My nurse friend works in dementia unit of an assisted living facility. She said she documented bruise size and said appearance of handprints. The DON said she should never have documented that way. And the bruises looked consistent with person hurting themselves.
my friend said it’s known in that facility of a caregiver that is rough with residents and the place tries to cover it up. She’s afraid she will get fired now for documenting that way.
any idea I can give her to help?
She should have taken photos (said photos could not be done without permission of family if they include picture of resident's face; photos should be of the bruising which should also be witnessed by others before it is gone). She should have reported to facility at once and made an "incident report with photo attached and her description of finding "bruising on bilateral arms between elbow and humerus meaures " blah blah blah. She would do followup with administration of what steps were taken in family notification and investigation.
The elderly bruise at a TOUCH. You likely know this. For instance, in trying to assist or catch someone near falling, the simple putting of a hand on either side of arm could leave such a bruise.
Now you say there is a history of abuse at this place. THAT is a problem and it is a problem for the administration.
This RN may or may not lose her job. One thing is for certain and that's that she needs a remedial course in how to document objectively.
I am thankful she is on the lookout for abuse and that she IS documenting (and the way to do this is an incident report). Abuse is awful. This may be abuse and this may not.
This RN knows the correct path of reporting and SHO ULD know how to chart. I think really it isn't your place to do much but listen, sympathize, and encourage this RN to speak with her administration, decide if she legitimately sees abuse and should report it higher up, and take a brief updating course on charting and how it should be done.
Yes, some elders bruise easily, it may be completely unintentional. Eg happened during an assisted transfer.
But (always a but..). Could be another resident, as mentioned by Geaton. I hope NOT.. but could be a rough staff member. That needs to be uncovered & stopped immediately.
Or even a fall/near miss. Where someone quickly grabs someone about to fall. I reckon my Mother has a new bruise where I had to steady her recently 😕
I am visiting my mom every single day. I know my mom is not being abused.
She reports what she has seen .
She should document her observations.
Side comment.. If the DON is telling her and other staff not to document bruises then that also should be reported that is falsifying medical records. great liability issue as well as a safety issue what else is not being documented.
If this is a problem at this facility then a call to APS, the Ombudsman's office and or a call to the State's Elder Abuse hotline number.
If there is a possibility that the resident is hurting themselves, self harm, that is also reportable.
If the possibility is self harm she should suggest to the DON that a camera be installed in the resident room so that they can document that it is self harm so family can not accuse the facility of abuse.
Then steps need to be taken so that the resident can not harm themselves.
If mittens are permitted (don't know if they would be considered a restraint) or making sure that the resident has clothing on that would not easily allow for self harm. (long sleeves, tucked in shirts)
And discussing with the doctor medications to reduce anxiety and possibly OCD tendencies.
If she's worried for her job, that's a whole other story. She should be worried for it if she doesn't even know how to do proper documentation. She learned that in nursing school and it sounds like her work is very sloppy.
She should talk to the state's Ombudsman because that is the office that regulates nursing homes and other care facilities and who abuse is reported to.
Your friend being an RN already knows this.
I did it 3 x in my career and 2 x got called by lawyers because family sued. One patient got several millions. Well good for him. I was not the only provider that documented that day.
As for worries about being fired. It becomes a long process, but many fired employees lawyered up and sued their employers. If she can, encourage her to save all documents. She can even copy her own document as evidence since it can match the record as long as she removes or redacts all HIPPA information
A RN is a mandate reporter but it has to follow the protocol for the facility which is tied into how the State examines these very serious issues. Alva really is spot on in that your friend is doing SUBJECTIVE reporting and not OBJECTIVE reporting.
Should she be worried about her job??? well that imho depends on just how much she has talked this around, what her overall evaluation is, and how tight of a ship the administration runs. If she’s newish at the AL without deep loyalties with other staffers, and it’s a tight hierarchy, imo, she's toast.
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