Contraband in psychiatric emergency rooms

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    Many patients are brought to the psychiatric hospital emergency room involuntarily; confirming whether the patient possesses contraband is often difficult. Do you have suggestions about how to examine for and remove such items?
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  3. 11 Comments so far...

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    Hey Psych!!!

    It doesn't answer your question, but I'll pass on an experience I had a year or so ago...

    CodeBlue was called on the Psych floor. I was first to respond (ICU just one floor below the PsychUnit and the doors very close to stairwell--I'm not that fast on my feet anymore!!!). Pt was apneic, cyanotic but had strong radial pulse. I was ambu-bagging, getting the Psych folks to hook up the O2, check a BP, that sorta thing. Then in roars the ER crew and the Resp crew and we decide to intubate him. Open mouth for laryngoscope and--what's this? We pull out a wrinkled and tooth-marked piece of plastic. Ah, I say, a fentanyl patch! Sure enough--we had an IV by now and right after an amp of Narcan we got the instant emesis that pretty much proved what the story was.

    The quy had had 2 'visitors' just before he coded. Never found out if there was any investigation about the source of the patch.

    Left the room thinking Wow!!! You'd really have to be SOOO careful if you worked in that kinda place. My hat's off to y'all.

    PapawJohn
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    in our hosp you have to do a body search before you are allowed out onto the unit. they have to take off their clothes at the same time covering as much of their body as possible so staff can check for scars, bruises, contraband, ect. they search pockets and shoes ect.
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    Quote from hsieh
    in our hosp you have to do a body search before you are allowed out onto the unit. they have to take off their clothes at the same time covering as much of their body as possible so staff can check for scars, bruises, contraband, ect. they search pockets and shoes ect.
    Thats how it was when I worked psych. Checking every pocket and every sock. Made the ladies turn their bra's inside out. Documented every scratch, zit, tatoo, and self cutting marks. We did not do cavity searches. Men did the male searches, and Women did the female searches. Most were compliant. I worked adolescent psych and we mostly got cigs off of the kids. On the dual diagnosis unit, we got just about everything.
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    I recall with embarassment one occasion where I contrabanded a patient on admission removing a bottle of valium from her and giving it to her husband to take home. A couple days later unit staff found the same bottle of valium on her. Helpful hubby had given her back her feel good pills as he said good bye.
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    Men search the male patients women the females. Strip & change into hospital PJs & slippers. All clothing is then washed, dried & returned. I have had patients come in with weapons, knives, ice picks...never a gun. I have seen them sew pills or drugs into the hem of pants or shirts, under the inside brim of caps, hidden in think hair or braids. No cavity searches but otherwise they are searched thoroughly. If it is someone I truely fear about behavior problems with I have security remain on the unit until the search is complete.
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    Thanks. Has the approach you use been approved by patient advocacy folks?
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    In our ER, we strip search ALL psych patients including overdoses, psych patients, intoxicated and high patients. Then the clothes and belongings get locked up.
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    Had one hide a bottle of pills in the middle of her knitting yarn. Another had a change purse full of librium. Had a male pt who had a butcher knife in the leg of his long johns.
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    It depends, are you working adult or children emerg?
    Asking forthright often can produce items too....sometimes you have to list them though...do you have any knives? forks? pieces of medal? anything sharp? anything you use to hurt yourself or others? Emergency checks are done differently than ward checks too. Watch their non-verbal...what are their hands and eyes doing...in emerg are they eyeing the med cart or surveying the environment?


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