dischargin psych pts question

[sassyann85]

The answer to this is probably pretty obvious. However, I guess I feel a 'maternal' role/responsibility with these patients, which is why I bring up the following. So if a patient is on a voluntary committment and is getting discharged, if they do not have a ride home or to the shelter or whatever follow-up program they are going to, we offer them bus tickets or a cab slip. The Dr writes a discharge order and then staff will walk them off the unit and down to to security to get whatever belongings that are stored there from when they were admitted. After that, we will take them to the hospital exit and direct them to the bus stop, or call the cab for them. Now let's say as you are calling the cab, the patient takes off in the other direction, leaves their belongings, and isn't around to get the cab when it comes to the hospital. I guess this is their right, once they are discharged they can go and do what they want. But I just feel like, oh no-they missed their ride, how will they get where they are going? But I guess even if given bus tickets, we don't walk them to the bus stop and stay there to make sure they actually get on the bus. We don't ride with them to make sure they get off at the correct stop. We can't come home with them and make sure they take their meds. It's just so disheartening when you think a patient will do well, and then they take off to who knows where.

[elkpark]

What is your question?? I don't see a question in there.

[sassyann85]

oop,s you are right. I guess what I am asking is, in this case is there any type of follow-up that should occur? Obviously if a patient elopes while inpatient, there is a process that occurs. But, once they are technically discharged, even if staff see them take off, there really isnt anything we could do, correct? (assuming they were a voluntary admission)

[MrChicagoRN, RN]

They have been discharged, so what purpose would that have to go after them except possibly convincing them to come get their stuff.

Does this happen a lot. If they're running away without even getting their stuff, one wonders about their DC planning and readiness.

Our patients go back to NH via ambulance, otherwise via medicar or public transportation.

I'd say get an idea of their ST compliance before they leave, try to figure out why your patients are doing this, then if they run; incident report and notify the doctor.

[Meriwhen, ASN, BSN, MSN, RN]

Once the patient is discharged, all we have to do is get them out the door...and then our responsibility ends. We are not obligated to transport them home or anywhere else, though we prefer to discharge the patient to a family/friend who give them a ride, we will also often provide a pass for the public transportation if they need it. But do we put them in the friend's car or watch them get on the bus? No. So if after we walk out of the facility, a discharged patient decided to do a runner and leave their belongings behind on the curb...well, that's on them. They were determined competent enough to be discharged and are free to make their own choices, no matter how foolish. You have to accept that they are no longer your responsibility.

And to be honest, once I have walked them out the door, I no longer care about what happens to them. That's not meant to sound heartless...but the reality is that I have to redirect my focus back on those who still are my patients and with whom I still have a nurse-patient relationship with. While I wish every single one of my patients well, I'm not their mom nor will I assume that role. They have to live their lives and deal with the consequences of their actions.

[Gooselady, BSN, RN]

We discharged an actively hallucinating young man because his public defender did an excellent job. He was sort of catatonic as well, and mute. He was found on the street without ID, and the only thing in his favor was that he was a frequent flyer in the ER, so we 'knew' him.

We called a cab to take him to a shelter with a reserved bed and stood with him in front of the hospital until the cab came, which he refused to get in. He stood there for a long time after the staff had to return to their job. Finally, two guys from the ER went out and bodily carried him back to the ER where we started all over again. His discharge lasted a couple of hours, maybe.

Of course there's that reaction of concern, but literally, there's nothing you could do or even SHOULD do. Out of pure self-preservation? Detach, let go. We go into nursing with the ideal of saving people. What 'saving' them actually means in real life is a whole 'nother thing than that old ideal.

[elkpark]

Document your observations. That's all you can really do.

[GeneralJinjur]

I would document it in my discharge note. I can worry about them, but it doesn't help the patient one speck. Recording their behavior as they leave my care can help the next treatment team address this.

[Mandychelle79, ASN, RN]

When we d/c someone we require their ride to come to the unit to pick them up. If they have their car on property we send them out the door. Taxi, picks up at unit, and by bus a staff member walks over with them and makes sure they get on the bus.