de-escalation

TerpGal02, ASN · Mar 31, 2013

Well de-escalation is pretty much when a pt gets agitated or is in a crisis situation, what you do to get them to calm down before you have to end up putting them in seclusion or chemical restraint. The biggestthing to be aware of are the pts triggers (ie do they not get along with their family and had a bad visit or phone call? Is there another pt on the unit that pushes their buttons? Are they becoming more aymptomatic?). If you can catch them before they really get going, its better for everyone. Once they are at critical mass with their crisis, people tend to lose the ability for rational thought and don't really hear what you are saying, or may perceive you as threatening. You have to maintain a non threatening body posture and the big thing is to STAY CALM. Be very direct and concrete with them. Give them choices and be ready to reinforce the consequences of a bad choice. An example of that wouldgive you be, "Mr Smith, you seem to be pretty upset, why don't you head back to your room and calm down a little bit.". If they refuse what I would do is say something like, "Ok Mr Smith, I can see you don't want to go to your room. The other option is for us to escort you to the quiet room, I will give you 3 minutes to decide what you want to do". At this point, you would want to have other staff with you. You have to be prepared to follow through in 3 minutes if they make a bad choice. It's always best to catch it early so you can talk to them about what's bothering them so you don't have to resort to taking someone to the quiet room or giving an IM. You could offer them a PO PRN as well. If someone is ramped up though, you definitely want to keep the other patients far away from that particular person. If that means sending everyone to the day room or their bedrooms, that's what you have to do.

edie1 · Mar 31, 2013

Thank you - so kind of you to help me understand :).