Did I do the right thing?

[edrn09]

So tonight I was working and picked up a patient with an "abscess" to his thumb, when I went in to assess him it was clear that he would be admitted for cellulitis and get IV ABX. Doc goes in and examines him, then orders 1 gram vanc, and 900mg clindamycin IV. I go in to start this guys IV, and he had ROPES for veins, they were gorgeous. However, when I stuck him the first time, it was like sticking a needle through steel. That one blew. All the while pt and pt's girlfriend are asking me if doc ordered pain med (he hadn't - but I said I'd talk to the doc and get an order). So I try and stick him again, and once again gorgeous vein that is hard as a rock.

So I send my much more experienced charge nurse in to start an IV. It took her 3 sticks and she finally got an IV in the back of his hand. After sticking him the first time she asked if he ever used IV drugs. He said no, but his girlfriend pulled me aside and said that he did "but he was clean for 6 months."

Well, after the IV is in, he gets 4 morphine, 4 zofran, and I start the vanc. Not even 10 minutes later, I walk by his room to the IV beeping and he is GONE. Gown on the bed, IV tubing UNSCREWED, and tubing clamped off. So I do the search around the ER, we go outside, and we send security to check all the cars in the parking lot. I mean the guy with the drug history just disappeared with a main line to his veins!

After talking with my charge nurse, I try and call his home (bogus number), and then she told me to contact the police, to either have him come in to get the IV out, or have the paramedics take it out. About 20 minutes later, I get a call from an Officer stating they are at his address and no one appears to be home. She wanted to run his social to make sure that it was his address. I gave it to her, and he turned up to have 19 - count them NINETEEN - FELONY WARRANTS! She said that if he returned to call the police to have him arrested.

Well, an hour and a half after her went missing he returns with IV still in reeking of pot, saying some story about he had to get a babysitter for his daughter blah blah blah, and he said he had to hurry out, but he told someone he was leaving... (Which no one in the ER was told). So when he showed up I sent him to the lobby to wait for a room, and I called the police.

They showed up right as my shift was ending. But from what I understand, he will be arrested. I guess my concern is did I do the right thing??? What do you do if a patient shows up missing and has an IV still in place? I mean even if he wasn't a drug user, that's a HEALTH RISK to leave that in there. Also, he has just gotten morphine, so if I believe his story and he was taking his daughter to the babysitter, he was driving under the influence of MORPHINE! ugh. I just need someone to tell me what to do in that situation. The doc didn't want us to call the police, our nursing supervisor did... I was just generally confused. Has anyone ever been in this situation? IF SO PLEASE HELP! :confused:

[mamamerlee, LPN]

Have Security stay with him. The police should be notified as soon as you pulled out the IV line. The police should be instructed to take him to whatever hospital in your area that has a jail ward.

If it is your hospital, have security stay with him until the police get there and he can be escorted to wherever you keep your possible perps/prisoners.

This man is VERY dangerous. And obviously a con man.

In my personal experience, the only people with 'ropes' for veins that you cannot access are people who workout alot (athletes, construction workers, gym nuts) and addicts/IV drug abusers. ASK after the first miss - the dopers will tell you where the best place is. No kidding.

One of hardest sticks ever was a pro-hockey player - skin like leather.

[Annisme]

Yes, you did the right thing. If someone leaves our ER w/an IV in place, we call PD to bring them back or assure it has been DC'd. If someone leaves after they have been medicated, they are "under the influence" and we are again required to call PD. We insist that patient's have someone to drive them and ask for names and to see the person. However, some of them lie. Someone was recently arrested for DUI after lying to a nurse and driving. Tried to blame the nurse, but great documentation had been done.

[morte, LPN, LVN]

not so sure you were on the right side of HIPAA on this one....better check with risk management.

[StudentNurse2011]

We've had to call the PD a couple of times when a patient left after procedures under anesthesia without a driver. Yes, we documented the heck out of it and contacted risk management. As far as I know nothing became of either incident (at least not on our end). I never found out what happened with either patient.

On the other hand, I had to go to the ER myself one night with a migraine - BP was off the charts high. The nurse put in a heplock and administered too many drugs to count (several doses each of pain meds and antihypertensives). They discharged me (my husband was driving) but forgot about the heplock. When I realized the mistake, I talked my daughter through removing the heplock instead of making another trip back to the ER. Nobody from the hospital ever seemed to realize they'd sent me home with a heplock still in. Nobody ever called or asked about it, and I didn't call to report it. I figured in all the insanity, they simply forgot. It's probably pretty stressful when one of your own coworkers comes into the ER with a BP in stroke range. That's no excuse, but since I knew how to take care of it myself (rather, how to teach a family member to take care of it), I just did that and called it good. I figured as long as my BP was down and I wasn't having a stroke it was all good.

I've always been taught that if we administer narcotics and the patient drives afterwards, we're just as responsible as a bartender who serves too many drinks to someone who doesn't have a designated driver. I know of one bartender who spent time in jail because one of his customers killed someone in an MVA after leaving his bar, but I don't personally know any nurses who've been implicated in a DUI offense. The nurses I've worked with are diligent in assuring that there is indeed a driver, as well as their teaching and documentation. Of course there are patients who will try to con the nurses, but most of the time they don't get away with it. The two I know of left just like your pt - snuck out AMA.

[netglow, ASN, RN]

I think what the OP is concerned about is this, am I correct?

Patient left unnoticed, with IV access in place and narcs on board

RN attempts to find patient, notifies security, calls patient phone with no success, calls cops to locate

(seems you would have to follow specific facility protocol to the letter to protect you and the facility. ERs of all, should be really experienced with this type of patient and have firm protocol on this!!!)

RN is notified by cops of patient criminal hx and active warrants

(cops give you this info hoping that you will participate in the arrest of this patient, slippery slope)

Patient returns to hospital, gives questionable story for behavior, and awaits further tx without causing trouble/disorder

RN calls cops and notifies them of patients return

(slippery slope as you are notifying them that they can call off their search, but, you need that protocol to follow to protect you and the facility)

[Christy1019, ASN, RN]

i agree with what you did, my ER FREQUENTLY has had to deal with this, however, our main concern is not only them driving w/narcotics on board, but some of them don't even wait that long, the minute you finally get iv access and walk to go get your meds, they take off, because now they don't have to skin pop.. they have direct venous access and are likely to end up on the street O.D'ed on heroin or whatever else they inject themselves with. Especially if your charge nurse was instructing you on how to handle the situation, you are backed up right there. You did the right thing, good job!

[SchnauzersRock]

not so sure you were on the right side of HIPAA on this one....better check with risk management.

I don't think HIPPA would apply in this case. The patient was under the influence of mind-altering drugs, left AMA, and was a clear danger to other innocent people. Under the circumstances, I do not believe that I would hesitate to notify the authorities either. This nurse did the right thing, in my honest opinion.

[Altra, BSN, RN]

In the 3 hospitals I work/have worked in ...

If you leave with an IV in place and we can't reach you by phone in a very short period of time ... cops are called.

[TeresaEDRN06]

You absolutely did the right thing.

[Kooky Korky, BSN, RN]

Sounds right to me.

What does your supervisor say about how you handled it?

[I_LOVE_TRAUMA, RN]

I believe you did do the right thing.

& coworker of mine once had a addict pt. Who was in for a severe arm abcess from iv use. The docs put in an EJ...her and her mother preceded to go outside (without our knowledge) & use heroin...she OD'd and died.

You must always cya with this type of pt.