Who is to blame

[Finallydidit]

SCENE SET-UP: Unit 1 = 60 Residents, 2 LPNs, 1 RN, 4 CNAs. Split into two halls..

TIME: 10:30pm (30 minutes before shift change)

RN setting at desk,

LPN #1 charting restocking cart,

LPN #2 on phone with Pharmacy trying to get pain meds (that were supposed to be delivered 6 hours ago) for new admit. (Been playing phone tag with Dr. Pharm most of the evening) Family present and very upset.

CNAs doing last dry round

CNAs for LPN #2 come and say LPN #2, Resident X has fallen of the bed and hit her head. RN and LPN #1 go to evaluate Res. X, because LPN #2 is on the phone.

RN and LPN #1 agree Res. has to be sent out, due to hitting head. (LPN #2 still on phone) RN calls EMS and does paperwork to send to E.R. with asisstance from LPN #1. 10:45 EMS arrives, (LPN #2 still talking with pharmacy trying to get pain meds.) RN handles the transfer, gives EMS report etc. Res. leaves the building.

11pm CNAs, RN and LPN #1 go home. LPN #2 hangs up with pharmacy at 11:10, her whole crew had left, she leaves at 12:30 because she due to being behind because she had been trying all evening to get pain meds for new admit.

3am Res returns from ER diagnosis UTI !!!!! Res. didn't even have head looked at... No one called report to hospital, prior to transport!

8am family showed up and is not happy that a c/t scan wasn't done at hospital, ADON goes to look at nurses note just to see what happened, and nothing was documented anywhere. Who was at fault for this?

LPN #2? Although she was busy with another Resident, and basically had no knowledge of what happened, other then something happened, although it was her Resident that got sent out.

RN ? Her role on evening shift is to asisst LPNs when they get behind, and she left without reporting to LPN #2 what had happened and what needed to be done.

according to the ADON, to appease the family, someone has to be fired! Who would you fire? RN or LPN #2 or both?

I'll tell you the outcome after I get a few opinions...

[Sparrowhawk]

RN and LPN #1..but no one should be fired. That'st eh easy answer to things..just throw them away

[caliotter3]

It was still the responsibility of the RN to see that things were properly handled. She should have instructed LPN#2 to get off the phone and take care of the situation if that was what she wanted, and she should have monitored the situation to insure that everything went as it should.

[GOOBR]

The responsiblity of the patient was LPN #2 who should have asked the RN or LPN to take the phone call so they could send their patient out to the ER thus addressing both issues at the same time. The nurse not taking the phone call could let LPN #2 know all the pertinent information. The correct paperwork along with a phone call the update the ER on a pending admission and the call to the pharmacy could have been handled by all present. The fact that it wasn't handled in this fashion goes to poor management skills which would fall under the domain of the RN. If anyone is to be fired it should unfortunately be the RN.

[TheCommuter, BSN, RN]

If the RN's name is on the transfer paperwork, perhaps it was the RN whose employment got terminated. LPN #2 could very well be dishonest to the DON and state that no one had ever made her aware of the fall. In addition, since there's no documentation, her story could hold water.

[CoffeeRTC, BSN, RN]

Ugh....I just feel like screaming. Why oh why must a person be fired over this? I know it wasn't the option that the OP gave us, but still....makes me want to scream.

I work LTC and have seen this situation play out before.

I really love the above poster with the :

Dear Family,

We share your concern about the unfortunate events surrounding your loved ones fall and are taking steps to prevent such an occurrence again. We have performed a root cause analysis and are following up with staff education and a revision of our policies. We believe that a positive approach, rather than a punitive one, will be more effective in the long run for providing appropriate care for our residents.

What really happened was little comunication and no team work.

There are many options as to how this could have played out. Why wasn't the desk nurse (the RN in this situation) calling the pharamcy about the med (I've been the desk RN and needed to do this many a time). If that was the case then the floor nurse could have been doing the primary care and could have went and assessed the injured resident. Having the desk nurse there is probably so that the other nurses are able to provide the hands on care and the desk nurse does the other stuff (doc and family calls, pharmacy issues, labs, etc)

Another option: all nurses communicate what they are doing. Hey...We will go check your resident and you keep on the pharmacy? Or Hey....I will do the charting on this resident.

Often times we will help each other out in situations like this. I will ask the nurses doing the fall/ incident etc...did you chart on so and so? Or I will let them know, "hey...I assessed so and so and charted on them" If for some reason, I don't get to speak with the other nurses...I will follow up on my own and check the chart. CYA.

I bet it was the LPN on the phone who was fired because it was her assigned resident. She could argue that the RN is assigned to oversee all of the care and actually had hands and eyes on the resident and the incident.

I can't wait to get the follow up from the OP

[chasemelony]

Op, it seems like you know a lot of details about this story. Do you happen to be one of the characters in this story?

[Ms.RN]

lpn #2 should be fired because her patient fell and had a head injury. she should've either give phone to nurse #1 to talk to the pharmacy and go to the patient's room and assess the patient, and prepare to send patient out. other nurses can assist, but it is her responsibility to take care of her patient. what's more important, head injury or pain med????

second, if patient didnt receive pain med for 6 hours, i dont know what kind of pain med she is on but i can call her doctor and ask him that pharmacy didnt deliver her pain med so can i give her something else? give patient something that is avaliable in the back up box.

i think what she did is ignoring her patient who is injured and i think it is considered a abandonment. she was on the phone until 11pm? wow...

but since another nurse assessed the patient and sent patient out, she needs to chart on what she have assessed and that she called doc etc. etc..

i havent read other posts so i'm curious to read what other people have to say

[PedsAtHeart, LPN]

Maybe all 3 of them?? Isn't it the rule, if it wasn't charted... it wasn't done??

I don't think any of them should have been fired over this, but technically they all failed in one way or another and if there is no documentation of the situation then it is all he said/she said.

[MAISY, RN-ER, BSN, RN]

Basically, the OP states that the RN and LPN 1 assessed the patient and sent her to the hospital-bottom line is that it is their responsibility to report. If this information was endorsed back to LPN2 in writing, according to the rule of not charted/not done LPN 2 should not be held responsible.

HOWEVER, no one should be fired....that's ridiculous! Perhaps the facility should have more cna staff, or allow volunteers to assist in watching patients. UTIs one of the most common reason we see AMS, hip fractures, and CT for head in jury in the ER!

JMO

[GHGoonette, BSN, RN]

Discipline the RN, warnings to LPNS, fire the pharm doc. He's clearly incompetent. Waiting 6 HOURS for meds, and they're still not there?

[Nascar nurse, ASN, RN]

No one should be fired, but certainly some education and perhaps some new, clearer policies are needed. May be check list: EMS called, DON notified, report to ED, family, etc.

Dear Family,

We share your concern about the unfortunate events surrounding your loved ones fall and are taking steps to prevent such an occurrence again. We have performed a root cause analysis and are following up with staff education and a revision of our policies. We believe that a positive approach, rather than a punitive one, will be more effective in the long run for providing appropriate care for our residents.

If only every facility had people in leadership positions with this much style and grace the world would be a better place.

[CapeCodMermaid, RN]

Fire no one. Perhaps the hospital is at fault. We have sent detailed referrals to the hospital with our patients AND have called the ER only to be told they didn't know why the person was sent in the first place.

What really troubles me about this....HOW IS THE RESIDENT? It's about him after all.