Your patient fell? You need to be disciplined!

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Hi everyone,

I'm just curious if anyone else is seeing this where they work. The healthcare system for which I work for has instituted new guidelines related to patient falls. According to the higher-ups, there has been an intolerable number of patient falls throughout the system. We received an email notification this past week that if one of our patients is involved in a fall that our nurse manager and department director will be meeting with us to review the patient's chart and to determine why the fall occurred and what we could have done to prevent it. If we have a second patient involved in a fall we are being threatened that we will be disciplined and that it will be reflected in our yearly evaluation.

Is anyone else seeing anything similar to this? I can't believe that they are threatening us with this. Do they think we're pushing our patients down to the floor? Do they think we're just sitting outside of the room twiddling our thumbs? Do they not realize how much of a patient's care revolves around the computer and that paper chart? Forget even having enough time to spend just 5 minutes in the patient's room. Why does it take almost 24 hours after an order for a low bed is placed to actually get it? Automated orders are being put in through our system to avoid administering sedatives and placing restraints. Physicians are being directed not to allow their patients to be sedated or restrained. Can't possibly have a sitter for the patient because there just isn't enough staff in the hospital. Staffing always seems to be an issue. I often have 3 patients in one corner and 2 down the hall. How can I be in two places at once?

The people making these rules and guidelines are so far from bedside nursing it isn't even funny. I thought safe staffing is what helped save lives and prevent falls? Guess I was wrong.

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Specializes in Onco, palliative care, PCU, HH, hospice.

Seeing this where I work as well. Thanks to Joint Commision adopting this zero tolerance of falls, pressure ulcers, and nosocomial infections our administration has turned up the heat on the nurse managers and staff nurses on preventing these things.

Needless to say in reality, patients are going to fall, some patients are going to have skin breakdown no matter what you do, and some nosocomial infections are bound to happen. That however isn't a good enough defense in Joint Commision's eyes. How can I prevent every patient from falling when we have 7 patients a piece and no CNA?

On top of this administration has decided we're OVERstaffed. I've decided I'm going to have to find a way to make 6 clones of myself that way I can accomplish all that I need to please administration. Trust me, I feel your pain.

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Specializes in Hem/Onc, ER.

I cannot believe that the nurse would get disciplined for that!!! :banghead: People fall. Especially the elderly who populate the hospitals. I used to work on an Oncology floor. We did BMT's, chemotherapy and many patients came in needing symptom control. Some of these people came to us confused with brain mets, etc. Some became confused. Anyway, we could not restrain and no bed alarms and we really tried as hard as possible to round as much as possible but I had 6 patients during nightshift and it was a very busy floor, i.e, hanging chemo, blood products, multiple antibiotics, etc. Sometimes we got sitters but they were few and far between. I had many people pull out their PICC lines and deaccess their Mediports from confusion and they would fall. :uhoh21:

Anyway, I'm not sure how that is going to work. I don't know a floor nurse who hasn't had a patient fall during their shift. We cannot be everywhere. Maybe some of the people who make up the Joint Commission should take a patient assignment for a shift and see what they think after that!! :bugeyes:

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Specializes in Cardiac Telemetry/PCU, SNF.

Another wonderful example of good ideas turned back by the Joint Commission. We have so much to be thankful for: especially TJC for making our lives soooo much better.

Yes, it is a good idea that falls should not happen. I'm totally in agreement with that, but there needs to be realistic and rational though that goes into it. People fall. Especially older folks with medical problems. It happens. No matter how much you round, how many staff you have, the loudest bed alarms or a psychic aide, the only way it's not going to happen is if they are sedated, paralyzed and intubated, and even then, it could...

Blaming the nurse ina situation like this only creates more division between administration and the bedside nurses. It's not like we encourage our patients to fall...that's too much paperwork to deal with! Should here be a review of the situation? Probably, we can always learn from our "mistakes" but taking it to the level of discipline and poor evaluations is counter-productive.

That's why I truly believe that members of TJC who make these rules should be required to spend time on the floor, doing bedside nursing in the current environment to gain a better understanding of the rules they want to enact. I think it would change their perspective.

Cheers,

Tom

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Has anyone heard of the new "nurse monitor" concept? Yes, someone is going to stay in the room with the very confused, agitated, often combatative patient. They will not attempt to intervene with patient care but will put on the light when the nurse is needed. The nurse is given so much time to get to the room and take care of the patient. If the nurse is not there in so many minutes(???) she will be given a reprimand, after 3 reprimands, she is given a day off and must undergo safety training. If a second incident occurs then she will be fired. I swear I am not making this up, I spoke with a girl yesterday and she told me the place where she works is going to this system. These monitors are paid minimum wage, have little to no CNA or other training, but are going to be an extra pair of eyes for administration. I know my mouth dropped open when she told me this. She said it is some new way to keep costs down and meet new JCAHO standards. ??????

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Hi everyone,

I'm just curious if anyone else is seeing this where they work. The healthcare system for which I work for has instituted new guidelines related to patient falls. According to the higher-ups, there has been an intolerable number of patient falls throughout the system. We received an email notification this past week that if one of our patients is involved in a fall that our nurse manager and department director will be meeting with us to review the patient's chart and to determine why the fall occurred and what we could have done to prevent it. If we have a second patient involved in a fall we are being threatened that we will be disciplined and that it will be reflected in our yearly evaluation.

Is anyone else seeing anything similar to this? I can't believe that they are threatening us with this. Do they think we're pushing our patients down to the floor? Do they think we're just sitting outside of the room twiddling our thumbs? Do they not realize how much of a patient's care revolves around the computer and that paper chart? Forget even having enough time to spend just 5 minutes in the patient's room. Why does it take almost 24 hours after an order for a low bed is placed to actually get it? Automated orders are being put in through our system to avoid administering sedatives and placing restraints. Physicians are being directed not to allow their patients to be sedated or restrained. Can't possibly have a sitter for the patient because there just isn't enough staff in the hospital. Staffing always seems to be an issue. I often have 3 patients in one corner and 2 down the hall. How can I be in two places at once?

The people making these rules and guidelines are so far from bedside nursing it isn't even funny. I thought safe staffing is what helped save lives and prevent falls? Guess I was wrong.

Every single patient that is even a moderate fall risk put in a request for a sitter. Document that you did this. If there is a fall then its because management didn't provide a sitter. If they ask why your sitter requests have gone up by 500% explain the effect of the new policy. Sit back and watch management's head spin. Not a nurse, but that's what I would do. Usually when management figures out that the unintended consequences of a policy are going to interfere with their country club membership then they come to some sort of accommodation.

David Carpenter, PA-C

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Specializes in Med/Surg.

Our management thought the greatest thing in the world happened when they adopted our program of sitters....but since there we so many requests for them, they now count against our staffing grid! Go figure! I can't afford to get a sitter for ONE patient out of twenty-some and lose a CNA. It's ridiculous. They implemented a program we can't even USE now. :argue:

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Specializes in dialysis (mostly) some L&D, Rehab/LTC.

I'd say super glue their butts to the bed but then you'd get skin breakdown.. so just keep putting in for sitters for all of the pts... These fools that implement this crap must have worked for the BUSH administration at some point in their life...

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Insurance companies & Medicare are considering denying reimbursement for fall-related films & injuries, too.

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Specializes in Rodeo Nursing (Neuro).
Has anyone heard of the new "nurse monitor" concept? Yes, someone is going to stay in the room with the very confused, agitated, often combatative patient. They will not attempt to intervene with patient care but will put on the light when the nurse is needed. The nurse is given so much time to get to the room and take care of the patient. If the nurse is not there in so many minutes(???) she will be given a reprimand, after 3 reprimands, she is given a day off and must undergo safety training. If a second incident occurs then she will be fired. I swear I am not making this up, I spoke with a girl yesterday and she told me the place where she works is going to this system. These monitors are paid minimum wage, have little to no CNA or other training, but are going to be an extra pair of eyes for administration. I know my mouth dropped open when she told me this. She said it is some new way to keep costs down and meet new JCAHO standards. ??????

I haven't heard of this one, but it sounds insane. If you're going to pay someone to stay with the pt, why not have them do something for the pt?

That said, there have been a few times when I've had a patient with a UAP for a sitter who calls out every five minutes to tell me the patient is agitated, or needs to be restrained and/or sedated. For that matter, I was once a UAP sitting with a patient, AOX3 but with psych issues, who was behaving reasonably well until an aide came in, said his family was complaining that he needed a bath, so he was getting a bath whether he wanted one or not. So patient flips out and aide leaves in a huff, because she "isn't going to listen to that kind of language." Nice.

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Heh.

I've never had problems with patients being combative with me, no matter how confused. I can always calm them down, if not redirect them. Not that I'm Mother Theresa, but I never announce to anyone that they'll do it whther they like it or not.

But this is the classic case of management refusing to bow to the new reality of the floor: increasingly debilitated and elderly patients with galloping confusion/dementia incapable of simple ADL's and unchanged or cut staffing. Yeah, bed alarms are great. Get you there just in time to see his butt hit the floor.

Luckily, I'm in a CAH and we do not belong to JCAHO. We do a lot of swing beds - people who are no longer acutely ill but need LTC placement - and our physicians will prescribe geri-chairs with trays.

*sigh*

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Specializes in Critical Care.
Hi everyone,

I'm just curious if anyone else is seeing this where they work. The healthcare system for which I work for has instituted new guidelines related to patient falls. According to the higher-ups, there has been an intolerable number of patient falls throughout the system. We received an email notification this past week that if one of our patients is involved in a fall that our nurse manager and department director will be meeting with us to review the patient's chart and to determine why the fall occurred and what we could have done to prevent it. If we have a second patient involved in a fall we are being threatened that we will be disciplined and that it will be reflected in our yearly evaluation.

Is anyone else seeing anything similar to this? I can't believe that they are threatening us with this. Do they think we're pushing our patients down to the floor? Do they think we're just sitting outside of the room twiddling our thumbs? Do they not realize how much of a patient's care revolves around the computer and that paper chart? Forget even having enough time to spend just 5 minutes in the patient's room. Why does it take almost 24 hours after an order for a low bed is placed to actually get it? Automated orders are being put in through our system to avoid administering sedatives and placing restraints. Physicians are being directed not to allow their patients to be sedated or restrained. Can't possibly have a sitter for the patient because there just isn't enough staff in the hospital. Staffing always seems to be an issue. I often have 3 patients in one corner and 2 down the hall. How can I be in two places at once?

The people making these rules and guidelines are so far from bedside nursing it isn't even funny. I thought safe staffing is what helped save lives and prevent falls? Guess I was wrong.

Wow, that is ridiculous. I'd put in the sitter requests and if patient safety was an issue, fill out a incident report. If the administration doesn't want to supply the appropriate staff to support their policies, then definitely get risk management involved. I can't say I'd accept such a write up for something out of my control. Patients will fall, unfortunately that happens no matter how well we are prepared sometimes. Good luck to you

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