Do you hold drunks against their will?

[OldNurseNewRN]

Something happened over the holidays that really bothered me. I work in an ER. A very intoxicated pt was brought in by EMS after passing out at home and having family member call 911. The pt was cleared medically. Nothing wrong but being drunk. This patient did not want to be at the ER and had initially refused transport from their home. This patient wasn't doing anything illegal; just drank too much at home. Once at the ED, the pt refused to stay in bed, so pt was placed in our psych room. Windowless room with no equipment in it, just a concrete block with a mattress secured to it so there is nothing a pt can hurt themselves with. When the pt refused to remain in the room and instead was walking around the unit, the mid-level provider seeing the pt ordered the door to the room shut and locked which is considered restraining the patient.

So, because this patient was minding their own business at home drinking during the holidays and ended up in the ED where they did not want to be, they basically were restrained. The pt was oriented to name, location, time, and situation and repeatedly voiced a desire to leave. Wouldn't have been driving as there was no car at the hospital. Was this false imprisonment or warranted for the pt's safety? Not my pt but I was nearby and heard everything.

[imintrouble, BSN, RN]

If the ED has to keep the drunk patient, what's to prevent every cop in town from bringing the drunks to the hospital, instead of to jail?

[BecomingNursey]

Nope. If the patient is drunk, I don't care if they are A&O. They're staying until they sleep it off with or without restraints. That's their choice. If they walk out that door and something happens, that's my nursing license. They are allowed to leave if a responsible party comes to pick them up and claims responsibility for the patient. Otherwise, they're getting a banana bag, a blanket, lights off and a nap.

[ED Nurse, RN]

If the ED has to keep the drunk patient, what's to prevent every cop in town from bringing the drunks to the hospital, instead of to jail?

And they do bring them to us, quite frequently.

Of course seclusion has a camera- what's the point if you don't have a camera to watch them?

[Nonyvole, BSN, RN]

If the ED has to keep the drunk patient, what's to prevent every cop in town from bringing the drunks to the hospital, instead of to jail?

Absolutely nothing at all.

Personally, if they are steady on their feet, I'm all for letting them leave. But I see a lot of chronic drunks; we don't want them to be perfectly sober because then they're risking DTs.

[morte, LPN, LVN]

Nope. If the patient is drunk, I don't care if they are A&O. They're staying until they sleep it off with or without restraints. That's their choice. If they walk out that door and something happens, that's my nursing license. They are allowed to leave if tra responsible party comes to pick them up and claims responsibility for the patient. Otherwise, they're getting a banana bag, a blanket, lights off and a nap.

this points to the fact that this particular one should have been left at home. and who on the squad is sufficiently trained to determine that this patient, in their own home, is impaired enough to basically kidnap and take to the ED?

[morte, LPN, LVN]

If the ED has to keep the drunk patient, what's to prevent every cop in town from bringing the drunks to the hospital, instead of to jail?

nothing.

[ProgressiveActivist, BSN, RN]

Absolutely nothing at all.

Personally, if they are steady on their feet, I'm all for letting them leave. But I see a lot of chronic drunks; we don't want them to

be perfectly sober because then they're risking DTs.

thank you

[ED Nurse, RN]

this points to the fact that this particular one should have been left at home. and who on the squad is sufficiently trained to determine that this patient, in their own home, is impaired enough to basically kidnap and take to the ED?

In my ED, EMS calls medical command and speaks with one of our MDs if they think the pt is impaired. The md will also speak with that pt and decide if they need to be brought in- it's not kidnapping- I take it you've never worked in an ED.

[mago8388]

I'd keep him until sober and explain this very clearly to them. It's for their safety and really, you never know what can happen or what other health issue might arise and it's all on the Healthcare staff who discharges him if something goes wrong after.

[AZQuik]

If the ED has to keep the drunk patient, what's to prevent every cop in town from bringing the drunks to the hospital, instead of to jail?

Nothing. We get them all the time. Mtf or metabolize to freedom.

[AZQuik]

Absolutely nothing at all.

Personally, if they are steady on their feet, I'm all for letting them leave. But I see a lot of chronic drunks; we don't want them to be perfectly sober because then they're risking DTs.

Yeah. We try to shoot for their "sober" or baseline. Usually around a etoh level of 100. Then po challenge, road test, and let them go to medicate their own dt's. When we overshoot that mark they frequently go to the ICU.

[Baloo]

but you do know what assume does, yes? i think the family was being twits. if he could answer the crews questions, that should have been the end of it. family needs to deal.

Generally, yes (about assuming), and I agree. But it's a standard of care for prehospital providers (EMS) to not take refusals from certain demographics.

I'm not disagreeing that it's not ideal, but once again it comes down to liability. It sounds like the family wasn't willing to take responsibility for the patient's condition. Maybe the patient is a RAGING drunk and the family wanted to cut it off before it got to a more dangerous point.

I also work in EMS, and am put in this sticky situation more than I'd like. But it is what it is. I've also responded to plenty of 'possible DOA' calls because friends/family wanted to let the person 'sleep it off' at home. Are THOSE families being twits and dealing? The ones who are crying because they found their loved one blue with rigor mortis and a mouth full of vomit?

ETOH and refusals (or just refusals in general) are probably the most frustrating part of EMS....but if someone is concerned enough to actually dial 9-1-1 for it, then the patient in question should probably be evaluated, as a precaution.