Dangerous patients

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Just looking for some help to find written law for a situation. I work in LTC. We have a new resident who on their first day on the hall attacked one of our nurses by strangling them and telling them they were going to kill them. They also took their stethescope and threw it into the nurses' chest. Our facility got an order for an IM med, which the resident could not be given.

Eventually, EMS was called and the resident was sent for a psych eval at hospital. The hospital sent them back just a few hours later. So, two questions--if someone attempts to strangle someone and says they are going to kill them-isn't that one of the qualifications for a mandatory 72 hour psych hold?

And 2--isn't our facility liable if they readmit this resident and they then attack someone else? It could just have easily been another resident. Am I wrong to say that I would have filed charges if someone attempted to choke me and threatened to kill me? (it wasn't me it happened to).

When I came in today and read the chart I went and told my charge nurse that if this resident did this again today that I wanted them sent back out. And that I would call the police if this happened.

Anyone know the legalities here? thx!

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If someone choked and threatened to kill me trust me I would call the police and press charges.

Sent from my iPhone using allnurses.com

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Specializes in Gerontology, Med surg, Home Health.

I, too, would call the police and have the resident removed. I recently tried to find a psych bed for a resident who was kicking and hitting the staff. No male beds to be had. He kicked a staff member again. We called 911 and told them we had an aggresive resident who needed to be sent to the ER. Amazing how quickly the hospital was able to find a bed.You would be held responsible by the DPH in Massachusetts if you knowingly had a violent resident in the building and you weren't able to prevent him from harming another resident.

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Specializes in being a Credible Source.

I work in the ER and have several times been on the receiving end of these patient dumps. We have no magic pipeline for them into a bed and the few inpatient psych faciliities won't take (a) violent patients or (b) patients with medical problems.

All you're doing is dumping the problem on us... and taking our resources away from people that we can actually help... and putting us at risk...

This is a financial and political issue, not a medical issue.

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Specializes in LTC, assisted living, med-surg, psych.

I'm sorry you have to deal with that. But where else can these patients go when they're dangerous to both staff and the frail elderly people we care for? At least the ER nurses can medicate them.....we can't even give IM Haldol in the LTC environment anymore.:no:

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Yes, no matter how you look at it the ER has more resources to deal with this than we do. Our hands are tied when it comes to physical restraints as well as chemical restraints. ER staff can use leather restraints and give powerful IM sedatives..... we in LTC cannot. And acute psychosis IS a medical issue, isn't it?

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Specializes in Clinical Documentation Specialist, LTC.

It's pretty rotten how the hospital conveniently leaves out little tidbits of info. such as violence in a patient's history, so when the patient is admitted to LTC the staff and residents suffer, and it takes an act of congress to get the patient out of the home. It's not so easy to say "We can't meet the patient's needs" anymore like in the past. I have worked in several homes where we were stuck with a violent patient until sadly, the patient attacked another resident. LTC sure has changed a lot in the past 10 years.

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Specializes in Aged Care & Post Surgical Recovery.

It isn't only hospitals that leave out violence in a resident history. It is amazing how many families leave this out too. They will tell you 'oh, he/she was never like this at home'. Then you assess a bit further or some other family member speaks to you and you find out they were. In a way you can't blame them. They have been through enough. But if they just told people, then the right facility could be found or their doctor could arrange psych evaluation, meds etc and stabilize them before entry to a facility. Why put anyone else through violence.

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Specializes in Clinical Documentation Specialist, LTC.

That is so true Lian. I can sympathize with the family members of a violent patient, but they don't think about how hard it is on themselves and the patient to be moved from one place to another because of violent behavior, when it would be better to seek out an appropriate facility where the patient's needs can be met appropriately in the first place.

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Specializes in LTC, Education, Management, QAPI.
I work in the ER and have several times been on the receiving end of these patient dumps. We have no magic pipeline for them into a bed and the few inpatient psych faciliities won't take (a) violent patients or (b) patients with medical problems.

All you're doing is dumping the problem on us... and taking our resources away from people that we can actually help... and putting us at risk...

This is a financial and political issue, not a medical issue.

WOW. This is not evidence of a patient dump. I have worked in hospitals as well, and they (maybe not yours) are more capable than a nursing home is to handle this type of patient. I find this particular post extremely hateful and rude. I hate when people assume we are dumping. WE ARE REQUIRED BY THE STATE DEPARTMENT OF HEALTH TO HAVE THE PATIENT REMOVED IF THEY POSE A RISK TO OTHER RESIDENTS!!!!!! Check with your health department and learn the rules before saying others are "dumping". So unprofessional!!!

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You are spot on!!! I'm an ER nurse and ex LTC nurse. I wasn't allowed to give Haldol IM in LTC but in the ED we can sedate and intubate if we have to.QUOTE=BrandonLPN;7139997]Yes, no matter how you look at it the ER has more resources to deal with this than we do. Our hands are tied when it comes to physical restraints as well as chemical restraints. ER staff can use leather restraints and give powerful IM sedatives..... we in LTC cannot. And acute psychosis IS a medical issue, isn't it?

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Management generally discourages calling the police and removing the resident because the facility doesn't get reimbursed for a patient that's not there.

So? If I'm being threatened and harmed by a patient, I'm calling the cops. However, it's pretty hard to get the cops to do anything most of the time.

I had a completely A&O bedbound resident throw whatever she could find at me (including a full bedpan). I called the cops, because I was not going to take that crap. The cops came and told her she shouldn't throw things and left.

The problem is a very physically ill person cannot be booked into jail. They'd have to be in the hospital under guard 24/7. The cops just don't have the resources for that unless the person is a murderer or a fugitive Nazi or something.

So good luck.

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