Last week we talked about what happens after a patient falls and the nurse finds the patient. This week we're going to deal with the same scenario, but this time unlike last week the patient will not be ok.
The nurse's note reads as follows
Nurse heard patient call out. Went to check on patient. Patient found lying on the floor. Patient's left leg clearly shortened and internally rotated. Vital Signs WNL. Patient complaining of pain of 10/10 in left leg. Patient made comfortable and 911 called. Patient transferred to the hospital via EMS, physician notified.
Again, this note is not ideal, but there are a number of key elements here that make this a very good note. While the it is still not clear why the client fell, or if they were a fall risk prior to the fall, the nurse did some very important things.
First the nurse noted that the client was injured (left leg clearly shortened and internally rotated). This is a very clear sign of a hip fracture. Likely of the femur area of the joint. The hip is three bones, and a break like this is the top of the femur.
The second thing this nurse clearly did right is that she called 911. A fractured bone after a fall is an emergency. In the hospital assistance would be called for and the patient would be transferred back to bed where the leg would be stabilized. But in the community, the nurse needed to contact emergency services to transfer the patent to the hospital. Because this is a medical emergency the physician has to be notified but not until after 911 has been notified.
Although it says that the patient was made comfortable while waiting for 911 it would be ideal if it said that the patient was made comfortable on the floor, rather the more ambiguous made comfortable. The reason for this is that a break can be made worse if the bone/extremity that is broken is moved prior to emergency medical services. But at the same time a pillow for the head and a blanket to help prevent shock, and to keep the patient comfortable is a perfectly acceptable treatment while waiting for EMS services.
Next week we'll focus on what an incident report includes.
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