I was charge nurse Saturday night and was walking down the hall in the wee hours of the morning to compliment an LPN on her charting when a patient, Dobbs, came out of his room and asked, "Why is there a mannequin in my room?!"
I replied, "There is no mannequin in your room". Dobbs then asked, "Well then, what's that?!" and pointed to the roommate, lying in bed. I said, "That's your roommate". Dobbs then said, "You'd better check on him. I think he's dead".
I did as requested, shining my little pocket flashlight on the roommate who said, "I'm okay".
I told Dobbs, "The patient is fine. You need to go back to bed". Dobbs became very animated, speaking rapidly and nonsensically, throwing circular punches in my direction. I said, "Dobbs, you need to stop this behavior because it's not safe". When Dobbs continued the behavior, I said, "Dobbs, stop his behavior or you'll need to deal with the ramifications of your actions". Dobbs continued to throw the circular punches and moved closer to me. I got Dobbs in a therapeutic hold and loudly said, "Call a Code Green!"
The LPN working the floor answered "Okay!" and was back in a matter of seconds to assist .
We escorted Dobbs into the Quiet Room and several staff arrived within a few minutes. I talked to Dobbs, giving the reason for the therapeutic hold, focusing on safety, and said that the intervention would be increased or decreased, in accordance to the responses received.
Dobbs had had 50mg of scheduled Seroquel at HS and could have 10mg of Zyprexa PRN. A choice was given to administer it IM or PO. Dobbs consented to take the Zyprexa PO.
Dobbs sat on the floor of the Quiet Room, took the Zyprexa, and I asked questions to ascertain a perception of reality. As Dobbs calmed and was behaving relatively appropriately, the other staff members slowly left the Quiet Room.
By the end of our discourse, Dobbs was able to relate the reason, with relative accuracy, for his admission, the events that led to this intervention, and the criteria to leave.
Dobbs had been brought into the ER after visiting a relative in a LTC facility, informing the staff that, as an inspector, he would close down the facility. The Police were summoned and Dobbs informed them of his Super Hero status and that he lived in a Yellow Submarine. He became agitated and the Police brought him in to our ER.
Dobbs was furnished a pillow and cover and choose to sleep in the Quiet Room that night on a mat. In the morning, as I was leaving, Dobbs stood at the Quiet Room door and asked to be allowed into the general population. Dodds assured me staff's directions would be followed, was allowed to leave the Quiet Room, and the oncoming charge nurse was informed.
