathroom and perhaps falls hard on a hospital floor unexpectedly is kind of a different situation and more likely to cause injury. Its usually patients like that that most likely get sent to the ER, because they are the ones who usually seem to injure themselves.

[LStar]

Thankyou so much for the advice it was really helpful.