Hospitals without psych units...what do you do with your psych pts

  1. We're having issues with psych pts who are being held at our facility (acute care hospital without psych unit) while waiting for mental health assessment/transfer to mental health facility. Most of the time, there will be as much as week wait for bed opening at the other facility....

    as we're not set up as psych...we're trying to develop policies and procedures....and how to protect pt while at our facility

    ..any input/advice/direction from anyone with similiar problems would be MUCH appreciated.
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  2. 19 Comments

  3. by   Nurse Ratched
    Wow. Are the problems that bring them in psych in nature, or are you talking about pt's who come in for medical problems, but also have a contributing psych component?

    Are you frequently having to restrain people? There are big differences between restraining for medical purposes versus for behavioral purposes, and the rules for each type of restraint have to be clear.

    I'm guessing a number of situations call for one-on-one staffing as well.
  4. by   essarge
    We have the same problem. We've had one patient that has been with us for 3 months now. Each psych patient that we recieve, requires a sitter (which is a form of restraint) so we cannot place them unless there is a direct admit from the psych doc and that doesn't happen very often.
  5. by   Marie_LPN, RN
    If our psych ward winds up full, they get transfered to our floor (med-surg). Typically the psych patients we get are the ones that are going through the DT's, and there's only ONE doctor that does that. They don't get a "sitter" it's up to the family whether or not they want to stay with them. I'm the float CNA on floor that can have anywhere from 20-35 patients, then 1 nurse for every 5-7 patients.

    So when this patient that has been on Ativan for about 12 hours decides to take off down the hall in nothing but their underwear, me and his nurse have to take turns sitting in a chair in the doorway of his room, which is taking away from the other patients. It's either that, or he gets far enough down the hall to bust through the pediatric ward's doors . Where's the orderly? On the psych ward floor, pretty much doing the same thing. :stone

    A big issue of patient safety if there ever was one.

    Which reminds me, we had a DT pt. not too long ago that kept walking out of his room out in the hall. The lady next door, who was very with it mentally, every single time she would get out of bed, she would walk out of her room and actually walk in to the psych pt.'s room and just STARE at him. This happened for about 30 minutes, until the nurse finally had to TELL her not to go into this person's room.

    Just kinda angers me when there are 15 beds available in the psych ward and this one doctor will try to put any pt. he has onto a floor with children 100 ft away if he can.
  6. by   thumper
    Thanks for your quick replies...it helps to know we're not alone....
    basically our problem is we have one lockable room with monitor for suicidal pt...when we get another suicidal/homicidal pt we don't have another lockable/monitered room.....and then end up keeping them in our ER for far too long or placing them on a med/surg floor with one on one....does anyone else deal with this...

    the sitter is considered a restraint??? interesting.....
    would family be considered....does the sitter have to be a trained medical person???
  7. by   Marie_LPN, RN
    One on one is considered a restraint at our place too That's why we have to sit at the doorway, and not in the room.


    And as always with any sort of restraint, we MUST get a dr.'s order first. Wish there was a way to get a standing order on that, but there has to be an obvious reason for it. We can't go by "well he might do this".
  8. by   Marie_LPN, RN
    Anyone who is suicidal is not to be admitted on our floor unless the psych ward is full, because, there are KIDS on our floor. But it's ok to run the risk of a drugged pt. to go crashing through the peds. door and scaring chidren......
  9. by   ceecel.dee
    We have the same problem. What is so frustrating is that our county family/social service facility looks for reasons why they won't help us ("you said VULNERABLE and the case is actually one of ADULT PROTECTION". It's like...SO WHAT! PLEASE JUST TELL US WHO WILL HELP US IF YOU WON'T!), or they can't address the problem in a timely fashion (don't they always come in on a Friday afternoon, so nothing can be STARTED until Monday after all their beginning-of-the-week meetings, or whatever?).
    We have no hospital social worker, so our discharge planners work so hard on these cases, and do the best they can.
    There is a real crisis in regard to the shortage of mental health facilities that can assist us acutely!
  10. by   Nurse Ratched
    In our facility, a one-on-one is specifically listed as an alternative to restraints, but we have to have a doctor's order for it or the house supervisor won't staff it (and sometimes even not then.) The order must be renewed q 24 hours. The person assigned to the one-on-one by policy must be within arm's reach of the patient at all times.
  11. by   lucianne
    LPN2B,
    Maybe you should suggest that the peds floor have a locked door if you're going to get psych patients on a regular basis. All the floors in our children's hospital have controlled access (only to get in) due to some incidents of physical abuse a couple of years ago and I think it's a great policy.

    We don't consider 1:1 staffing a restraint unless the person is confined to their room but we do have to have a doctor's order for it.

    Do you guys get training in Safe Physical management or Crisis ...oh, what's it called? CPI...my mind has blanked out. I would demand the training for your physical safety and the safety of your patients.

    luci
  12. by   Marie_LPN, RN
    Originally posted by lucianne
    LPN2B,
    Maybe you should suggest that the peds floor have a locked door if you're going to get psych patients on a regular basis. All the floors in our children's hospital have controlled access (only to get in) due to some incidents of physical abuse a couple of years ago and I think it's a great policy.

    We don't consider 1:1 staffing a restraint unless the person is confined to their room but we do have to have a doctor's order for it.

    Do you guys get training in Safe Physical management or Crisis ...oh, what's it called? CPI...my mind has blanked out. I would demand the training for your physical safety and the safety of your patients.

    luci
    The peds unit has locked doors, but they have been malfunctioning for the past 2 months. New doors, locking system, etc, are on order. Not in yet

    But i also see it from a parent's POV, though. If i saw somoene running down the hall half out of it, i'd be worried.

    We were offered SPMI training (self-defense) and it was our choice to take it. I took it, you never know what will be admitted next.
  13. by   healingtouchRN
    Guess waht my hospital has done???? They admit the psych pts to SURGICAL! yup, the post op surgery floor is where psych holding is until the psych hospital next door has an opening!!! Wow, ortho-uro, mother-baby, psych-surg!!!! amazing!!
  14. by   Marie_LPN, RN
    Psych-surg, sounds like our floor

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