?'s for experienced inpatient acute psych unit staff re: police and pt. observation

[superpsychnurse]

This is actually 2 questions: What are your policies and procedures regarding calling the police to assist with an acting out patient? It used to be part of our policy as a last resort as our psychiatric unit is actually in a separate building from our main hospital. Due to some changes in management, our hospital hired a consulting firm from out of state, and now they tell us it is prohibited to call the police unless grave bodily harm has already occurred. They tell us that nowhere they have been have they ever called the police. They don't seem to understand the acuity of patients we sometimes have (although they claim they do). We recently had an episode where a very large patient was agitated on a weekend. There were only 6 staff located in the entire building, so the police were called to assist, but luckily they weren't utilized. Being the charge nurse on duty I was called to a "meeting" about this. I feel I took proactive methods to keep everyone safe. I want to know how other psych units function in this aspect.

Question 2 is related to observation of patients. Is close observation considered a doctor's order? Or a nursing intervention? We were told by our past director that nurses have the capability of placing patients on more intense supervision without a doctor order, such as changing from 15 minute checks to close obs or 1:1, but we require a Dr. order to place them on less frequent obs. such as from close obs to 15 checks. The consulting firm is now telling us that it is not in our scope of practice to order more frequent supervision. Can others please weigh in on how you handle this?

[elkpark]

I've worked inpatient psych for almost 30 years now, in five different states, many different facilities/organizations, and I've never worked anywhere where the policy was to call the police for help unless it was a situation of an armed gunman shooting people in the building. That was the only situation in which police would be called.

As for observation levels, everywhere I've ever been, the policy has been that nurses can initiate a higher observation level (like moving someone from 15" checks to constant obs) at any time if they feel that is indicated for safety, but then get a physician's order later to maintain the observation level. Nurses have never been able (anywhere I've worked, that is) to move clients to a lower level of observation (from constant obs to 15" checks) without a physician's order.

[superpsychnurse]

Thank you. It's great to find input from other sources as I've only worked on the one psych unit for 8 years.

[marshmallowstar, BSN, RN]

You said your unit is in a separate building than the main hospital, is there security available from the main hospital to assist? 6 staff is bare bones staff for a code situation. If they don't want you calling the police do they have suggestions on how to manage aggressive/restraint situations? I've never worked anywhere that calls the police for code responses but I've only worked at larger psych hospitals that have designated responders each shift.

As far as Obs levels; RNs can increase to more intense level, MD must assess in person to decrease.

Good Luck!

[superpsychnurse]

Yes, our main hospital is about 2.5 blocks away from the building where we are. Originally our building housed more services but they gradually all migrated to the other newer building. They say they plan to move us there too, but i think it's very far in the future. So meanwhile we have 20 psych beds split into 2 units of 9 beds and 11 beds. On the weekends the only ones in the building are 2 techs, 3 nurses and one guard.

[phattass, BSN, RN]

On the units I have worked, we often needed to call the police. It was supported by management.

As for close obs, a nurse can increase the frequency without a doctors order (even seclude but need a dr order as soon as you have secluded and only in an emergency) but a nurse cannot decrease the frequency without a dr's order.

[Whispera, MSN, RN]

I've worked in 3 psych hospitals. When there wasn't enough staff to take care of a dangerous situation, in all those psych hospitals, we called the police. It didn't happen often, but it did happen. Personally, if I know someone could get hurt without police backup, I'd call them whether it was what a management company said or not. It's too late to fix getting hurt after it's done.

[chevyv, BSN, RN]

I call Security and if there is a physical altercation resulting in injury, I then call the sheriff and they do a report. I do not call the authorities to assist with any situation until I have it under control and then follow up with the legal end. I wish we could call the sheriff to assist because there are times when it's pretty nasty, but the respond time would be 3-5mins which would be way too long.

I can put anyone on q 15 checks at anytime if I feel it's necessary. I can put someone on SOS 1:1 but must have the doc come up and evaluate within 1 hr.

[chevyv, BSN, RN]

Yes, our main hospital is about 2.5 blocks away from the building where we are. Originally our building housed more services but they gradually all migrated to the other newer building. They say they plan to move us there too, but i think it's very far in the future. So meanwhile we have 20 psych beds split into 2 units of 9 beds and 11 beds. On the weekends the only ones in the building are 2 techs, 3 nurses and one guard.

Most of my patients would tear your place up! That best be one highly trained, huge, muscle-man with an attitude acting as your guard! I work in a county psych so I'm pretty sure it's a bit more violent.

[TerpGal02, ASN]

We don't call police until a last resort but we're pretty well staffed during the week with the hospital, 2 PHPs, c&a residential program, and school. Our facilities manager will come up too, and he's a pretty big dude. Weekends are a little more lean, but we can still call on residential staff if we have to. Really the only time we call the police is if there's an elopement off grounds, but we own the 100 some acres the property is on. We have a levels system that basically delineates the level of obs the patient is on. Nurses can put a pt on closer obs, but we do notify Tue MD if that happens. Only the MD can put them on less frequent obs though.

[superpsychnurse]

This is great input. Basically our small unit serves about 1/3 of our state as we have some large rural areas. We serve as a crisis and stabilization unit as well as dabbling in "treatment". But when I started we were predominantly triage and stabilization. Since then our local state hospital has closed down, so we do end up getting some pretty acute patients at times. I feel like our consulting company is having difficulty understanding that all of our patients do not come in voluntarily and happy to be here. And of course we would call the police only if we don't think we can handle it on our own, and that isn't often, but it happens. I just don't appreciate being made to feel inadequate for making that judgement call, and your input has greatly helped me feel justified.