hospitalists clashing and nurses stuck in the middle

We have policies in place that say patients are not allowed to leave the ward whilst attached to any IV medications, if they insist on doing so they are not complying with medical instructions and the IV is discontinued until they are prepared to comply.

If they are pain free enough to leave the ward area then PCA is taken down and they will be converted to alternative analgesia, if they are in pain enough to need a PCA they do not leave the ward.

You cannot force someone to stay on the unit, you cannot force someone to remove their pca, you cannot force someone to have their iv removed. The best thing in this case is to have a policy in place. You then instruct the patient on the policy with another nurse or manager present and document, document and document some more. If they choose not to comply that is their issue and they would not have a leg to stand on if it went to court.

I can't believe any doctor would allow it. We also have a nonsmoking policy at my hospital. We do not disconnect people and let them go outside to smoke across the street. It's a safety issue. Why would you allow that anymore than allowing them to hit the bar down the road and having a few drinks?

I believe you most certainly can force somebody to have their PCA disconnected if they leave the facility. It's a controlled substance. Why would you think it can't be disconnected? Medications get discontinued all the time. You can't force a doctor to continue a prescription, nor can you force a nurse to continue the administration of a drug that has been discontinued.

On a side note, I worked in Utilization Review for an insurance company for a while. If we read the notes and saw the patient was well enough to go off the premises and smoke cigarettes, we would deny the stay.

I agree you cannot force someone against thier will to stay on the floor but if policy says no IV narcotics off the floor or unsupervised by a nurse then that is MY PCA pump and I'll disconect it if I need to in order to protect my licence and whoever the wanderer may want to share the meds with. If they insist on leaving the floor they are in actuality refusing PCA meds since PCAs can't leave the floor with them. I could be wrong but that is how I see it- A written policy would be a great idea.