Contraband

elkpark · Sep 14, 2015

What do you consider "out of the box"? There's a lot more to it on any psych unit I've ever experienced than just "weapons." Toiletries containing EtOH or otherwise toxic, anything in glass containers, cords/shoelaces/drawstrings/belts, any electronic devices, knitting needles. Obviously, any kind of smoking/vaping materials. Any kind of medication. I've worked on adolescent units in which paperclips and pencils with the rubber erasers on the end were considered contraband and were carefully controlled.

Having said all that, it's impossible to create an environment safe enough that you don't need to be constantly monitoring client's emotional states and behaviors. I've worked places in which some staff erroneously believed that, if we just controlled enough stuff and made the unit safe enough, we could sit on our butts at the nurses' station all day and not have to keep track of people or be concerned about safety. Never gonna happen ... :)

Meriwhen, ASN, BSN, MSN, RN · Sep 14, 2015

My most memorable was a sex toy. She wasn't intentionally trying to sneak it on the unit--her admission was rather precipitous and she had thrown a whole bunch of stuff in her suitcase in her haste to get here. I had fun calling the supervisor and asking if we should put it in the safe :)

She also had "included" a whole batch of used syringes and some heroin. Not the most fun belongings search.

As far as measures to prevent stuff from entering the unit...all patients are scanned with a metal detector, then have to undergo a body search down to the skin (no cavities). Usually if people are trying to smuggle in stuff, they do it in their clothing or suitcases, or have a visitor try to bring it in.

You will never make a 100% safe environment. I had a teen patient who cut herself with pieces of plastic from the shampoo bottle cap. If it wasn't that, I'm sure she'd have found some other benign object around the unit to use.

Orca, ADN, ASN, RN · Sep 14, 2015

We always searched patients and inventoried any belongings that they brought in. Searches were always done by same sex staff. We once had a patient (LPN) who had a BKA who was admitted for opiate detox. She was reluctant to allow the tech to search her prosthesis. The tech found about 50 Lortab concealed in it. As elkpark says, it isn't just about weapons.

We had a locked area on the unit for personal belongings that patients could not have in their rooms, apart from valuables. They got them back upon discharge. Valuables were inventoried, sealed in an envelope and taken to the safe by security.

Long Term Care Columnist / Guide · Sep 15, 2015

When I was IP last year, I wasn't even allowed my iPod because of the wires. I can't imagine how I could've caused myself any harm with those, but who knows...one of the other patients on the unit cut his wrists with a plastic toothbrush he'd snapped in half. Where there's a will, there's a way I suppose.

ThymeRN · Sep 15, 2015

On our unit, iPods and such aren't allowed either. The ability to take pictures can be invasion of the other patients' privacy.

elkpark · Sep 15, 2015

On our unit, iPods and such aren't allowed either. The ability to take pictures can be invasion of the other patients' privacy.

I've never heard of a psych unit that would allow any kind of electronic device, including cell phones, because:

A) Nearly all of the cell phones, tablets, laptops, etc. have cameras built in, which aren't allowed for confidentiality reasons.

B) Chargers, headphones, earbuds, etc., involve cords which could be dangerous. The concern is not necessarily the person who owns the device, but anyone on the unit could possibly get hold of a charger, headphones, etc., and use it to harm her/himself. People who want to do so are often extremely creative and resourceful about finding things they can use.

C) Units don't want to have anything of any value floating around on the unit (including things that might not be specifically dangerous, like jewelry) because they don't want to have there be any question of responsibility/liability if something valuable gets damaged or stolen.

Abbyrose · Sep 15, 2015

We don't allow patients to wear a bra with an underwire because we had a patient remove hers and use it to cut.

Whispera, MSN, RN · Sep 15, 2015

no bottle caps, nothing hard plastic, no plastic bags, no jewelry chains

on the unit, we learned that cords on blinds, glass light bulbs, and the aerator screens on faucets could be big problems

Meriwhen, ASN, BSN, MSN, RN · Sep 15, 2015

At the current hospital I work at, we have "open" units where patients can have such things as iPods, personal electronics, jewelry and other extras, though cell phones and cameras are not OK because of the privacy rules. They were also more lenient with what was allowed in terms of attire--drawstrings, sashes and underwires were usually OK. These units are only for patients with a very low risk of suicide (e.g., detox or who came in voluntary without SI).

A&Ox6, MSN, RN · Oct 8, 2015

I would like to point out that a patient may respond to excessive restrictions by finding other means. As an example, I know of a young woman who suffers from PTSD and BPD. She is currently doing very well, and has a great sense of her conditions. She has described an episode of disassociation during which she was on 1:1 watch for self-harm. She proceeded to use her short fingernails to scratch her arms. Because of the use of fingers that may not have been clean, she ended up with MRSA. Oddly enough, she claims that five years later, she has no other scars from her self-harm other than from this scratching episode.

I would also like to remind you that one of the reasons that psychiatric patients are encouraged to wear their own clothes is because it promotes normalcy and self-respect. For some women, an underwire bra is necessary to be fully dressed.