Will our home be cited?

[banditrn]

One of the girls speculated that we will - here goes:

Yesterday, during the day shift, three different residents fell. One fella apparently died.

When I came in last nite I was told that Mr. X had fallen out of bed and died. But then I heard MORE of the story - apparently they found him with his head on a pillow, and a blanket covering him. Well, the nurse on that hall has come up with this fantastic theory - and she's dead serious - she's speculating that his implanted defibrillator shocked him enough to throw him out of bed. But if that were the case, then it caused him to completely change the direction in which he was laying, then covered him up???

After thinking about this, I'm betting the old guy climbed out of bed with his blanket and pillow, lay down on the floor - and died - but there will be no proving how it happened because it wasn't witnessed.

And apparently there were 3 falls last weekend. I have no idea if they were working short or not.

Ours is not a bad LTC - but some people are just going to fall - because no matter how many monitors you put on them, and how accessible the call lite is, they WILL try to get up on their own from time to time and fall - usually 10 minutes after you last checked them.

What do you guys think?

[SuesquatchRN, BSN, RN]

Well, that state is certainly going to show up. Just make sure your A&I's are complete and the safety precautions taken are well documented, and that the care plans reflect them, as well.

*sigh8 They have "the right to fall," and then we get into trouble when they exercise it. Which they do, with frequency.

[AirforceRN, RN]

she's speculating that his implanted defibrillator shocked him enough to throw him out of bed. But if that were the case, then it caused him to completely change the direction in which he was laying, then covered him up???

I think that if it will do the dishes and the laundry too I'm going to fake an arrest and get myself one.

[dcnballmom, ASN, RN]

so what do you tell the state - that you were working short - thats a no- no where i work - or do you tell them what your findings were and hope for the best?

[fultzymom]

Depends. Did someone report you to the state? If they come in for your annual review then you could get cited if these were charts that gets reviewed. Or if a staff member would volunteer the information to the state. Just because you have the falls does not mean that you will be cited for sure.

[CapeCodMermaid, RN]

Was the fall unavoidable? Did you have documented safeguards in place?

Any fall with subsequent death HAS to be reported to the DPH and the Medical Examiner. Having 3 falls in one weekend doesn't make it a 'bad' home. The last facility I worked in was a 'good' home, but in one weekend we had 3 incidents which had to be reported to the DPH. Do a thorough job in your investigation,documentation and reporting and you'll be better off.

Good luck. Let us know what happens.

[banditrn]

Do they only report the falls that result in death? Or injury? MY theory on the fella that they found dead is still that he climbed out of bed on his own and laid down on the floor and died - who else would have placed the pillow and covered him with the blanket? He was in a private room.

[CapeCodMermaid, RN]

You are supposed to report any incident that results in an injury...fall with fracture, fall with death,fall and sent to the ER for sutures. You don't have to report a fall with a trip to the ER if there was no fracture or sutures. Also have to report resident to resident altercation...if they are both demented there has to be an injury. and of course you have to report anything of a sexual nature. We had one guy who liked to grab women's bosoms. He was demented ...the women were demented. I had to do 3 reports to the DPH in 8 weeks. We did not get cited. Had a fall with fracture. We put all sorts of interventions in place. ...we did not get cited.

From what you say, I think you're right. The guy put his pillow and blanket on the floor, went to sleep and died.

[Nascar nurse, ASN, RN]

You are supposed to report any incident that results in an injury...fall with fracture

In my state, we only have to report fall with fracture of a "dependent" resident. Recently had a CVA resident in for therapy. Was back to independence, home eval complete and scheduled for discharge within 2 days. She was up in room, doing "normal activities", hip audibly cracked than she fell down (heard/witnessed by family present). In our state, that is not reportable. If she had required assist with transfers and and staff left her, say, sitting in bathroom unattended and she fractured hip.. than that is reportable.

Just pointing out differences state to state.

[banditrn]

In my state, we only have to report fall with fracture of a "dependent" resident. Recently had a CVA resident in for therapy. Was back to independence, home eval complete and scheduled for discharge within 2 days. She was up in room, doing "normal activities", hip audibly cracked than she fell down (heard/witnessed by family present). In our state, that is not reportable. If she had required assist with transfers and and staff left her, say, sitting in bathroom unattended and she fractured hip.. than that is reportable.

Just pointing out differences state to state.

Oh, ouch, that poor lady!

[regulating and lovin]

Can't get ahead of yourself. Who says the fella fell? If he fell and was with it enough to grab his pillow and blanket, then why didn't he call for help? Unusual incidents must be reported to the State. And..if a facility self reports an incident and sends it through the QA&A process, then the state cannot cite the facility. Do the right thing, be up front. No one can say or prove what actually happened. The facility must conduct a thorough investigation..interview staff on the floor at the time of the incident, etc. They probably won't be able to determine what happened, but they must show that they tried. Did the fella have a history of falls from the bed?

[banditrn]

Can't get ahead of yourself. Who says the fella fell? If he fell and was with it enough to grab his pillow and blanket, then why didn't he call for help? Unusual incidents must be reported to the State. And..if a facility self reports an incident and sends it through the QA&A process, then the state cannot cite the facility. Do the right thing, be up front. No one can say or prove what actually happened. The facility must conduct a thorough investigation..interview staff on the floor at the time of the incident, etc. They probably won't be able to determine what happened, but they must show that they tried. Did the fella have a history of falls from the bed?

I don't know much about him, as he wasn't in my section, but from I heard, he was confused. He hadn't used his call lite.

If I understand the process, they are 'self reporting' this incident.

What concerned me was the two other falls that same day, and the three the previous weekend. Only one of the falls this past weekend was in our section - the fella has a history of falls, is non-compliant a good part of the time - he's kind of an old curmudgeon that's going to do things HIS way - and he's been charted on frequently - he's also mostly A&O.

I was just going by what I heard one of the other girls saying - that we'd probably be cited for all the falls the last two weeks.