Forcibly removing piercings in psych patients

[KathyDay]

I have a very sensitive question. I have recently learned of a patient, who is bipolar and who was having a crisis, went to the ER. There, every patient has to go through a metal detector, and security checks bags. The smaller ER across town does not do any of that. This woman had piercings, nipple and belly button and she was told to remove them. I am not sure who made that demand, but when she refused, a security guard forcibly removed them lacerating both areas. Apparently a nurse was in the room. This exacerbated the woman's anxiety and she fought back...escalating the situation and she ended up netted and medicated.

As a retired RN who worked many years in an ER, I found this appalling. If a patient refused anything I would have brought that to the attending ER doc and gone from there. NEVER would I have allowed unprofessional, untrained, brutes to forcibly remove sensitive piercings like that.

I was also told that patients in mental crisis are stripped and searched at that hospital where I use to work. Is that routine? Is that done by security people or professionally by nurses? Are male security officers allowed to do such things to female patients? Is it right that male security people stay with female psych patients even in the bathroom?

I understand that in order to protect patients from themselves if they are deemed potentially harmful to themselves, that some of these measures may be needed, but from what I was told, it seemed that patient was assaulted and that escalated her anxiety and combativeness. The results were disastrous.

Exactly what is the general policy regarding people in mental crisis? How far should security people be allowed to go? Should male security people be allowed to even touch a female patient unless she is threatening to others? Would a professional nurse first look out for the patients rights to safety and privacy and seek the doctors opinion, before allowing such a horrible scene to take place. What about calliing in professional mental health crisis workers?

I am very serious about this discussion and would love to hear from ER nurses who work with this type of issue every day.

[/username, BSN, RN]

Hey guys... so there's no potential she ripped them out herself?

[KathyDay]

What does this question mean, or imply?

[Julius Seizure]

Color me skeptical of the original story.

I certainly hope so. It sounds awful.

If things happened the way they were described, this was assault and the patient's nurse did not protect her patients safety or rights.

The nurse may have been horrified as well and didn't know what to do. Or maybe she thought it was fine. We don't know. But the nurse didn't do it. The security guard did. The security guard didn't protect the patient's rights. The security guard escalated the situation unnecessarily. The security guard is the one that caused physical injury to the patient. Lets make sure the focus is on the right person here.

If the story happened as described, I would be contacting the hospital as well, and maybe via my lawyer.

By the way, I've never seen an ER with metal detectors for the patients. Out of curiosity, do they send all patients through it? Just psych patients? I can't imagine wheeling a trauma patient through. Just wondering how it works.

[That Guy, BSN, RN, EMT-B]

Hey guys... so there's no potential she ripped them out herself?

This is why I hate this job, its so hard to trust anyone. I always assume the worst in people when I read this stories of second hand accounts.

[JKL33]

What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...

I specifically didn't elaborate because I tend to agree with you and didn't want to make more of it than it is - - although digging, scratching, lacerations and other problems are certainly not impossible with body piercing jewelry. The issue isn't limited to what long-term "harm" it causes, though, but also what others can say about how well the patient's safety was being assured if they were able to do something like swallow a metal object. KWIM? What else might they have done ("since apparently no one was paying attention") - and yes, I have observed accusations like this. I won't even say it is likely to go anywhere legally. It is another layer of shenanigans that doesn't need to happen, and is not a therapeutic situation.

Actually the more I think about it, the fact that any particular piercing may not cause much damage if swallowed may very well be purely secondary. The manipulations that tend to evolve from this general situation are a bigger deal, though. Say she removes the jewelry and then tells everyone she swallowed it and that she is having sharp lower chest or epigastric pains. Doesn't matter if it's "likely" to cause any harm or not at that point - we're now off track and won't be able to get a psych bed for this patient anywhere that isn't med-psych - which in plenty of areas simply means you won't be getting a bed. These, and more, are the kind of things that happen. There are actually reasons for the SOP.

Would I allow someone to be assulted? No. Not if I could help it. Which is also what I already wrote. I've had my rounds with security and even the police going to bat about things like this. But earlier in my career I've also had situations where I didn't consider all the possible ways things could go wrong, so I'm pretty reluctant to just say sure no problem, we don't need to follow our procedures for you. Rather, my belief is that there are usually ways to follow procedure while educating and giving appropriate information and interacting respectfully.

[JKL33]

Say she removes the jewelry and then tells everyone she swallowed it and that she is having sharp lower chest or epigastric pains. Doesn't matter if it's "likely" to cause any harm or not at that point - we're now off track and won't be able to get a psych bed for this patient anywhere that isn't med-psych - which in plenty of areas simply means you won't be getting a bed. These, and more, are the kind of things that happen. There are actually reasons for the SOP.

Should say "or" that she is having pain (after having actually swallowed). The point is the freedom to manipulate OR to actually cause harm to self or others is not okay.

[FNPTOB2018]

That was a very interesting read. Thanks for sharing!

[/username, BSN, RN]

This is why I hate this job, its so hard to trust anyone. I always assume the worst in people when I read this stories of second hand accounts.

Yep because patients can never ever harm themselves or be manipulative..

[Zyprexa]

Hey guys... so there's no potential she ripped them out herself?

That's what I was thinking....

[hppygr8ful, ASN, RN, EMT-I]

What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...

We have had cutters do quite a number on themselves with the sharp end of piercings.

Hppy

[FolksBtrippin, BSN, RN]

The risk of forcibly removing piercings is greater than the risk of leaving them in. That's why at my hospital we ask patients to take them out, and if they refuse, the piercings stay.

I am a psych nurse.

I have seen the most horrific things done to patients to force them to comply with rules. This is a very big problem in psych. Bigger than I can handle sometimes.

[pluckyduck, MSN, NP]

We have a six bed secured area for mental health patients. Anyone who is actively suicidal, homicidal or having hallucinations or acute psychosis is assigned a bed there by the triage nurse, as long as they don't require any immediate medical attention (any suspected intentional overdose would go to our highest acuity area to be medically cleared first). Our policy is the triage nurse must bring those patients back to the area and give report in person to the MHT nurse. The patient is asked to get undressed in a room and place all their belongings in bags (underwear, jewellery, everything.) I usually allow them a couple minutes to do so with the curtain mostly closed so I can keep an eye on them for any suspicious behaviour. Then the tech inventories and locks up their things in a designated locker and we provide them with a gown, socks, paper pants, blanket and make the stretcher up. They are not allowed to keep phones. We allow them to write down numbers so they may make calls if they want with a designated patient phone. we then place a tether on their ankle that alarms throughout the department if they try to leave.

If someone is non cooperative I then ask security to send an officer to "supervise" and encourage patients to cooperate. If a patient escalates we notify staff MD and they order meds, and we restrain only if necessary. Security cannot apply restraints but they may hold arms and legs down for nursing staff to apply restraints. we are required to have face to face documentation and order within 15 min and q15min checks.

What happened in your scenario is bizarre and I don't feel like the whole story is there.