Found on the Floor at 0230 - Anticoagulated and Insisting on Getting Up
At 0230 you find Mr. Boyd on the floor beside his bed, lying on his left side in a puddle of urine. He takes warfarin and has fallen twice in the past year. He is awake, breathing normally, and says his left hip hurts and that he 'just slipped.' He is trying to push himself up and tells you to help him into bed before the nurse finds out. The call light is on the far side of the room, the hallway is empty, his bed alarm did not sound, and the bed is at its highest position with the rails down.
1. What do you do, in order, from the moment you see him?
Read the worked answer
- Do not lift or move him. Crouch down, tell him to stay still, and put a hand lightly on his shoulder to steady him rather than to hold him down.
- Check that he is awake and breathing normally and ask what hurts - you already have 'left hip.'
- Call for help loudly enough for the hallway, or use the call light if you can reach it without leaving him. If you must leave, this is the rare case where you go get help immediately.
- Keep him warm with a blanket over him; do not try to remove the wet clothing or pull him out of the puddle.
- Stay with him, note the time, keep talking calmly, and hand off to the nurse when she arrives.
Reasoning: the priority is 'do not make it worse.' Helping a resident with hip pain after a fall to stand is how a fracture becomes a displaced fracture.
2. He is alert and keeps saying 'just help me up.' Why does his warfarin change your answer?
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Warfarin raises the risk that an injury bleeds - including bleeding you cannot see, such as into a joint, muscle, or the skull after a head strike. A hip that hurts after a fall in an anticoagulated 80-something is a possible fracture until proven otherwise, and bearing weight on it can turn a stable injury into a surgical one.
Reasoning: his alertness and clear speech feel reassuring and are not the deciding factor. Alertness does not rule out fracture or internal bleeding, and 'he asked me to' does not transfer the decision to the resident or to the aide. Only the nurse, after assessment, decides how he is moved - often with a lift and often after a provider call. Your job is to keep him still, warm, and supervised.
3. After he is settled, what belongs in the chart and what belongs on the incident report?
Read the worked answer
Chart (objective, in the resident record): time found, position and location on the floor, that the bed alarm had not sounded and the bed height and rail position, his statements, complaints of left hip pain, vital signs if taken, who was notified and when, and the care given afterward.
Incident report: the facility's separate factual form - what happened, when, who was present, equipment involved. Complete it as directed by the nurse.
Reasoning: both documents are factual and neither assigns blame. Do not write 'resident was confused and fell again' or opinions about the previous shift, and do not copy the incident report into the chart or chart that you 'filled out an incident report.' Never chart an entry before the event it describes.