Specializes in Hospice, corrections, psychiatry, rehab, LTC.
I agree but at no time in the description of the OPs case was the patient involuntarily comitted for psychiatric treatment. That being the case the nurse cannot and by all means for their own safety should not physically prevent the patient from leaving. The provider needs to be contacted to make the decision to allow AMA or not.[/quote']
Spot on. The way that this was presented, the physician was never contacted, and the nursing staff made the decision on their own to hold the patient (unless there is something that I'm missing). This is not legal. In my state, a person can be placed on a 72-hour hold for personal safety, but that requires a provider order.
Tell your Charge RN first. Then he/she most likely to tell you to page the doctor. If the doctor takes too long and the pt is trying to leave aggressively, call a code gray/silver.
If they left AMA on my shift, it would be from running out the door. I definitely wouldn't have them sign AMA paperwork. A lot of our withdrawal patients get IV ativan which seems like it complicates the issue even more. I feel like I can't give someone IV ativan and then let them run into traffic or hop on a bus.
Considering Ativan reduces their withdrawal symptoms I would argue the opposite; anyone being discharged who is at high risk for worsening D/T's prior to being able to consume more alcohol should be properly medicated to ensure their safety in that in-between period. Some of our ED docs directly ask the patient how long it will take them to get another drink in them, and if it's going to be around an hour or more then the doc orders Ativan or valium prior to leaving.
Our ability to hold patients is one of those things where nursing common wisdom is often way off, which most often isn't a big deal, until it is a big deal in which case I've personally seen a nurse lose their license and face criminal charges.
To hold a patient on a medical basis, the person needs to have a problem that justifies treatment and be unable to provide an informed refusal. If the patient can convey that they are aware of what we think is wrong with them, what we are proposing to do about, and what might happen to them if they refuse treatment then they cannot be held, regardless of whether they are having hallucinations or other symptoms that some would describe as "not being in their right mind". If the only purpose of treating the patient in the OP's description is that they are an alcoholic but they have no intention of quitting drinking after going through withdrawal then informed refusal doesn't even come into play since detoxing them would be inappropriate treatment.
Mental health holds are rigidly defined, and according the OP the patient has not gone through a process to be placed on a mental health hold.
Declining treatment doesn't count as posing a danger to themselves, and just because a doctor believes they are sick enough to be admitted that doesn't mean they also cannot decline treatment.
Considering Ativan reduces their withdrawal symptoms I would argue the opposite; anyone being discharged who is at high risk for worsening D/T's prior to being able to consume more alcohol should be properly medicated to ensure their safety in that in-between period. Some of our ED docs directly ask the patient how long it will take them to get another drink in them, and if it's going to be around an hour or more then the doc orders Ativan or valium prior to leaving.
It seems to make them "woozier", though ...although I don't see them in the ED- just on the floor. Maybe they're better off after the Ativan than they were before it? I guess I can't make that determination with the information I have to work with. All I know is that we gave them something (in the hospital) and now they're running towards the street with their IV pole. It gives me a headache every time.
DeeAngel
830 Posts
That you didn't notify the doctor is absolutely negligent, egregious behavior on your part.