Dangerous patients - page 4

by dallet6

8,242 Views | 47 Comments

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. 1
    I work in a LTC facility & we have residents that kick, bite, pinch, grab private parts, & hit staff. Why can't we be allowed to inject Haldol, instead of forcing the staff to put up with this? They have mental issues--Alzheimers, advanced Parkinsons, etc. that cause this, but shouldn't staff be protected?
    Fiona59 likes this.
  2. 4
    Why is the doc at your facility not ordering a psych eval? If the pt continues to attempt or to hurt staff, document document document. Request prn meds (ativan can act like giving someone a martini so be careful with that one) geodon works well and the all to familiar cocktail of benedryl, haldol, and ativan help as well. I work psych and go through this on a daily basis. I can't stress the need to document enough. Each time this pt is assaultive, call the police. Eventually, the powers-that-be will have to deal with the behavior. It helps to get to know the signs before the pt becomes assaultive. Is this like a sundowning thing? Does the sight of one particular person send then into violence? Do they have a UTI? Be consistent and watch your back. It helps if the rest of the staff can get on board and document as well.

    I'm sorry this is happening to you. At least where I work I can utilize restraints if necessary and give IM's.
    Fiona59, LTCNS, IowaKaren, and 1 other like this.
  3. 2
    In your second post you said "Since my original post, this resident has not had a behavior change unfortunately but has continued to hurt staff and did have resident-resident altercation" -- that sounds to me like grounds to send the patient out again.

    I'm employed at a local ER as a crisis worker and have been on the receiving end of situations like this. We're required to call a psychiatrist for disposition, either the patient's own psychiatrist at the LTC, if s/he has one, or the psychiatrist on city call. I've been in situations where the psychiatrist elected to send a patient back, but when I called the RN at the facility to give report, the RN would respond with something like, "I talked with our DON and we simply cannot accept the patient back because of the risk to staff/residents," or "don't send the patient back until I talk with the DON" after which the RN will say the same, the DON says we can't take the patient back. It can get awkard -- on the one hand a nursing home can't refuse a patient, on the other hand a nursing home can't accept a patient that poses a significant risk to staff and/or residents.

    I've also been in situations where a patient was sent back after the psychiatrist decided it was a one time kind of thing, the patient had a similar behavior outburst and was sent back, and I would tell the psychiatrist "the patient was sent back but is still being aggressive, we need to admit the patient this time." Sending the patient back ER for continued aggressive behavior after previous ER admits for the same sends a signal that this is not an issue that the facility is supposed to deal with.

    If the patient is being seen by a psychiatrist at your facility, and the psychiatrist has admitting privilages at a nearby psych unit, call the psychiatrist before the patient is sent out. If the patient doesn't have a psychiatrist, see if you can get one.

    It can be a problem in admitting a patient for aggressive behavior when underlying medical causes are ruled out, or if they can't be attributed to a psychiatric condition. None the less, an LTC facility can be liable for continuing to house residents who are a threat to staff and other residents. If a serious injury happens to one of the residents or your staff because of your resident, and there is continued documentation of aggressive behaviors in her chart, a lawyer feeding frenzy will likely ensue.

    If your doctor had given an order for psychiatric evaluation, and the documentation you've been able to find shows that it wasn't done then I'd call the doctor and have him/her look into the matter. Did the ER call you with report before the patient was returned? If not, then maybe that is something your DON should look into.

    Hope this is helpfu!

    -- Dan M.
    chevyv and binary like this.
  4. 1
    I have certainly not worked in all states, but in states where I have worked, any citizen can call the police regarding a person (patient) who is in danger of hurting himself or others. The person (patient) is then put in a secure facility--usually a 72 hour hold--for a psych evaluation.

    If a person threatened or injured myself or another person, and I was unable to administer a prn, I would call the police.
    sweetlilwolf likes this.
  5. 0
    In states where I have worked, most public jurisdictions have a secure facility for lock-up psych evaluations. Rules vary from place to place. Sometimes it may be the community hospital with a couple of lock-up rooms, a public funded crisis intervention center, perhaps the nearest state hospital--but anywhere I have lived/worked, there ARE facilities available. Maybe in your area call city/county sheriff dispatch and ask where they send psych evals.
  6. 0
    OP what state are you in?
  7. 2
    This is why I am now unemployed.I got beat up on a nightly basis until I could take no more.My facility did nothing to protect my safety of other residents.I call the police and was written up for it...even after the police had to help the emt's escort the patient out if the building after choking me and another resident.....I amnow re evaluating my workplace choices and collecting unemployment until I make the next move..sadly it will not be in my beloved LTC I just can't take the abuse they let go on .my body is broken down and so is my spirit.
    Fiona59 and Blackcat99 like this.
  8. 1
    As nurses we have to realized we don't HAVE to take abuse, verbal or physical. We can press charges and if your company doesnt stand with you so be it but you can sue them for a unsafe work environment. Documenting EVERYTHING that happens and using quotes is your best defense...
    Here is a list by state of what the laws are regarding Assaulting a healthcare worker:

    http://www.ena.org/IENR/Documents/St...d%20Felony.pdf
    Fiona59 likes this.
  9. 1
    It does sound like a dump. I don't want to be rude, and I don't know you or this specific case but many times we get pt's from LTC and when they get to us they are sweet as pie. They meet after waiting hours to see a psych dr, NOT AN ED MD! and they again are sweet as pie sometimes leading us to think that these LTC facilities are just trying to abuse pt (as they often are found to do) and this particular pt wouldn't let them get away with it. So then back they go.

    Now sometimes they are legit crazies. But if they get sent to a LTC because they are demented, then you send them to us because they are sundowning... IDK it just doesn't make sense, they were demented in the first place.

    Also many people forget that it is an ED. We have the resources to deal with EVERYTHING! We're an ed. But should you use an ED for everything just because we have the resources? NO. Should you come to the ED because you need a pregnancy test? NO. Should you come to the ED to have you toe nails cut? NO. Should you come to the ED because you think you might have the flu and spiked a low grade fever an hour ago? NO. But we have the reasources to handle these things. Hence you can see why the resources arguement is a lame arguement to use in this case. If you used that reasoning for every medical issue you would always go to an ED, why use a doctors office for anything?!

    And speaking from experience, please refrain from being upset when you or someone you love has to wait while having an MI because 3 LTC's in the area have demented pt's that suddenly are acting demented, and they all sent them to us because we have the resources. This is the case, there is usually more than 1 LTC in the hospital area... and the ed must deal with their sundowning pt's and the area's trauma's, burns, rapes, and medical issues. Sounds like overwhelming one little department. So now you or someone you love with a true medical emergency must wait while half the ed wrestles with some unknown male we just recieved riled up from a LTC... where's that w10? LOL. Let's not even get started on what a waste of tax dollars that is.

    My suggestion is that if a facility accepts care for someone who is demented they should develop protocols to deal with demented people. That's like accepting care for a person with AFIB, but then when their HR increases, stating, WE DON"T HAVE THE RESOUCES TO DEAL WITH THIS!!! Lol. silly.

    I don't mean to jump down your throat or be rude. But I hate LTC dumps too. And to me this would classify as a classic dump.

    Quote from dallet6
    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 them. They also took their stethescope and threw it into the nurses' chest. Our facility got an order for an IM med, which the resident could not be given.

    Eventually, EMS was called and the resident was sent for a psych eval at hospital. The hospital sent them back just a few hours later. So, two questions--if someone attempts to strangle someone and says they are going to kill them-isn't that one of the qualifications for a mandatory 72 hour psych hold?

    And 2--isn't our facility liable if they readmit this resident and they then attack someone else? It could just have easily been another resident. Am I wrong to say that I would have filed charges if someone attempted to choke me and threatened to kill me? (it wasn't me it happened to).

    When I came in today and read the chart I went and told my charge nurse that if this resident did this again today that I wanted them sent back out. And that I would call the police if this happened.

    Anyone know the legalities here? thx!
    sweetlilwolf likes this.
  10. 8
    So should a person with a mental illness not be sent to the ER then,
    because they were seen on the street attacking and accosting every
    person who walks by?

    I used to work at a psych facility; we didn't even have walk-in service.
    The ONLY way someone could be admitted to our facility was by first
    going to the ED downtown.

    That ED had a section reserved specifically for Psych emergencies.

    Before you fuss at me because my LTC doesn't have a unit set aside
    for dealing with agressive residents... well, why doesn't your ER have
    a section set aside for Psych emergencies?

    This problem, the problem that the OP presents.... it's no one's fault.
    If an LTC has a resident that has become a legitimate danger to
    themselves or others, the only safe and logical place for them
    is an ED, UNLESS that LTC does happen to have an area set aside
    for aggressive residents. BECAUSE an LTC is NOT a hospital, but
    is in fact a HOME.. the likelihood is pretty low that that LTC is going
    to have it's own psych unit. I'm sure some LTC's *DO* have areas
    set aside for aggressive residents, but I think it's rare.

    If you have someone in your home who becomes physically out of
    control as a result of a problem inside of their brain... is a danger to
    the rest of your family... what are YOU going to do with them?

    An LTC is a HOME. I think some people who have never worked LTC,
    forget that. It's not a hospital.
    AheleneLPN, dallet6, casi, and 5 others like this.


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