[NOIRLINCOLN]

Last night we had a pt delivered to the ED by the local police dept. THIS IS HIS 20TH TIME COMING IN. He gets the works, and of course he is SELF PAY. Well to make a long story short: He is admitted b/c his ammonia level is too high, been smoking crack. He is combative, loud, uncooperative, and flailing about. I suspect he is mentally retarded as well. It took (8) nurses to hold him down to get blood drawn. The charge nurse was attempting to start a 2cnd line on him? I am a nursing student. One of the doctors went to the charge nurse and told her this man is constantly tying up our manpower. Eight nurses spent at least (1) hr trying to hold him down for the second line which never happened. I kept saying he has ropes for veins in his hands, let's just go there and get the blood that we did not already get. I got tired of saying this. Finally this is exactly what happened. This man typically comes down off his high in the morning and leaves AMA. I talked to the the police sargeant and asked him can't they make this man a ward of the state? He told me they did not have grounds to "app" him. Is there no where that BEAURACRACY does not get in the way of good ole' common sense?

[rjflyn]

Three words- haldol, bendaryl and ativan. Then wait about an hour then do your labs, they generally dont put up much of a fight.

As far as making the pt a ward of the state most the states I have worked in have some type a cival commitment/48-72 hold procedure for acute mentally or chemically incapacitated individuals. My current state being the easiest- ie a doctor or police officer just has to fill out a one or two page form and thats it. I would reccommend that this be looked in to.

rj

[oramar]

I think the hospital officials and goverment officials need to get together and develope somesort of plan of care to deal with this persons behavior. I think the goverment has as much to lose in this situation as the hospital does.

[SnowymtnRN]

Originally Posted by NOIRLINCOLN

Last night we had a pt delivered to the ED by the local police dept. THIS IS HIS 20TH TIME COMING IN. He gets the works, and of course he is SELF PAY. Well to make a long story short: He is admitted b/c his ammonia level is too high, been smoking crack. He is combative, loud, uncooperative, and flailing about. I suspect he is mentally retarded as well. It took (8) nurses to hold him down to get blood drawn. The charge nurse was attempting to start a 2cnd line on him? I am a nursing student. One of the doctors went to the charge nurse and told her this man is constantly tying up our manpower. Eight nurses spent at least (1) hr trying to hold him down for the second line which never happened. I kept saying he has ropes for veins in his hands, let's just go there and get the blood that we did not already get. I got tired of saying this. Finally this is exactly what happened. This man typically comes down off his high in the morning and leaves AMA. I talked to the the police sargeant and asked him can't they make this man a ward of the state? He told me they did not have grounds to "app" him. Is there no where that BEAURACRACY does not get in the way of good ole' common sense?

Just because he makes poor decisions or doesn't necessarily take care of himself isn't a reason to make him a ward of the state. I agree, it seems like a patient like that that is constantly coming in, sucking the system and then leaving AMA is a waste of time, resources and energy. BUT he's just one person. I think the other poster who said they should develop a plan of care for him is a great idea. Something they can do KNOWING he's going to come back into the ER. But for patients like that, i would think that giving total care would be changed. Honestly it would probably be better to let them sleep it off, give iv fluids and send them home. No matter what their condition.

[SnowymtnRN]

Originally Posted by rjflyn

Three words- haldol, bendaryl and ativan. Then wait about an hour then do your labs, they generally dont put up much of a fight.

As far as making the pt a ward of the state most the states I have worked in have some type a cival commitment/48-72 hold procedure for acute mentally or chemically incapacitated individuals. My current state being the easiest- ie a doctor or police officer just has to fill out a one or two page form and thats it. I would reccommend that this be looked in to.

rj

Same here. The docs can make them a MHH or the police. And they do quite frequently. We almost ALWAYS give Ativan on admit to the ER too!

[BabyRN2Be]

What about getting a social worker involved in this if he's a frequent flier? Could they possibly discuss this with local police about getting a psych hold/consult and eventually a care plan?

Just curious, I'm not familiar with the hierarchy of ED and holds such as these.

[hollyster]

The hsp gets to deduct all non-payments as business losses on tax filings. They do not lose any money. We get to pay it in higher taxes and hospital costs.

[SnowymtnRN]

Originally Posted by hollyster

The hsp gets to deduct all non-payments as business losses on tax filings. They do not lose any money. We get to pay it in higher taxes and hospital costs.

EXCELLENT point.

[tridil2000]

Originally Posted by hollyster

The hsp gets to deduct all non-payments as business losses on tax filings. They do not lose any money. We get to pay it in higher taxes and hospital costs.

yep....
it's socialized medicine, but shhhhh... don't tell anyone.
word might get out!

[SWFlorida]

His amonia level is high so of course he will have bad decision making. Its not like its going to get better. If he is into substance abuse this is where he will turn. This doesnt make him mentally ill, it is his medical condition. Sure he may have brought it on himself from chronic etoh or drug use, but some end up with bad livers from other sources too. Get social services working on this case. Find out if this fellow has any family who could over see his meds. It is a red flag that other avenues need to be addressed if he keeps popping into the ER or being brought in by the cops. While this isnt the most fun scenario or convenient for the staff it is a fact of life, people sometimes develop conditions and illnesses that aren't pleasant.