I had a resident which was admitted for altered mental status a week ago. Last night, she was extremely confused, verbally and physically abusive, exit-seeking, and verbalized that she will kill herself if we wouldn't let her go home. MD was called and got an order for stat p.o Haldol (which didn't help at all). Got a call from Behavioral Unit stating that they were contacted by MD about a possible admission. Now, MD wants a direct admit to Behavioral Health, Behavioral Health on the other hand doesn't want to admit said resident pending papers that needs to be signed by POA and its already 10PM. They wanted me to send resident to ER while awaiting for POA to come in and sign the said paperwork. Resident was sent to ER at 2230. I wote a V.O to send resident to ER for eval.
To make the story short, my ass is getting burned today about the said resident. MD didn't want the resident to be sent to the ER but I sent her instead. Behavioral Health told me so. My fault for not making MD aware of Behavioral Health's conditions. Though before I left my 16hour work for the day, I made sure my nurse's note was well documented. Plus there's a red flag because it's a NO-NO to administer Haldol prior to leaving facility since the MD prescribing it is not a psychiatrist. Since when anti-hypnotics limited to psychiatrists only??
Now, did I made the wrong call?