I'm so ****** off. We got a guy last night that was violent, fighting with family, breaking windows, ect. The family called the police and he cried suicidal and ended up with us instead of in jail. That was my first problem with the whole thing. He should have gone directly to jail. He has a violent criminal history.
So in the ER he is in 4 point leathers and continues to yell and swear. He states that if he is admited to our behaviour unit he will assault staff, steal a badge, open the doors and escape......He has done this before. He escaped the leathers, he tipped the cart, he was verbally abusive. Ativan did nothing. As I tried to give him an IM of Haldol he looked directly at the security officer and spit in his face. 100% intentional.
The psych facility refused him because he is to violent for them to handle. We called the police because psych, the MD, and I are all feeling like that is where he belongs. Well the officer comes in and says right off the bat he will not take him to jail because he has a 24 hour psych hold. Long story short if you have claimed suicide, psych, ect you can not be arrested and sent to jail because he is not in his right mind. Security wanted to press charges and was told he couldn't. It seems to get more common lately that the police just do a 24 hour and dump them with us instead of dealing with it.
So now we have this viloent patient that I believe is 100% in his right mind and is just an *******. Psych won't take him and jail won't take him. We can't let him go. What is the solution???? When I left after having him for 6 hours. Lets just snow him with drugs and wait until morning for a pyschiatrist. I have NEVER in 10 years seen a psychiatrist come to the ER.
So frustrating, such a waste of time. We can get verbally and physically abused for hours and there is nothing we can do about it because he claimed suicidal at one point. Jail is a safe place! I guarntee they can do suicide watch and he can get a mental health eval there. All this while the kids and little old ladys are not getting the best care they can because we are so tied up with this ahole. Plus he was yelling and swearing loud enough for the whole ER to hear for hours!
What do you guys do in these situations? Can you press charges if you are assaulted? Do you get a lot of police dumps?
Well, after re-reading the original post NOT on my tiny screen phone, I see that I read into the situation a bit r/t the substance abuse -- the OP didn't say the pt. was intoxicated...must have been someone down the thread a bit, or reminded me of patients who have suicidal ideation and are intoxicated.
Spitters get once chance, then they receive a mask for the protection of the staff. As for the rest, I agree, continue to go up the chain of command, document, and fill out whatever your version of incident report/risk management report when you feel there is potential for things to go bad due to mismanagement of these patients.
Also, more than anything, with people with a history of violence it is key to watch cues that they may be ready to escalate their behavior. A few of the things I watch for are staring or lack of any eye contact, really tense body language (ex- balling up fists, etc), yelling, damaging things (ex- trying to tear off monitoring equipment, restraints, etc). Keep yourself safe first. Never let them get between you and an exit when unrestrained, leave the room door open, don't turn your back on the patient, avoid entering their personal space unless absolutely necessary, and don't enter the room alone. Don't have anything they can grab (ex- stethoscope around neck, lanyard, etc) or let them have anything they can throw. Also, no matter how frustrating it is, keep your voice calm. If you refuse to give them any attention or show fear, they aren't getting what they want (to intimidate or gain attention).
I think you need to include some learning objectives in your nursing care plan. Beating up your family in not an effective way of committing suicide, jumping off a very tall building is. Perhaps the patient just needs some better instruction. After-all suceeding in suicide gets you out of absloutely everything!
Specializes in Spinal Cord injuries, Emergency+EMS.
this is why sensible legislation for police to section / place a psych hold makes it last only as long as it takes to get the requisite Medical and Spcial Worker opinions .
The patient has some serious psych issues because no normal person would have behaved like that. Manipulation, attention seeking are psych symptoms in my little world. But at the same time i agree that this guy should have been in jail or close Psych Unit and no ER or floor. I have only seen such characters at the jail psych unit where they are locked up 24-7 and when they refuse medications court orders are given to forcibly medicate. As psych nurse there is no way in hell i would try take care of such a patient. And yes the security guard should have been allowed to file charges; exposure to bodily fluids is no laughing matter.
And last but not least as someone said....for hostile patients always go for Geodon...it works wonders. If not get an IV, put them on monitor + oxygen and then Ativan IV, Benadryl IV and Haldom IM if your facility allows it and patient is at risk for injury to self and the surroundings . ALWAYS BE SAFE.
This is when you need propofol. Paralize and intubate. We have done with violent traumas, but in this man's case, we really have no grounds. Mask for the spitting. He needs a UCLA 5150. 5 haldol, 1 ativan and 50 of benadryl. Then close the door. They usually calm down. I have never had one as bad as the story.
But if he really is that out of hand, make the police come deal with him. They have to stay till he's calm enough for us to manage safely. I have threaten to call the watch commander if they leave, but usually they stay. Not sure where this er was.
I'm very sorry for your no-win situation. I am currently an LPN in a county jail. I don't know what state you are in, and therefore, the policies and procedures may be different. In my facility, we can accept suicidal arrestees. The arresting officers will bring them straight to the jail (unless they are injured) and it is then the responsibility of the intake officer and, if applicable, nurse to assess the situation. We have psychologists in house (except for midnight shift, which I just happen to work), and a psychiatrist on call. We have the option of refusing a new arrestee, which would then send them to the ED. As a general rule, if a new arrestee is making suicidal statements or has even had a recent attempt, as long as any medical injuries have been addressed, we accept them and put them on a suicide watch. They receive a "suicide-resistant" blanket (looks like a moving blanket you place over your furniture) and a mattress and that's it. A correctional officer then has to see the inmate every 15 minutes at least. Of course, there are variations that are possible depending on the situation, but that's the general procedure.
I'm wondering if the correctional facility that you are dealing with does not have medical or psych staff available. There is the chance that they are doing a "dump job", but I wonder if maybe they don't feel they have the resources to manage a person in the condition you have described. My facility has a padded cell, and another facility I am familiar with has a restraint chair for patients who are actively trying to harm themselves. Nurses are in the facility 24/7/365 with the ability to medicate dangerous patients if ordered by the psychiatrist/judge. This may be something to speak to your supervisor about. He or she may be able to speak to someone at the correctional facility to find out what the situation is. At the very least, it seems an appropriate concern to voice. A patient like that takes a lot of time and energy that could be redirected to patients who actually need it.
I hope you are able to find a solution to your problem. I wanted to respond to let you know that not all correctional facilities run like this, and maybe that would be something to look into. Keep your chin up and keep venting if you need to! Good luck!
manchmal
61 Posts
Well, after re-reading the original post NOT on my tiny screen phone, I see that I read into the situation a bit r/t the substance abuse -- the OP didn't say the pt. was intoxicated...must have been someone down the thread a bit, or reminded me of patients who have suicidal ideation and are intoxicated.