Discharging intoxicated patients

[Freedom42]

I'm curious: What's the policy for discharging intoxicated patients in your ED? Is there a maximum BAC or Breathalyzer level? I'm concerned about patient safety and nurse liability. At what point does your policy dictate that it's safe to let someone go?

[nuangel1, BSN, RN]

per our policy we can d/c a pt when he/she is less then .100 either by breathalyzer or bal.we will also d/c a pt who is still intoxicated >.100 who is alert and amb as long as the person picking the pt up is willing to take responsibilty for pt and signs for the pt .the decision is made by attending ed physician.

[MassED, BSN, RN]

we routinely don't do breathalyzers - usually metabolize to freedom (which is when you can walk straight, talk, and eat, you're out the door). If you have a breathalyzer, you're (the doc) obligated to metabolize them however much per hour (10 point drop, or something along those lines). Which would mean a much greater stay for most of our intoxicated patients, who may be baseline intoxicated to some degree and if you detox them, then you're going to have problems....

[casper1]

Many of our intoxicated patients are MHA. They are not allowed to leave. They want to leave to avoid a trip to police station. You turn your back on them for one second and they are out the door.

[MassED, BSN, RN]

Many of our intoxicated patients are MHA. They are not allowed to leave. They want to leave to avoid a trip to police station. You turn your back on them for one second and they are out the door.

MHA??? Multiple health issues? Mental health ass? Haa!

[KSRN2b]

I also wondered what MHA stands for.

[Larry77, RN]

Case by case for us...if you are a homeless drunk and can walk straight usually you are allowed to still be a homeless drunk...otherwise we usually wait for a ride or admit occasionally for detox. Often times we have D/C orders on the chart and when they wake up asking to "get the hell out of here" we let them :-)

[nghtfltguy, BSN, RN]

it all depends on why they are in your ER to begin with...

everyone has different levels that their BAC could be.. you could get a chronic alcoholic that is "functional" at .30

its up to your facilities policies and the doc, and of course why they are there..

and of course wheather or not they have a responsible adult to take them home and watch after them.. if they are there because they tripped on something and hurt their ankle is quite different than if they drank so much they are having a hard time maintaining their airway.. in most cases you can discharge a drunk patient as long as they are in no immediate harm to themselves or others and they have a responsible adult "not drunk" to take them home and keep an eye on them~

[rjflyn, ASN, RN]

Everyone has pretty much covered it, 1) if they can get a sober ride and they are clinically safe i.e. maintaining their airway they can go at about anytime. 2) otherwise generally we don't let them go until we have calculated them to be sober less that 0.10. With the exception of a few of our regular chronic alcoholics who would probably seize if they get that low. Those few generally get kept around until they can walk and talk and request food and then they are let go, often depends on what time of the day they arrived. We have had to admit a couple of the chronic one a few times as they have drank themselves to renal failure.