A mini BHU in ICU

[EyeSeeYuRN]

I work in a 16 bed ICU in a rather rural community, and because of budget restraints, the BHU upstairs was closed down quite a few years ago. So, we in ICU get the behavioral health patients... We have the standard 2 MD hold paperwork where the patient loses their rights, yada yada, and some of us have our own ideas on the special considerations for these patients (no clothes/belongings in room, visitors leave bags outside, etc) but we don't have any set policies for handing these patients. I'm on UBC and am beginning to draft such a policy. Anybody have any suggestions? Run into the same problem at your work? Here any tips that would be especially helpful on such a policy? I never knew I'd end up being such a psych nurse! Appreciate any thoughts/feedback!

[ckh23, BSN, RN]

My first concern would be having them on an unlocked unit. Everywhere I have worked had a seperated locked unit for inpatient pysch patients. Who is going to be responsible when the suicidal patient gets out, runs up to the roof and jumps? I would also look into a policy/protocol for when they start getting agitated or violent. Is there something in place that will get you help for when this happens? Another possibility is the windows. I don't know what type you have, but if they can be opened and they can get out that will be an issue.

[EyeSeeYuRN]

Yup, the lack of a locked unit is a problem. What usually happens with these patients is that they first end up in ICU because they are not medically stable (receiving dialysis, vented, etc) after being admitted, usually, with a dx of OD. So we treat them, then when they wake up/start feeling better, they stay with us until they are cleared to be medically stable in order to be transferred to an inpatient psych unit. When these patients do get out of hand, we have security at our disposal (which we employ). Unfortunately, they tend to wait til they know that no ones watching to run. Windows do not open from the inside. I'm looking specifically for a set of guidelines that can be put into place when we get these types of patients. Like I said, there are things that many of us employ because we've had something go wrong, then put into practice the interventions because we've had experience with them. Such as taking down the curtains, removing all clothing (to deter running), etc.

[neurorn6]

Having worked in a small rural ICU, I can understand the issues at hand. You will need to make sure your restraints are for violent and non violet patients and also take in consideration the ages which may be in volved. The restraint orders for violent must have time assessment protocals for different ages. The physician should see a patient with 1 hour of being placed in violent restraints. Look at what your state mandates. Also, suicide patients should have a sitter with them (after being extubated). Has soon as possible get them medically cleared and sent to the appropriate facility. With sucide patient, only paper plates and plastic utensils, no phone, no call bell (this is why a sitter can help), all personally items removed, no visitors. You could look into having suicide rooms with a camera. Find out what you state says you can and can not do first.