Depressed self-referral to ED

sallyrnrrt, ADN, RN · Oct 29, 2015

Way over violation of patient bill of rights, maybe even false in prison containment....... I mean without emergent mental health warrant......not impressed

jana82 · Oct 29, 2015

Way over violation of patient bill of rights, maybe even false in prison containment....... I mean without emergent mental health warrant......not impressed

I thought it was overboard. I wouldn't have wanted to see her leave, myself. But, it was a mad house and I even thought they may have influenced her decision to leave. She didn't stay in seclusion long, and the ankle restraints came off and moving her back for eval. Where her clothes hadn't been taken before, I thought it was unnecessary we did - esp since she was eventually allowed to go home.

elkpark · Oct 29, 2015

Of course, we have only one side of the story. Appeared "very calm and composed"? Pfffft. Lots of people who intend to kill themselves appear very calm and composed. "Admitted to drinking earlier"? How much? How much earlier? Was a BAL drawn? Did she appear intoxicated, or was the BAL high enough that she could be considered intoxicated regardless of her presentation? A reasonable argument can be made that someone acutely intoxicated lacks the mental capacity (due to the intoxication) to choose to leave the ED prior to the full evaluation being completed, and, in the case of an identified lack of capacity, it's not a psych or "patient rights" question, and no involuntary commitment or mental health warrant is needed to detain people (legally).

I agree that the ankle restraints seem a bit much, but the rest of the scenario seems reasonable enough to me. Maybe not the ideal way of handling the situation, but not that uncommon a response to the scenario described (and I'm going to go out on a limb and guess that, as is so often the case here on AN, there's significantly more to the story than we're hearing). Healthcare professionals tend to err on the side of caution when it comes to suicidality. Nobody wants to let someone leave precipitously and then read in the newspaper the next day that she left and killed herself. What exactly was this individual expecting when she presented to an ED with that CC, and then decided to take off before the facility completed a thorough evaluation? We're not talking about a rash or a cough here ...

jana82 · Oct 29, 2015

Of course, we have only one side of the story. Appeared "very calm and composed"? Pfffft. Lots of people who intend to kill themselves appear very calm and composed. "Admitted to drinking earlier"? How much? How much earlier? Was a BAL drawn? Did she appear intoxicated, or was the BAL high enough that she could be considered intoxicated regardless of her presentation? A reasonable argument can be made that someone acutely intoxicated lacks the mental capacity (due to the intoxication) to choose to leave the ED prior to the full evaluation being completed, and, in the case of an identified lack of capacity, it's not a psych or "patient rights" question, and no involuntary commitment or mental health warrant is needed to detain people (legally).
I agree that the ankle restraints seem a bit much, but the rest of the scenario seems reasonable enough to me. Maybe not the ideal way of handling the situation, but not that uncommon a response to the scenario described (and I'm going to go out on a limb and guess that, as is so often the case here on AN, there's significantly more to the story than we're hearing). Healthcare professionals tend to err on the side of caution when it comes to suicidality. Nobody wants to let someone leave precipitously and then read in the newspaper the next day that she left and killed herself. What exactly was this individual expecting when she presented to an ED with that CC, and then decided to take off before the facility completed a thorough evaluation? We're not talking about a rash or a cough here ...

As for the drinking, she did not appear intoxicated at all. She had 4" spike heels on and could walk perfectly. She said she'd had 2 1/2 cocktails (whiskey) the last almost an hour before she came. She was 5'9" and thin.. 135... No BAL. She was cooperative, but became very less talkative as time went on - very soft spoken when she did, and difficult to hear if not paying close attention. Nothing threatening at all. I believe she was depressed, but didn't think she was a threat based on those things above. However, like I said, I wouldn't have wanted to see her leave before evaluation. I took her shoes off her feet, but she undressed herself. You could tell it was probably upsetting for her, but she did without argument and diligintly folded her jeans and blouse and neatly stacked them with her underwear on top. It seemed surreal to have someone (except for attempting to leave) cooperative, to be doing this so cooperatively... I felt bad at this point. I didn't apply the restraints, but watched. Just leather cuffs and connecting strap. She looked surprised/apprehensive, but cooperated fully and didn't say anything. I think she was glad to ge it all over with by the time the eval was finished.

Guest219794 · Oct 29, 2015

Ankle restraints in a locked room?

For what purpose?

I get the locked room part- what kind of ankle restraints?

jana82 · Oct 29, 2015

Ankle restraints in a locked room?
For what purpose?
I get the locked room part- what kind of ankle restraints?

Padded leather humane type with locking connecting strap... â‰¤20 min... Unknown, at that time if door would be shut, or if pt would would be taken back to former room.

lavenderskies, BSN · Oct 29, 2015

As for the drinking, she did not appear intoxicated at all. She had 4" spike heels on and could walk perfectly. She said she'd had 2 1/2 cocktails (whiskey) the last almost an hour before she came. She was 5'9" and thin.. 135... No BAL. She was cooperative, but became very less talkative as time went on - very soft spoken when she did, and difficult to hear if not paying close attention. Nothing threatening at all. I believe she was depressed, but didn't think she was a threat based on those things above. However, like I said, I wouldn't have wanted to see her leave before evaluation. I took her shoes off her feet, but she undressed herself. You could tell it was probably upsetting for her, but she did without argument and diligintly folded her jeans and blouse and neatly stacked them with her underwear on top. It seemed surreal to have someone (except for attempting to leave) cooperative, to be doing this so cooperatively... I felt bad at this point. I didn't apply the restraints, but watched. Just leather cuffs and connecting strap. She looked surprised/apprehensive, but cooperated fully and didn't say anything. I think she was glad to ge it all over with by the time the eval was finished.

Well that probably most effectively nixed any chance she'll reach out for help ever again. That's all I have to say about that. I really hate how we don't treat and then horribly treat mental illness. :no:

Whispera, MSN, RN · Oct 29, 2015

Unless there's something missing in what you wrote, I'd be steaming angry at how this person was treated...

jana82 · Oct 29, 2015

Well that probably most effectively nixed any chance she'll reach out for help ever again. That's all I have to say about that. I really hate how we don't treat and then horribly treat mental illness.

Well, I can only hope it didn't. I tried to be as polite and friendly as I could. I commented on her (perfect) pedi when I was taking her shoes off. Not much opprotunity to say much else. But she said thanks and smiled a little. She was polite too, and was (obviously) appreciative - rather than rude or acting like it had been unnecessary - when she was finally given her clothes back to her to put on. Barefoot, and carrying her shoes in her hands as she walked through/out of the ED, I thought accentuated the defeated look one might thought her to have had - as I did anyway... But it had been extremely chaotic that night.

AZQuik · Oct 29, 2015

Restraints on a cooperative pt? This was a physicians decision? I'd be writing a report up about that. Completely unnecessary. Restraints are a last resort. I have never applied then to a flight risk only to keep pt's and staff safe.

BSN GCU 2014.

Sent from my iPhone using allnurses

MunoRN, RN · Oct 29, 2015

Of course, we have only one side of the story. Appeared "very calm and composed"? Pfffft. Lots of people who intend to kill themselves appear very calm and composed. "Admitted to drinking earlier"? How much? How much earlier? Was a BAL drawn? Did she appear intoxicated, or was the BAL high enough that she could be considered intoxicated regardless of her presentation? A reasonable argument can be made that someone acutely intoxicated lacks the mental capacity (due to the intoxication) to choose to leave the ED prior to the full evaluation being completed, and, in the case of an identified lack of capacity, it's not a psych or "patient rights" question, and no involuntary commitment or mental health warrant is needed to detain people (legally).
I agree that the ankle restraints seem a bit much, but the rest of the scenario seems reasonable enough to me. Maybe not the ideal way of handling the situation, but not that uncommon a response to the scenario described (and I'm going to go out on a limb and guess that, as is so often the case here on AN, there's significantly more to the story than we're hearing). Healthcare professionals tend to err on the side of caution when it comes to suicidality. Nobody wants to let someone leave precipitously and then read in the newspaper the next day that she left and killed herself. What exactly was this individual expecting when she presented to an ED with that CC, and then decided to take off before the facility completed a thorough evaluation? We're not talking about a rash or a cough here ...

Detaining due to being incompetent to make the decision to leave can't be based solely on having had some drinks anywhere in the US