Tuesday, January 21, 2014

Catching a Fall

The last several days were rife with physical fights.  I have to write separate incident reports for each patient and then re-write the summary in each patient's charts.  Four hand-written copies minimum.

Physical altercations are not unusual on the psych ward.  Punches and kicks and screams.  Me hoping that no other patients join in before the staff breaks up the original fighters.

Idiot supervisor decided to also require fall incident reports, complete with fall investigation reports and new fall risk assessments and plans of care whenever a patient in a fight ends up on the floor.  Landing or hitting the floor is common in the fights I've seen and I think it's covered under the fighting incident report and is not truly reflective of a fall incident.

Idiot supervisor would not budge.  As if I have nothing else to do but write the fighting incident reports and add in the pamphlet I have to write for the "fall."  I tried arguing that it was not really a fall; rather, the patient was not able to withstand a push, punch, or kick, and went down.  Surely that is different from stumbling and falling over one's own feet or an object on the floor.

The supervisor still wanted the fall incident reports.  So she got them.  Reasons for falls:
---"Was kicked on thigh by another patient, bent at the waist, and then was pushed to floor by other patient."
---"Pushed from behind by another patient and fell forward."  (Like the use of the word "fell?"  Makes it seem more logical, right?)
---"Punched on back of head by another patient, lunged forward into the wall, punched at the other patient, missed, and swung onto floor."

It's not just a fall incident report.  It's a new risk assessment with copies for the report, the chart, and the Fall Risk (Reduction) Committee.  Plus the care plan must be re-written to include the new problem of Risk of Fall.  I put the problem as "Risk of Fall related to potential for violence."  Usually the Risk of Fall is related to decreased vision, unsteady gait, orthostatic hypotension, or decreased risk awareness.  But these falls were special, so I may have a new category here.

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