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Legal requirement to report?
KlatBlutig
Registered User regular
Registered User regular
***tldr: I saw a resident at the nursing home I work at who had fallen and injured his head get picked up by staff without taking C-Spine precautions and found him unattended and semi-conscious in his bed a short time later. EMS was not called while I was there. Did the staff screw up and do I have a legal and/or moral requirement to report?
It has been a pretty long time since I've posted anything here but as I've often found these forums to have a fair number of helpful people I feel that this is a good place to ask for advice on a matter that is very troubling for me:
I work at a retirement home that is run by a non-profit entity. I'm a good little name tag wearing lackey working in the activities department and have thus far received good reviews for my job performance. I am also a former EMT. The residents that I work with require enough care that medical staff is on site at all times and the residents are not allowed to leave the facility unless special arrangements are made with staff and family members.
Today one of the residents I work with regularly fell and injured his head and I feel the staff mismanaged the incident. Events played out as such: I did not see the resident fall, I did hear an employee who works in a non-medical capacity shout for help. After trying unsuccessfully to get a CNA's attention that was nearby I moved to the area where the resident had fallen and sounded an alarm. The resident that had fallen was face down on the floor and shaking. This particular resident has Parkinson's Disease and often has "spells" during which he is unable to speak or move and is prone to falling out of his wheelchair. Once medical staff did respond to the incident they moved the resident from the floor back into his wheelchair during which time I noticed an open wound above his eye. The staff did not utilize C-Spine immobilization and did not summon EMS professionals. Shortly after the incident I went into the resident's room to return a pair of reading glasses that the resident had left in the activity room and found that the resident had been placed in his bed and left unattended and that the wound over his eye had been treated with what appeared to be Neosporin. The resident appeared semi-conscious Shortly before ending my shift I saw the resident's wife and asked her if she had been notified of the incident, she answered in the affirmative and asked where her husband had fallen. I pointed out the area where I had found the resident whereupon the nurse supervisor approached me and suggested to me that I return to my post and let "nursing staff handle this." I felt that this individuals posture and tone was threatening and complied.
Do I have a legal requirement to report this incident? More importantly should I report this incident and if so to whom? Should I report what I saw to the resident's wife? I figure that I stand a good chance of loosing my job if I do report what I saw
It has been a pretty long time since I've posted anything here but as I've often found these forums to have a fair number of helpful people I feel that this is a good place to ask for advice on a matter that is very troubling for me:
I work at a retirement home that is run by a non-profit entity. I'm a good little name tag wearing lackey working in the activities department and have thus far received good reviews for my job performance. I am also a former EMT. The residents that I work with require enough care that medical staff is on site at all times and the residents are not allowed to leave the facility unless special arrangements are made with staff and family members.
Today one of the residents I work with regularly fell and injured his head and I feel the staff mismanaged the incident. Events played out as such: I did not see the resident fall, I did hear an employee who works in a non-medical capacity shout for help. After trying unsuccessfully to get a CNA's attention that was nearby I moved to the area where the resident had fallen and sounded an alarm. The resident that had fallen was face down on the floor and shaking. This particular resident has Parkinson's Disease and often has "spells" during which he is unable to speak or move and is prone to falling out of his wheelchair. Once medical staff did respond to the incident they moved the resident from the floor back into his wheelchair during which time I noticed an open wound above his eye. The staff did not utilize C-Spine immobilization and did not summon EMS professionals. Shortly after the incident I went into the resident's room to return a pair of reading glasses that the resident had left in the activity room and found that the resident had been placed in his bed and left unattended and that the wound over his eye had been treated with what appeared to be Neosporin. The resident appeared semi-conscious Shortly before ending my shift I saw the resident's wife and asked her if she had been notified of the incident, she answered in the affirmative and asked where her husband had fallen. I pointed out the area where I had found the resident whereupon the nurse supervisor approached me and suggested to me that I return to my post and let "nursing staff handle this." I felt that this individuals posture and tone was threatening and complied.
Do I have a legal requirement to report this incident? More importantly should I report this incident and if so to whom? Should I report what I saw to the resident's wife? I figure that I stand a good chance of loosing my job if I do report what I saw
KlatBlutig on
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You saw a client who was injured, and you do not feel that the response was appropriate. You're an ex-EMT, so you have working knowledge of the proper procedure that needs to be followed whenever a patient is injured.
Report anonymously if you have to, but report.
If there isn't, weigh up what you believe to be the right thing, I suppose.
I recommend reporting this incident to your own supervisor, especially if they didn't have you fill out any reporting forms regarding your assistance there. Don't let them intimidate you. If you feel something going on there is wrong, say so to the appropriate authorities there. If you feel you directly cannot do so without retaliation, I suggest using this:
http://www.ncea.aoa.gov/ncearoot/Main_Site/Find_Help/State_Resources.aspx
If they DO attempt to terminate you for reporting this, or find out you were the one to do so anonymously and attempt to remove you from their employment doing so contact your union representative if you have one.
Even if things are okay, always keep an eye out for that kind of thing as part of your duties as a member of the home. You might end up being the difference between a happy elderly resident or a dead one someday if yours is the call or report that makes a difference.
Again, the actual legality of it and how you should go about it will depend on your location.
protocol aside, if you witness/can rule out a neck injury you don't really need to manage c-spine. semi-concious seems more concussion symptoms which a neck injury would not cause
As to my concern regarding c-spine injury; when I trained we were told to take c-spine precautions anytime there was a fall or head injury, even if it seemed overkill. The adage was "when in doubt, whip it (meaning a collar) out" and went along with other gems like "no glove, no love." In this case I would have held c-spine (there are no collars in the facility AFAIK) until an ALS unit could arrive simply because I could not determine the victims state of consciousness. I still can't believe that the resident was put in bed unattended after sustaining a head injury though, I just assumed RNs would know better...
Anyway the report is filed and I gave my name, I figure if it's worth doing it's worth doing all the way. After sleeping on it I've decided that if I'm pressured to resign I don't really want to work at a place that would do that.
First of all, yes, you are legally required to report such incidents either to your management, the Joint Commission on Health Care Organizations (sometimes called 'The Joint Commission' or 'JCOH'). You may also get involved with independent patient safety departments based on what state regulations you follow. I've worked as an RN in Minnesota, Illinois, and Massachusetts and every institution (both rural and academic urban centers) have very clear guidelines on what you must report. Regardless, a 'patient fall' is considered a safe to patient safety and should both be reported internally to a 'Sentinel Event' committee who makes such information available to state government and independent agencies.
Second, and I don't want to call out mts directly, but this is actually the opposite of protocol, medical-legal liability, and Joint Commission standards. I won't get into the definitions of what defines a 'Sentinel Event', but they include things like patient falls, wrong-site surgery, blood transfusion reactions, or medication errors. In short, anything that happens to a patient's injury that were the result of the staff and not medical morbidity. For what it's worth, patient falls are ALWAYS, without exception, the fault of the institution. You cannot rule out acute neurological injury without (at least), a full body neurology exam and a radiographic exam (CT / MRI), which is why every institution I've worked in (including two nursing homes), all falls were immediately transported to the nearest emergency facility for a full workup prior to returning. I literally mean every single institution, you are even required to send patient family members to the emergency department for falls or fainting. Finally, the symptoms that KlatBlutig mentioned are classic signs of an epidural hematoma.
Of course, it could just be symptoms of his Parkinson's, but then again - that's why you get a full neurological evaluation. I'm not a neurologist, neither are you.
Finally, and this is more of a personal piece of advice from a registered nurse who's worked in several locations from nursing homes, health departments, rural institutions, and large urban academic centers, this does NOT sound like the kind of place you want to work at. It sounds like you are in training for a medical career, and the atmosphere you are describing is not only dangerous, but makes you vulnerable to litigation. Simply put, not only is this institution not following standard medical protocol, but you've also been intimidated into not reporting the actions. This is a real risk to you, the institutions, and most importantly - the patients.
Look, no one is perfect in medicine and I won't lie to you, I've covered for friends (nurses and physicians alike) who've made minor mistakes that didn't hurt anyone rather than reporting them to the immediate institutional committee, but this is a flagrant violation of standard medical care and protocol.
It sounds like you've got a pretty solid head on your shoulder if you're planning on furthering your career, but I'd get the hell out of there.
but thats not in a home type setting and a lot of things are different when you are away from civilization
I'm not even going to read any of the other responses. This one is the only one that's relevant.