How do you prevent psych/etoh elopements?

[mmutk]

Just wondering how you guys handle your patient's who come in and are seen by the ER MD, are treated but have a condition that warrants their being held against discharge. I'm not talking about 6404 psych commitals, I'm talking about patients that fall into one of these categories...

1.Drunk without a ride.

2.A patient who got pain meds but now wants to leave with no ride.

3. Pt who is dissatisfied and attempts to leave with their IV in.

Now assuming for 1. and 2. you tried to get them a ride but they drove themselves and this has failed.

I know security is an option, but does that always work at your facility? Our security if good at holding them when they get there, but it can take them 2 or 5 minutes to get to the ER sometimes. What do you do yourself as the nurse till security gets there? Do you hold these patient's and how?

[Knoodsen]

I do not believe there are any easy answers. Like all things legal in this land of ours, the decisions are made on a case by case basis in court. It cannot be said, "do this and you will be immune from prosecution" or "don't do this or you will be guilty of a crime". Yes, I know, I have heard it many times; "we are a nation of laws, not men"". It just isn't true. You are guilty of kidnapping, or whatever else, if you are found guilty by a court. It pays to be careful and act in a prudent fashion, and it certainly helps to know the laws that apply. Trouble is, we nurses can get in trouble regardless. And, we are handy scapegoats when something goes wrong. Personally, I do not give mind bending drugs to anyone without a responsible adult driver and I try to keep anyone that seems altered from leaving the ER. Sounds like pretty much the standard nowadays, right? Question: if some one leaves against instructions and I call the police, can I give them the name in light of HIPPA?

[mmutk, BSN, RN, EMT-I]

if some one leaves against instructions and I call the police, can I give them the name in light of HIPPA?

If they are impaired, no it is not a violation. From my unsderstanding of the duty to report act.

[TraumaNurseRN]

I say the cops need to take them to jail as that is where they belong. Hav the jail RN assess and send per injury, pain, etc.....

We're babysitters to these idiots...ticks me off

[MacERRN]

I just had a pt leave with IV inplace this weekend. No way was I going to tackle him and take his IV out. He was upset we were discharging. I'm just getting sick of taking care of these ETOH/Psych pts who come in demanding something to eat, drink, and a refill on their pain meds that they "lost or had stolen," Then when you refuse, or call them on their b.s. behavior...the press-ganney police come looking for you

THis is going off topic but I don't post much.But NO ONE should have to put up with with the typical ER nurse has to deal with regularly. I guess I'm just burnt. 22 yrs is too long to deal with this. These are problems that are happening across the nation. Everyone looking for handouts.

[MN BigJ]

Personally, I don't see it as our duty to protect idiots from themselves. However, the courts may disagree and just because Al Coholic left and wandered into the river and drown I don't want to be sued by family coming out of the woodwork even though none of them would pick him up. So, in closing, to cover our asses we don't let them leave, be it security or perhaps chemical sedation (maybe they were nauseated and needed some Vitamin D).

[mmutk, BSN, RN, EMT-I]

I just had a pt leave with IV inplace this weekend. No way was I going to tackle him and take his IV out. He was upset we were discharging.

Yeah I would agree to that, I will try and hold a patient, but I am not wrestling anyone to the ground w/o a 6404 commitment. This is a big topic to me though being a male nurse in a female dominated ER. When the sh*t starts to fly I am held to a higher standard to do more than some of the female staff as I should expect.

[sumas8]

We would put them on a 1:1 or safety sit and have an aide sit with them. Being drunk impairs your judgement to make medical judgements. After being given narcs (which we try to remember to ask prior to giving them how they are getting home if no one in rm with them) we either tell them they have to wait 4 hrs after the narc before driving self, or, if they say so-and-so will pick them up, the driver must come in and present themselves in the ED before we will discharge them. Otherwise we won't give them the drugs here, just a prescip at discharge. This is not to say that we NEVER have people leave after receiving narcs or with an IV in, we do. But we try - we have alot of 1:1s and safety sits, but it beats going to court as mentioned above...

[Christy1019, ASN, RN]

wow i guess things are done a lot differently where i work. if we have a drunk pt that is trying to leave before discharge and re-direction/explaining to pt that they aren't capable enough at that time to make that decision, doesnt work, then security gets called, pt gets "escorted" to MHT (6 bed mental health tx area mainly for observation/sobriety/waiting for transfer to in-pt psych facility), they get a tether on their ankle that will set off alarms if they even get too close to the door to mht, and if they STILL are attempting to leave or get aggressive w/staff, they automatically get 4pt leathers. i hear the staff docs tell pts all the time that they can't let them leave because they aren't legally competent to make that decision for themselves while drunk, AND because they aren't just a risk to themselves if they leave, but what if they stumble into traffic and cause a huge accident that kills OTHER people? we would be held legally responsible, just like if a bar overserves a customer and lets them drive and they get in an accident.

for the people who believe this is "false imprisonment" and "battery", whats the difference between someone who isn't within their full faculties because of alcohol or because of some sort of brain bleed? if they are confused/combative/refusing tx because of a bleed or something, and ur aware that pt isn't able to make medical decisions for themselves at that point... would you consider THAT false imprisonment/battery to hold them and treat them still??

[canoehead, BSN, RN]

We use any excuse or opportunity to undress psych or drunk patients, especially footwear, and then take their clothes to a closet for safekeeping. Then if they leave they have to do it in a johnny (most won't go undressed) and they'll stand out for police.

[USIJurgy]

We use any excuse or opportunity to undress psych or drunk patients, especially footwear, and then take their clothes to a closet for safekeeping. Then if they leave they have to do it in a johnny (most won't go undressed) and they'll stand out for police.

Absolutely! It is much easier for security and the police to find someone wandering around in a hospital gown! Also, if someone comes in drunk or OD'd or otherwise not competent to make medical decisions their belongings should be secured so that they do not have access to materials for self harm. I have had many a drunk come in with a bottle hidden in their jacket or a tylenol OD come in with a purse full of pills.