A charge nurse on busy med/surg floor answered a call bell to see about an IV leaking. After checking the IV at about 10 a.m., the caregiver asked for a bedside commode. The charge nurse looked for the bedside commode but was unsuccessful. She asked the unit secretary to ask one of the nurses’ aides to find one and continued on her way to other duties. Shortly after midnight that night, the 85-year-old patient fell and broke her leg. She was alert and oriented and said a commode was never given to her. The unit secretary never followed through. Is it the charge nurses fault?
Dear Nancy replies:
As the RN in this scenario, you are ultimately responsible for the care to patients to whom you are assigned or to whom you owe charge nurse responsibilities. Although you may not be responsible for the unit secretary’s lack of follow-up, it is your responsibility to follow-up and determine if the patient received the item you requested. When delegating anything concerning the healthcare of a patient to another person, you are responsible for follow-up and an evaluation of what was done.
A question might arise as to why you delegated the task of getting a beside commode to the unit secretary rather than you seeking out and asking a nurse’s aide on the unit to do so. It is doubtful it is the unit secretary’s duty to follow-through with a request of a nurse’s aide to obtain care items. Rather, again, it is your responsibility to check with the unit secretary to determine if what you asked was accomplished, or to check yourself if the patient received the commode.
Hospital or nursing home falls are among the most common injuries in healthcare. Although you described the patient as “85 and alert, elderly patients can become confused upon waking or are unable to see well enough to get to the bathroom alone, especially at night. The fact that the patient asked for a bedside commode might clearly emphasize her concerns about getting up to get to the bathroom herself.
Remember, as an RN in any role, one of your duties is to prevent unreasonable and foreseeable risks of harm to a patient. In this instance, if a lawsuit is filed, this injury might be determined to be one that was unreasonable and foreseeable. All of the evidence presented in the situation will be evaluated by a jury and it will decide who was at fault.