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, my hospital doesn't even employ sitters. The only time we can get someone to sit in a room and watch a pt is when their suicidal. And of course half the time, you find the person who is supposed to be watching them sleeping.
All our beds have bed alarms on them but once they go off people forget to turn them back on or when they're going off, no one is around to respond to them. Or even worse, they go off and people just sit at the nurses station like they can't hear them.
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Let them not get reimbursed for a fall a couple times, and they will get their butts in gear & hire some sitters. They're much cheaper than covering x-rays, etc. It's all about the $$$, unfortunately.
People fall . Especially the demented elderly. Lots of them fall at home and break hips and that is how they get to us in the first place. What are the options ?
Low beds, personal alarms, bed alarms, pads on the floor, restraints, veil beds ? unless you want to tie pts down or put them in veil beds that they can't get out of then 1-1 staffing is the only sure way to prevent falls.(
Although toileting q2 hours would help) Maybe after the fall risk assessment identifies a fall risk families should be required to provide a sitter.:smokin:
I thought that the JCHAO's school of thought was to use restraints/sedation in extreme circumstances - it would be preferrable to have a pt fall than to be restrained. Not saying that its good for pts to fall, but that there's only so much you can do and its not right to take away the pts dignity in the process. I guess things have changed!
Document your butt off! "Call light in reach", "Low-bed ordered, awaiting arrival to unit", "Central Supply called regarding low-bed, charge RN notified that bed has not arrived for pt", "Room lights on", "Writer requested sitter for pt secondary to pts cognitive status and confusion; request denied by management".
These new policies regarding falls that management is trying to implement are only going to cause people to avoid filling out incident reports and avoid charting that a pt was "found on the floor", etc.
I had a little old lady in our ED this week; the NH sent her for right knee swelling, of which an x-ray showed no fracture. Upon her arrival, her right leg was shortened, her right calf was yellowed, her knee had a huge purple bruise, and her right hip had green-yellow bruising. The NH denied trauma or fall. I ordered a stat hip xray, and it was fractured - the xray techs hunted me down to let me know personnally that it was a "terrible" fracture. Now, there's no way this lady could have fallen without anyone knowng it - she probably fell but no one reported it. Poor lady, it had probably been fractured for several days and she didn't get the care she needed because someone didn't want to get in trouble for a fall that most likely couldn't be prevented. How can we provide proper care for our pts if we are being punished for situations beyond our control?! And in the end, its the pts that suffer...
Nurses should not be blamed for falls. I'm sure most of us that have had a patient fault have felt bad enough about it, not need to reprimand and possibly fire us over it. I don't see a problem with management and administration sitting down with the nurse to review the chart and try to determine why the patient fell, but to potentially fire a nurse over a fall, I don't think so.
Who needs a chart review? Too many patients, too few hands, and Granma forgot that she, well, can't walk.
It's not about you or making your life hell- it's about money.
Bed alarms? On my husbands floor, the beds have alarms. Not the type in the nursing home that get pinned to the patient- if there is a significant shift in weight in the bed (like going from laying to sitting on the side of the bed), it will alarm if set to do so. If the bed is not locked, an alarm sounds.
There's another group of people who should be required to do bedside nursing, and that's Medicare folks who are the ones who drive reimbursement, and thus staffing. Not to speak of they are among the prime generators of the usually repetitive paperwork that continues to proliferate.
They live in a political bureaucracy, and it's only accidental that their goals coincide with good patient care. As Weber pointed out many decades ago, bureaucracy's prime motivation is its own survival and expansion.
Who is this Weber person and how did they get so smart?
BGgirl
109 Posts
Wow, my hospital doesn't even employ sitters. The only time we can get someone to sit in a room and watch a pt is when their suicidal. And of course half the time, you find the person who is supposed to be watching them sleeping.
All our beds have bed alarms on them but once they go off people forget to turn them back on or when they're going off, no one is around to respond to them. Or even worse, they go off and people just sit at the nurses station like they can't hear them.