Contraband Checks?

[chocokitten]

Hello,

I just started working in an inpatient acute psychiatric facility a few months ago. I work at a VA hospital and we have a 21 bed unit. A few weeks before I started working here the ward was shut down because a patient pulled a knife on a nurse. Since then there have been some changes to safety policies: we now have a enclosed nurses station (the ironic thing is they put up the windows then took down the doors and said they would replace them in "2 weeks"... right, we've been without doors for at least a month now), we do q15 minute "safety" checks or the floor, qhour checks where we check of that each patient is safe/visualized, belongings have been limited to none for level 1 patients and level 2 patients get 2 sets of clothes, no belts etc, and shoes without laces.

However, we still have a huge issue with contraband. Last week nurses responded to a room after smelling cigarette smoke. A patient was in the bathroom, flushed the toilet, and no contraband was found.. (I think he flushed it). I suggested, along with some other nurses and aides, that we have qday THOROUGH safety checks of the floor, and pointed out to my nurse manager that the q15 checks are inadequate and are too rushed to do a thorough check. When doing 15 minute checks one often finishes just in time to start the next round... My nurse manager an I did a trial thorough check, checking under mattresses, in pillow cases, in tissue boxes etc. In 45 minutes we checked the entire floor. We found a light, tobacco "crumbs", 3 wallets (not allowed on floor), 2 plastic patient belongings bags, one duffle bag (not allowed), and lots of garbage. We also discovered many other, non-contraband related, safety issues just by looking around the floor.

I'm working on making this a daily thing and I wanted to get some input. What does your hospital do as far as contraband checks? What have you found during your checks that wouldn't have found otherwise? Any stories, suggestions, etc would be very helpful :)

[jeckrn, BSN, RN]

You are in a catch 22. if you start doing the searches and the liberal media get ahold of it you will be the villian and withholding the veterans rights. But, if that same veteran hurts himself or another patient the same liberal media will go after you for not keeping the veterans safe. It is a no win for you. Worked at the VA and understand what you are going thru

[chocokitten]

liberal or conservative, that's how media works lol.

Anyways, we already have policies in place to do contraband searches, I'm just asking for input on adjusting it and to get some advice :)

[jeckrn, BSN, RN]

After working at the VA in order to adjust anything is diffucult because of the political climate that is intrenched in the VA system, it is even harder in the BH areas. Make sure that you have your upper management, union (due to work rules) evolved in any changes that you might like to do. If they are both not onboard with the changes that you would like to make it will be next to impossible to get them done no matter how good they are.

[chocokitten]

upper management is supportive :) Union is not involved, and since this is SUPPORTING staff safety, I don't think they'd have much bad to say about it. Thanks for the input though!

[StormRN]

I've been a psych nurse for the past 13 years and currently run a 16-bed psych hospital. The best way to deal with contraband is to provide strict screening as soon as the patient comes into the hospital by having them remove their clothing to provide skin checks and to be able to go through all belongings and clothing in order to make sure that there is no contraband items on your unit. Tell your patients who complain that it is a policy, if it is not a policy it should be now that your staff has been threatened with a weapon. Further, tell the patients that it is to make certain that no one has any items on them upon admission which could hurt staff or other patients, and that you are responsible for the safety of everyone on the unit. Let them know that if you let them slide on the screening then you might let someone else slide on the screening who has a knife or worse a gun. That usually gets their attention and cooperation.

Another activity which brings in contraband items is visiting hours. Make sure that your rules are posted at the door before visitor come in, and state any and all contraband items, you do not want on your unit, and ask if the visitor has read the rules. The rules should include language which bans further visits from occuring, if a contraband item appears on or in the patients room or belongings located with the patient. You will need to keep a strict visitors log and screen each visitor and remove belongings from the visitor for safe keeping during the visit. If a visitor "feels" sketchy monitor the visit with staff close by. Most important is if contraband is discovered, get a doctors order to ban the visitor from returning during the patients hospital stay. This sets an example and demonstrates that your facility takes safety seriously. You are in the business of keeping people safe.

As far as room searches go, do a walking round with the RN from the shift before you, to visually inspect each room before the previous shift leaves. This promotes responsibility for unit safety and you can check on where your patients are, do a quick mental status, introduce yourself as their nurse and see if there are any safety hazards. Continuity of care is key. Each shift must be as diligent as the last.

15 minute checks are great, but patients get wise to when they are happening and will time you. They have nothing better to do, if they are up to no good. We do random room checks too, and that seems to help. People want to know that you care about their safety, so use this time as a tool to see if anyone needs anything and to spend a little time with your patients.

If you are doing room checks, people will hide things everywhere. If you suspect there is contraband in a patients room, make the bed, sometimes you will find a hole in the mattress. The toilet paper holder is another place to look. Take it apart as a cigarette is easily concealed there. If you have electricity in your rooms, a piece of paper and a pencil will start a fire in an electrical socket. Don't forget to have the person thoroughly searched for lighters, and matches. The last thing you want to deal with is a burning mattress or worse your patient.

I hope that the above suggestions help. It sounds like you are new to this field. We don't have doors or windows on our nurses station. We take preventative action when we feel a patient is becoming anxious. We spend time with them, talk with them, offer prn's and activities or just sit with them until they are ready to talk. Catching a person in an anxious state and alleviating the anxiety is much easier than dealing with a physically acting out person.

I wish you the best of luck with your proactive endeavors to rid your hospital from contraband.