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:
I work in a pretty busy ER in a metro area. This happens all the time. We just make sure we document something like "patient and family instructed to alert RN if leaving facility for removal of heplock.....stated understanding." Then if we go to check on them and they've left we will call security to take a quick look. If they haven't come back in a half hour or so we AMA them. I don't think we've ever called Metro about this. It would be really low on their priority list, they would most likely chuckle at us if we called them. I've had heroin drug users walk out with IV in. We just use the above documentation and make sure we document very well on mental status. If someone is altered and getting IV we usually do a medical restraint or keep them in eyeshot. Most of our drug users who come in are regulars, we will do all testing first, and only if they have a real health concern do we then give pain medication. Medicated patients must have ride home, taxi is ok. If no ride or money for taxi they get bus voucher.
I think as long as no medical information was given out such as why they were there to be treated and such then everything should be ok HIPPA wise. Ive worked for 3 ERs and all 3 called the police if someone left with an IV line still in them.
As far as the police wanting you to call when he comes back, I think that is fine, but the thing you need to tell the police is, that unless there is a medical reason , the hospital wont be able to make the person stay there and just wait on them. You can call and tell them to come pick him up, but you can keep him there unless there is reasoning, and him having warents are not a valid reason.
That was my thought, but only with the social security number being given to the police when they asked for it.
I'm not sure the hospital could back up the rationale of it being given to the police without a warrant damanding the information.
What surprises me is that is usually the first thing that people lie about, their SSN.
Thanks, i was feeling more than a little lonely,lol! this discussion has been done here before...WHAT is the legal reason for calling police on someone who leaves with IV access.....theft of property? can't be reused.....i think some are confusing ethics with the law.....and heaven knows they are NOT one and the same! Even telling the police a person was in the ED would seem to come too close to a HIPAA violation to me...unless they had a warrant..
Yep. We've been told that it's a HIPAA violation if we call the police about a patient (unless they're walking out and suicidal, and we're getting into an ECO situation).
Thanks, i was feeling more than a little lonely,lol! this discussion has been done here before...WHAT is the legal reason for calling police on someone who leaves with IV access.....theft of property? can't be reused.....i think some are confusing ethics with the law.....and heaven knows they are NOT one and the same! Even telling the police a person was in the ED would seem to come too close to a HIPAA violation to me...unless they had a warrant..
Agreed, if they walk out they are essentially, refusing treatment.
They have the right to do it. The only other thing that I could think of is that "a risk to themselves or others" argument could be made with an IV that is in, but not attached.
I wondered if this guy was a drug user and couldn't get a line on his own veins and that is why he came into the ER in the first place...that was my first thought.
Agreed, if they walk out they are essentially, refusing treatment.
They have the right to do it. The only other thing that I could think of is that "a risk to themselves or others" argument could be made with an IV that is in, but not attached.
I wondered if this guy was a drug user and couldn't get a line on his own veins and that is why he came into the ER in the first place...that was my first thought.
It's hard for me to understand how involving police in a "dangerous to self or others" situation violates HIPAA.
If you can be sued for NOT taking action to prevent a patient harming himself, you should be able to call police without regard for HIPAA. Right?
yes, stealing a used IV is stealing, regardless that it couldn't be reused. It belongs to the hospital and it stealing. We al know why as well. People who aren't addicts refuse to leave with the IV in and beg us to take them out.
In the ER where I work, if a patient leaves with a hep lock and DOES NOT have narcotics on board, we DO NOT call police. Our administrators have said this is a HIPPA violation. Will have to find out about someone leaving after narcotic administration.
In the ER where I work, if a patient leaves with a hep lock and DOES NOT have narcotics on board, we DO NOT call police. Our administrators have said this is a HIPPA violation. Will have to find out about someone leaving after narcotic administration.
The fact that someone IS or WAS a pt is NOT a HIPPA violation as that fact is not protected by HIPPA. The circumstances surrounding their care, diagnosis, etc is. However, it does not violate HIPPA if someone calls and asks if Mrs. Smith is a pt and you answer, "yes." Just like when we busted a pt stealing a bunch of needles and syringes, we had him escorted out in handcuffs. Just because you are a pt doesn't make stealing ok. You still have to be held accountable for obeying the law.
This is a tough call. As for leaving with an IV, we normally notify police but I cannot say with certainty that this is sound policy. I don't agree that it is "stealing" hospital property, but it may be a public safety concern. I don't think that the Fed will prosecute under HIPAA for this. I think that if you called the police to let them know they no longer need to look for the individual then that would be acceptable. I do not think that it would be acceptable if you called police to let them know a person with an outstanding warrant was in your emergency room so they can come arrest him, unless there is some law or policy compelling you to do so.
:confused:
HikingNinja, BSN, MSN, DNP, RN, APRN, NP
612 Posts
I work in a pretty busy ER in a metro area. This happens all the time. We just make sure we document something like "patient and family instructed to alert RN if leaving facility for removal of heplock.....stated understanding." Then if we go to check on them and they've left we will call security to take a quick look. If they haven't come back in a half hour or so we AMA them. I don't think we've ever called Metro about this. It would be really low on their priority list, they would most likely chuckle at us if we called them. I've had heroin drug users walk out with IV in. We just use the above documentation and make sure we document very well on mental status. If someone is altered and getting IV we usually do a medical restraint or keep them in eyeshot. Most of our drug users who come in are regulars, we will do all testing first, and only if they have a real health concern do we then give pain medication. Medicated patients must have ride home, taxi is ok. If no ride or money for taxi they get bus voucher.
D