Dangerous patients - page 2

Just looking for some help to find written law for a situation. I work in LTC. We have a new resident who on their first day on the hall attacked one of our nurses by strangling them and telling them they were going to kill... Read More

  1. 4
    You are spot on!!! I'm an ER nurse and ex LTC nurse. I wasn't allowed to give Haldol IM in LTC but in the ED we can sedate and intubate if we have to.QUOTE=BrandonLPN;7139997]Yes, no matter how you look at it the ER has more resources to deal with this than we do. Our hands are tied when it comes to physical restraints as well as chemical restraints. ER staff can use leather restraints and give powerful IM sedatives..... we in LTC cannot. And acute psychosis IS a medical issue, isn't it?[/QUOTE]
    TeleRN44, poppycat, nrsang97, and 1 other like this.

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  2. 0
    Management generally discourages calling the police and removing the resident because the facility doesn't get reimbursed for a patient that's not there.
    So? If I'm being threatened and harmed by a patient, I'm calling the cops. However, it's pretty hard to get the cops to do anything most of the time.
    I had a completely A&O bedbound resident throw whatever she could find at me (including a full bedpan). I called the cops, because I was not going to take that crap. The cops came and told her she shouldn't throw things and left.
    The problem is a very physically ill person cannot be booked into jail. They'd have to be in the hospital under guard 24/7. The cops just don't have the resources for that unless the person is a murderer or a fugitive Nazi or something.
    So good luck.
  3. 0
    "More resources," sure...

    Adequately equipped and staffed to safely handle these people? Nope. Sure, I can strap them into the bed but we have nobody to interact with them, no activities, no ability to shower them, no TV, no music, no nothing... strap 'em down and wait for placement...

    Just because they pose a risk to your staff or your other patients doesn't mean that they belong in an ER.

    Dumping? Yes... because we have no choice but to take them and they often have no treatable medical condition...

    Unprofessional? I don't see how.

    Rather than being mad at me for stating the truth, you should be mad at a system that provides no place for these people to go.

    They belong in the LTC with whatever is needed to provide a safe environment... and if Haldol (which isn't generally helpful with the demented old folks) and restraints are what it takes, so be it.

    They're not legit ER patients.
    Last edit by ♪♫ in my ♥ on Jan 28, '13
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    If a resident goes from placid and sweet to vicious and assaultive in under 60 seconds, there IS an underlying medical problem. We can't forcibly sedate someone to do labs or get a urine. The ER can.I don't think this post started out as an us vs. them. The REAL problem is the system which ties our hands in LTC when it comes to dealing with dangerous residents.
    AheleneLPN, Barley, chevyv, and 4 others like this.
  5. 1
    Quote from CapeCodMermaid
    If a resident goes from placid and sweet to vicious and assaultive in under 60 seconds, there IS an underlying medical problem.
    There can be... and often, it's simply that the patient has acute dementia and their demons have interacted with their environment to provoke an outburst.

    I've seen it in my family, seen it while on the m/s floor, and seen it in the ER.

    Agreed that the problem is the system... simply pointing out that we often get patients who are demented, only demented, and without emergent medical conditions... in what appears to be simply a matter of "we can't deal with this... here" and that we can do little to address the problem...

    ...which is that our society neither wants to pay to care for these people nor is comfortable with the idea of letting them go...

    Emergency departments have become the dumping ground and catch-all for all sorts of social problems, this one included, and we are not resourced to deal with it.
    sweetlilwolf likes this.
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    I am confused that their entertainment (tv, activities, music, interaction) would come over safety for those who have to care for them. The LTC does not have a restraints option! ER does. Showering? Easy. Bed bath.

    Hierarchy of needs. Safety comes way before social needs.

    Is the system broken? Yes. That does not change the fact that in the brokenness, the ER is less broken than the LTC.
    RkfdNurse1, sunny3811, nrsang97, and 3 others like this.
  7. 5
    Quote from ♪♫ in my ♥
    I work in the ER and have several times been on the receiving end of these patient dumps. We have no magic pipeline for them into a bed and the few inpatient psych faciliities won't take (a) violent patients or (b) patients with medical problems.

    All you're doing is dumping the problem on us... and taking our resources away from people that we can actually help... and putting us at risk...

    This is a financial and political issue, not a medical issue.
    Ouch, while I can understand this point of view, I don't feel that this response is at all fair to the OP. She, too, is trying to do the best for her patient population and her co-workers. If there is blame to be directed at someone or something, then blame the system. I realize it sounds like a lame response but I seriously doubt she is attempting to "dump a patient" on you. It sounded as though she was attempting to have a patient who who wasn't appropriate for HER level of care and whose needs could not safely be addressed at HER facility get the care they needed.

    Unfortunately, it meant filtering them through a ED first, so they COULD receive a higher level of care. Surely, it is not being disputed that a Nursing Home is the appropriate venue for this kind of violent individual? I know that the Nursing Homes I've seen are poorly equipped to deal with this type of patient that any ED I have to in recent years.

    That's the sticky wicket of using the word "you're". There are rules. We all, more or less, are forced to play by these rules. That means that we're all on the SAME team. Why nurses tend to forget this annoys the heck out of me...it's futile to rip into the OP for following the rules and trying protect those in her care. If we don't like these rules...GET INVOLVED. Don't be bystanders when it comes to state/local legislature. For example, when they start making noise that they're going to close a local inpatient psych facility...start writing your local reps/congress-persons...instead of simply wondering what and how you're going to cope or who you're going to blame when someone in your ED gets the tar beaten out of them by one of the crazies.

    Shredding a fellow nurse for venting her frustration and blasting her that she is in turn making your work place unsafe? Not playing well with others...for shame.
    RkfdNurse1, vdrapeau, chevyv, and 2 others like this.
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    In my experience, dementia seems, more often that not, to exacerbate the less flattering attributes of an individual's personality. On our floor, when they start to sundown...they hit, scratch, kick, bite, scream, punch, kick or weep hysterically without end. Some of them are just pleasantly demented...kindly and confused.

    I hate to be tongue in cheek about it, but in so many ways it is like Forrest Gump's box of chocolate...you never know what you're gonna get. LOL
    IowaKaren, nrsang97, and VivaLasViejas like this.
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    I knew a LTC patient who said she was going to explode and tear the place apart if they didn't find her a new place to stay ASAP.
    They kept telling her that they were trying hard to find her a new place to stay. After 2 weeks, she finally exploded and did tear up the LTC-breaking windows destroying furniture. It was amazing that no one was injured during her rampage. Of course, once she did that they were able to find her a new place immediately. I believe she went to the state psych hospital.
  10. 2
    I will say speaking from a psych perspective, violent behavior does not automatically mean psych. We frequently get referrals from ER's and floors trying to give us patients when there is no psychiatric problem, as dementia and especially aggressive behavior related to Dementia is NOT a psychiatric problem. IM haldol isn't necessarily going to fix the behavior, and in many cases can make it worse in the elderly.

    I agree it's a system failure. While the LTC is only equipped to handle so much, and has their protocols to follow, the same goes for ER and the psychiatric units.
    SoldierNurse22 and Meriwhen like this.

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