Depressed self-referral to ED

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Just curious how other hospitals might have handled the situation. Early 40's female pt self-referred to ED complaining of feeling depressed and suicidal ideation - no plan, however. It was a little surreal because pt appeared well-put-together - very calm and composed. However, pt admitted to drinking earlier. Pt attempted to leave before her psych eval could be conducted, saying she felt better and had changed her mind. At that point, pt was re-directed to a locked room, her clothing, underwear were taken, ankle to ankle restraints applied. She ended up being discharged after her eval. Didn't know what other hospital policies might be in similar situation.

Specializes in Critical Care.

Restraints for medical purposes can be nurse initiated with a time limit on how long they can be continued without being seen by an LIP who will write a continuing order for restraints. Restraints for mental health purposes are different and generally nurses can't initiate even a temporary hold, which is why it's so important that people presenting with SI are seen by someone quickly who can legally evaluate them and initiate at least temporary hold orders. We see this every once in a while and our DOH has been very clear that until we have a legal psych hold in place, no patient can be held based on that criteria, not even temporarily until they can be evaluated. We have to notify the police that a welfare check is needed.

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Specializes in Emergency Room.

This was a violation of her civil and constitutional rights. She was falsely imprisoned without due process.

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Specializes in Oncology; medical specialty website.

Whoa, whoa, WHOA!!! That was ten thousand shades of inappropriate! You don't just strip someone and strap them down because they state they feel depressed.

I worked in psych for several years. We only restrained people who were acting out/danger to self or others. Your patient, by your description, didn't meet either of those criteria. I also worked in the ED, and don't recall restraining any of our psych patients. Four point restraints should be reserved for extreme circumstances.

Your department needs some in servicing on the appropriate management of patients who present to the ED with psychiatric issues.

This makes me sick just thinking about it.

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Specializes in Oncology; medical specialty website.
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.

You were lucky she was that docile, because that was inappropriate.

Busy or not, she shouldn't have been placed in seclusion and restraints. If your ED was that concerned about her, why not call the local mental health agency/crisis intervention for a psych eval? Pts. shouldn't be placed in seclusion and restraints for the convenience of staff.

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Specializes in Oncology; medical specialty website.
I was surprised by the resrtraints - as was pt, but I would've found having to strip completely naked more unsetling, as I feel she did. soft-spoken.

You're not saying that she lay naked and restrained in that room, are you? Please tell me she got a gown or paper scrubs.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.
I'm having a hard time understanding what exactly you strongly disagree with.

I strongly disagree that the OP should avoid using her own discretion. I disagree with the implication that being familiar with hospital policy is a substitute for the OP's judgment. I think the OP very much needs to use her judgment about whether or not the patient was treated appropriately.

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Specializes in Psych, Addictions, SOL (Student of Life).

WOW and just WOW

I am a psych nurse and find it very hard to imagine a patient with these presenting symptoms would be relieved of their clothing and left shackled in a locked room- talk about over kill.

WOW

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Specializes in Pediatrics, Emergency, Trauma.
I strongly disagree that the OP should avoid using her own discretion. I disagree with the implication that being familiar with hospital policy is a substitute for the OP's judgment. I think the OP very much needs to use her judgment about whether or not the patient was treated appropriately.

However, knowing policy and procedure will help determine what options the OP has with clinical judgement.

Even if the OP has issues, KNOWING how to use resources, the OP can call the ethics hotline, help create and/or change policy and procedure so an event such as this won't happen again...that's using nursing judgement in lieu of policy and procedure, which as a nurse you still have to have some knowledge of facility policy to determine whether there needs to be a change, prompting advocacy due to nursing judgement. :yes:

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While I am not disagreeing with the psych people who have chimed in, several qualify their posts with," I'm a psych X"

Just to be clear, people get restrained in the Ed MUCH quicker than in a locked psych unit. The two are not apples to apples comparison. That said, based on the information given, I would have raised hell if someone put my pt in restraints in the OP scenario.

BSN GCU 2014.

Sent from my iPhone using allnurses

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Don't think I said anything about that. I don't disagree with you. Restraints are for immediate threats when other less restrictive means have failed. I was referring to changing clothes and placing them in a monitored room. Reread my post again.

BSN GCU 2014.

Sent from my iPhone using allnurses

I wasn't criticizing you, so I don't feel the need to reread, thanks. I was referring to the OP's situation, which was handled in an abominable way.

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Specializes in Oncology; medical specialty website.
While I am not disagreeing with the psych people who have chimed in, several qualify their posts with," I'm a psych X"

Just to be clear, people get restrained in the Ed MUCH quicker than in a locked psych unit. The two are not apples to apples comparison. That said, based on the information given, I would have raised hell if someone put my pt in restraints in the OP scenario.

BSN GCU 2014.

Sent from my iPhone using allnurses

They get shacked in four point restraints naked? Never happened when I worked in psych, and certainly never happened when I worked in the ED.

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While I am not disagreeing with the psych people who have chimed in, several qualify their posts with," I'm a psych X"

Just to be clear, people get restrained in the Ed MUCH quicker than in a locked psych unit. The two are not apples to apples comparison.

Exactly. ED is an entirely different world. "I'm a psych X," :) and the scenario described by the OP would never happen on an inpatient psych unit. However, in my experience with ED, it's not at all uncommon a scenario for an ED. Is it my first choice of how I would like to see the situation handled? Of course not. Am I surprised in any way that it played out the way it did? Other than the restraints, which seem overkill to me, not at all.

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