There is a policy in development for our ED that deals with nurses physically detaining patients that want to leave after receiving narcotics. The tentative wording is that nurses are to.....physically detain them. I see this as battery
and/or kidnapping and certainly not legal. What are your ED's doing? There is a degree of liability when an impaired person leaves the ED. The risk of injury when physically restraining someone against their will is a given.
Security on our campus are not to ever touch anyone with the intent to stop them. So why would the nurses?
Wow -- ratting out clients to the police is a new one on me. I wonder if, when she goes to parties, she writes down the license plates of everyone who's had a few drinks and reports them to the police?? If she sees someone run a red light or speed?? Once you start down that road, where does it stop?
I guess the nurse was being extra cautious, because one of our frequent flyers for pain meds, after she left another area hospital with narcs, hit a woman crossing the street with her son and killed the women, was in several papers and the papers blammed the hospital for letting her go with out a ride.
I used to manage a fast food resturant and when we would get drunk drivers in the drive thru I would call and report them, as someone who has lost a family member to drunk driving, I say YES you report when someon is intoxicated!
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Technically, they are under the influence induced by the healthcare provider. They are legally under YOUR care. They can't leave unless you let them...that is technically speaking.
I suggest you call the police like I did on the last one who tried to walk out to try and drive. The cop stood next to his car, and was preparing to arrest him for DUI. It worked. He didn't leave.
Security on our campus are not to ever touch anyone with the intent to stop them. So why would the nurses?
What do you think?
I think the person who dreamed up this particular part of the policy had their head up their butt.
I personally think that in most cases the no-narcs-unless-you-have-a-ride-home policies are not workable. Either give narcs ... or don't give narcs. We get ourselves in such a tizzy about giving narcs in the ED and then write scripts for narcs without a thought in the world about how patients may take them appropriately or inappropriately when they are at home.
If you are going to attempt to not give narcs to patients who do not have a ride because we do not think it's appropriate treatment, then ED providers need to be willing to stick to their guns and not give the narcs until the person willing to drive the patient home is physically present ... and be willing to absorb the resulting impact on patient throughput times and patient satisfaction scores.
We are also firm believers of the "No ride-No narcs" system but in the rare cases when they walk out we chart like crazy but don't physically restrain them.
Although drunks that are too impaired to make their own decisions get locked in their room or restrained--how is that different? Hmmm...
Psych patients that are unable to make their own decisions d/t psychosis or meth (or both) are held against their will as well....maybe you could group a normal pt stoned on narcs in these categories?
call the police if they are attempting to leave in their own vehicle, but otherwise they can be d/c'd if not driving. I'm not understanding why you would have to detain a patient..... do you mean a patient leaving AMA? Again, would call the police (or hosp security to watch them if they get into their car and attempt to drive). Otherwise, I'm not putting a hand on a person unless they're trying to harm me.
Wow -- ratting out clients to the police is a new one on me. I wonder if, when she goes to parties, she writes down the license plates of everyone who's had a few drinks and reports them to the police?? If she sees someone run a red light or speed?? Once you start down that road, where does it stop?
that is what we, as professionals, have to do if a person who was provided narcotics and told not to drive then chooses to drive. By the way, that is covered in discharge instructions on not taking narcotics and driving. I add that it is just like drinking and driving.
How is it not the right thing to do to report an impaired person to the police????? What would you do if you saw a car swerving all over the road, would you not call the police? Would you like that on your head if that person who left the ED under the influence harmed or killed a person? We have only so much control, but we can do the right thing. Also, if I saw a drunk person getting into their car, I'd do my best to prevent it, but having been in that situation, that is pretty difficult to do. Calling the police might be the best thing we can do for anyone that is intoxicated - that decision to act or not act impacts all of us. Why would you turn a blind eye to a potentially dangerous situation??
I'm with the "consult the legal beagles" here and develop a policy that is clear cut.
Our ED also is--'no ride, no narc' rule. And yes, we get the tricksters. If they leave, we document that they eloped from the ED (similiar to AMA)--usually without notifying staff
I am working on updating our policies in our ED, and this is one I am working on--when is a patient considered 'incapicitated' --fro drugs, alcohol, where the ED staff CAN detain them using restraints (the overtly OD'd patient or drunk as a skunk) but, they are not 'involuntarily committed" (we call it a 302).
It is a very grey area and I am finding that we need to be VERY specific regarding lab data results, patient behavior assesments, fall risk, etc when developing this
Specializes in Clinical Research, Outpt Women's Health.
So, if i come in with an injury and my spouse or friend is not with me i do not get a pain med? Ouch! I promise I will have someone come, but please give me the benefit of the doubt and do not make me lay their in pain until I can get someone..........
ED abusers are a whole nother thing I know, but please remember us normal folks when making policy........
So, if i come in with an injury and my spouse or friend is not with me i do not get a pain med? Ouch! I promise I will have someone come, but please give me the benefit of the doubt and do not make me lay their in pain until I can get someone..........
ED abusers are a whole nother thing I know, but please remember us normal folks when making policy........
This is not directed specifically at you, Crunch ... but NEWS FLASH ... there are non-narcotic pain meds!! Toradol can be a great thing!
The policies being discussed here are related to the IV administration of narcotics.
And I'm curious -- those of you who are stating that your ED does the no-ride-no-narcs thing, but are then restraining/documenting/writing down the license plate of patients who skip out ... are you not waiting for the patient's ride to actually show up before giving the meds?? What's that -- you can't afford to keep the patient waiting that long?? They would jam up the whole patient flow?? Satisfaction scores would go down??
We don't hold the narc until the ride is here--but we do ask the patient who will drive them home so we can give it--and then we give it, and if/when the pt is discharged, we have them call for their ride. (or taxi)
Similiar to procedural sedation--the ride doesn't have to be here on site until they're ready to be discharged.
Specializes in Clinical Research, Outpt Women's Health.
I haven't been in an ER in over 20 years (thank gawd), bit it would have to be something very, very painful to get me there and i would have already gone to my go to drug (Ibuprofen).
I just wanted to make the point that not everyone out there is the difficult repeat visitor/abuser so don't make policy that penalizes the innocent.........
I agree, Crunch. Appropriate pain relief is a medical priority.
But because we refuse to hold people responsible for their own behavior, we get ourselves in this quandry. There is no reason that providers should not say to a patient, "we want to give you Med X for pain relief. Med X is a narcotic which impairs driving ability, therefore, it's prudent that you get someone to drive you home. If you were to drive yourself after receiving Med X and were stopped by law enforcement or, God forbid, were in an accident, you would be considered to be driving impaired. The vehicle you drove yourself here in is safe in the garage/lot and can be retrieved later. We'll go ahead and medicate you - please use the phone now to call whomever you wish to pick you up. You will be discharged as soon as your treatment is complete and are welcome to remain in the waiting room until your ride arrives."
In my fantasy world ... alert, oriented & mentally competent patients could and would bear the responsibility of choosing their course of action. Yes, it sucks to have to choose between pain relief and inconveniencing friends/family. Yes, it sucks to have to pay more for parking because you had to leave your car in the hospital garage for an additional several hours. It sucks to have to seek treatment in the ER in the first place. However, this sucky phenomenon is called LIFE. Unexpected and inconvenient things happen.
But ... we as a society have largely decided that people do not have to be responsible for themselves. If an alert, oriented, competent patient is given appropriate narcotic pain relief by medical professionals with instructions not to drive ... and then drives ... somehow it's our fault. So we devote more time & resources to developing babysitter-like policies to substitute for personal responsibility and common sense.
LoveMyBugs, BSN, CNA, RN
1,316 Posts
I guess the nurse was being extra cautious, because one of our frequent flyers for pain meds, after she left another area hospital with narcs, hit a woman crossing the street with her son and killed the women, was in several papers and the papers blammed the hospital for letting her go with out a ride.
I used to manage a fast food resturant and when we would get drunk drivers in the drive thru I would call and report them, as someone who has lost a family member to drunk driving, I say YES you report when someon is intoxicated!