Found on the Floor at 2:15 A.M.
It is 2:15 a.m. on a 32-bed unit, and the other aide is on a scheduled break. You enter Mrs. Okafor's room and find her, age 88, lying on her side on the floor beside the bed. She takes warfarin. The bed is in the low position, the call light is on the floor within her reach, and there is a small scrape on her forehead. She is awake but confused and says her hip hurts when she tries to move. No one else is in the room.
1. List your actions in order for the first several minutes.
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- Do not lift or move her. Stay with her and keep her still, especially her head and hips.
- Check responsiveness and breathing by voice and touch, and ask what happened.
- Get help immediately - pull the call light cord or call out to the hallway. Do not leave her alone to go find the other aide.
- Cover her for warmth and keep the area quiet.
- Note the time and the exact position you found her in.
- Report to the licensed nurse as soon as someone arrives, and stay until the nurse takes over.
Reasoning: on warfarin, a fall can mean internal bleeding, and a painful hip after a fall may be a fracture. Moving her could make an injury worse. "Stay, call, don't move, report" is the sequence that protects her.
2. The nurse asks you to help her back into bed. What do you need before you agree?
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You need the nurse's clinical decision, not the other way around: the nurse must assess her first, and in most facilities a fall with a painful hip and possible head injury means she is not moved by staff until she has been checked, and possibly not until emergency services arrive.
Questions to raise politely: "Have you checked her hip and her head? Do you want to move her, or wait?" If the nurse tells you to move her, ask how many staff she wants and what her instructions are. You are not refusing to help, you are making sure the help is what the nurse ordered. Never attempt a lift alone. Document who directed the move and when.
3. What goes in the incident report and the chart?
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The chart gets the clinical facts: time found, position, what she said, the scrape, vital signs the nurse takes, who was notified, and care given. The incident report gets the same factual narrative plus equipment and environment - bed height, call light location, footwear, lighting.
Neither gets your opinion or blame. Do not write "she probably tried to get up alone again" or "call light should have been closer." Do not mention the incident report in the nurses' notes, and do not discuss it with other residents or the other aide in the hallway. Report it before the end of your shift, not the next day.