Violent/combative residents?

Specialties Geriatric

Published

How do you handle them? As in, what is your company protocol? Recently, we had a 96 year old (dementia with no noted behavioral issues) become extremely aggressive and violent. They had wandered into another area of the facility thinking it was their home and when an attempt at being redirected was made, resident began swing at staff, causing legitimate injuries to myself and another coworker (bloodied lip, bruises, and a nice gash to my left leg where it became the victim of being hit with a walker) our facilities protocol is to call our mobile mental health unit in such circumstances. We followed protocol and when they arrived, they asked us the residents age, if she had any known mental issues, and what they were. When their age and dementia came out of our mouths the social worker looked at me and goes "what the hell did you call me for? I'm not even making a report. She's over 90 with a known issue." And they left. Not long after they left, they began swinging at another resident. At that point, I called 911 from which they were transported to a Geri psych unit as an impatient. Today I got slapped with a nice little reaming out from my DON and Administrator for "not following protocol" despite having tried and our mental health unit dismissed it. She said that that should have "told me something" I feel like it was a lose/lose situation. Not only were they a harm to themselves and staff but they were a danger to my other residents who I have a duty to protect as well. What could I have done differently? I feel like I can't do right by this place.

Specializes in Critical Care, Neuro-trauma.
I work on a adult psych unit that accepts geri patients. Yes we get patients from ltc with a dx of dementia on a 302 commitment all the time. If they have the dementia dx chances are they are not going to be able to sign in voluntarily but they can be committed involuntarily.[/quote'] We have a special unit that is dedicated JUST for our Geri Psych patients at our hospital and the majority of them already have a dementia diagnosis. It's almost always on a 302 basis. The mental health worked who came out wouldn't 302 her due to basically not wanting to do the paperwork involved and also the interviewing process (this was an admission on her part, not an accusation on mine) That was the first time I had ever had to call for our mental health unit to come out so I'm not sure what all that entailed in detail. But once we had the lady sent to the ER, they automatically 302'd her.

This is news to me! We always send residents out to try and commit them and they always send them back saying they can't with a dementia diagnosis. Maybe we just have some dumb hospitals around here. :) haha

In Mass. you have to have a scheduled antipsychotic before you can have a PRN, also make sure you medically clear them of UTI or any other labs, elevated BUN etc. THEN you can send them out for psyche eval, and only then. It may appear as a long process but if it were your loved one you would want everything done before they were committed. Many people act out with a UTI.

In long term care you can NOT give a PRN antipsychotic unless there is already a scheduled dose. I don't know where all y'all practice, but we don't do that here. Ativan sure...trazodone great...but not a PRN antipsychotic.[/quote']

I don't know what to say other than that is exactly what the M.D. prescribed for PRN when I had to call him that night. (Seroquel)

dumb like a fox.....

This is news to me! We always send residents out to try and commit them and they always send them back saying they can't with a dementia diagnosis. Maybe we just have some dumb hospitals around here. :) haha
Specializes in LTC.
In Pennsylvania, when you send a resident out to a psych facility or even to the ER to have them 302 committed, they will not keep them if there is a dementia diagnosis. Doing so is actually illegal.

This bothers me. It seems like they think that once there is a dx of dementia it immediately erases all possibilities of any old/new psych diagnosis. I have very few patients who don't have a secondary psych diagnosis, most are depression/anxiety, but we also get bipolar, schizophrenia, catatonia, and so on. Heaven forbid they develop the secondary diagnosis after they receive the dementia diagnosis.

I'm so relieved that I'm not the only one who gets into these situations. It's very frustrating to do the best you can with what you have and you still get in "trouble". I decided to become a nurse to help and provide care to those who can't do it themselves, but when did I stop being a human? Mgmt ony sees $$$$$$$. It's really sad when you are hoping the "state" comes in to investigate. No one should go to work afraid of a resident.

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