Detox in a stand alone psych hospital

Jules A, MSN · Sep 6, 2015

The thing with diagnostics is that "outside of the normal limits" really varies. With labs in particular there are some that it doesn't matter if they are really wonky and some that it definitely does matter if they are off by a few points. EKGs can also look pretty scary but if that is where the person lives based on previous EKGs in many cases it isn't a big deal. Detox can be tricky depending on the substance but I would agree with your physician that in many cases its largely supportive care and time.

It will be interesting to see if there is research out there. This is a gray area and I think in many cases psychiatric units and free standing psych hospitals tend to be a bit unnecessarily gun shy with regard to what they consider "medically stable". Although I know a staffing issue for monitoring its difficult to accept there are some inpatient psych units that won't do IV fluids. Research wise the only thing I have seen is a large study on direct admissions of children and adolescents supporting there isn't noted benefit to the long list of labs many psych hospitals require be done in the ED before they will accept the patient.

elkpark · Sep 6, 2015

I would defer to the judgment of your psychiatrist, unless something really awful is happening. I agree with Jules that, in my experience, inpatient psych settings tend to be overdramatic about what constitutes "unstable" and are unnecessarily quick to decline or ship out peope out on fairly flimsy (IMO) excuses. Is the person with a BP of 170/110 and P of 125 being medicated for that? How is s/he responding?

I work in consultation-liaison psychiatry, so I constantly have a foot in both worlds (medical and psychiatric). My experience has been that the medical folks freak out over psych stuff that the psych people would consider perfectly ordinary and routine, and vice versa. To the extend that there ever was a bright line between the psych population and the medical population, that line is GONE. Psych nurses need to be able to deal with people's medical issues, and nurses in other settings need to be able to deal with people's psych issues. The medical folks aren't any happier about that than the psych folks are, but it is what it is.

vintagemother, BSN, CNA, LVN, RN · Sep 10, 2015

I recall one time a pt was obviously high. The psychiatrist said she was coming down and we should put her in a safe room for observation, which we really didn't have the ability to.

My DON told me, the Nurse, to make A judgement as to whether the client was coming down or actively high!

I had no idea! I did know that she did not appear medically stable. Thankfully my don told me to use my own judgement. I conferred with the medical director via phone and he did not medically clear her.

/crisis averted/

adnrnstudent, ASN, RN · Sep 10, 2015

2 criteria for acceptance in Illinois is med clearance and sober. PERIOD!

Sniper06 · Sep 11, 2015

Thanks everyone for responding. I already understand that psych nurses have to be able to do both psych and medical stuff. My issue is that the place I work at isn't set up to do so. We have no monitors, the only stat lab I can draw on the unit is a finger stick, IV access Iis not allowed at the hospital and we dont have a 24 hour pharmacy. At any given time I am the only RN for 40 patients (sometimes giving meds for 20 of them). It just does not seem right to detox some one under these conditions.

elkpark · Sep 11, 2015

Thanks everyone for responding. I already understand that psych nurses have to be able to do both psych and medical stuff. My issue is that the place I work at isn't set up to do so. We have no monitors, the only stat lab I can draw on the unit is a finger stick, IV access Iis not allowed at the hospital and we dont have a 24 hour pharmacy. At any given time I am the only RN for 40 patients (sometimes giving meds for 20 of them). It just does not seem right to detox some one under these conditions.

All of that sounds perfectly ordinary and reasonable to me for a free-standing facility except for the part about one RN for 40 clients. Yikes!!

Have you talked with your unit medical director and the facility medical director about your concerns? (And do other nurses working there share your concerns? I hope you have some support on this. Have you talked with your nursing leadership about your concerns? What do they say?) In my experience, they are the ones who are establishing the standards for what the facility is or isn't able to handle medically, and some physician (or NP or PA) is agreeing to accept these clients from whatever facility is referring them. I've worked in the kind of setting you describe (but, again, without that high a nurse/client ratio), and, in my experience, a lot depends on the physician/provider who is making the clinical decisions about admitting people. Good communication between the medical staff and nurses is so important. Often, they don't really "get" how limited the resources for medical treatment are in a setting like that unless you really spell it out for them.

If I were in your situation, I would be talking to my colleagues and nursing superiors about the situation, getting a feel for how everyone else feels, putting together any evidence that I could of the validity of my concerns (any bad outcomes, "near misses" related to acute detox clients or other acute medical issues on your unit?), and getting organized to talk with the medical director of the unit. It's a difficult spot to be in, I know. Best wishes!

Sniper06 · Sep 11, 2015

Thanks elkpark,

The administration knows about this concern. Everyone does. But its one of those things where the nurses on the floor just do what they need to to get throuh their shift. I guess the main reason I started this post was to find out if there was any research available for me to access regarding proper setting, care and staffing for detox patients. It would be very helpful to take to administration studies and research regarding what type of care these patients need. As a staff nurse I don't have access to the QAPI that the organization collects but my gut tells me this is not right. I really need help finding the standards.