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.

[morte, LPN, LVN]

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.

only as a clerk, 30+ years ago, but civil rights are the same, floor or

ED

[morte, LPN, LVN]

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?

then this family wasn't dealing. they were ignoring.

[canoehead, BSN, RN]

We keep them until sober unless they have a sober adult willing to stay with them at home. Then if they can walk and talk, they can go. If there's no sober adult and they are walking, they get a choice to stay voluntarily, or we will call the police because of disorderly conduct, and they take them to the drunk tank.

[OldNurseNewRN]

Nothing. Since my original post, I've actually found out it is common practice for EMS to be called to pick up the "just drunks" because the local county facility doesn't want the liability of keeping them safe until they sober up. That night I was told by an officer they wouldn't arrest the pt because technically, the pt was doing nothing illegal before ending up in the ED. They were just drinking at home. It wasn't like the police brought the pt in. And they weren't going to support any efforts to keep the patient in the hospital against their will since they were brought to the ED and held against their will simply for drinking at home. I keep thinking about how I would feel if I had a couple of drinks at home, that effected me strongly for some reason (sluggish liver) and I ended up locked in a concrete room against my will. Doesn't seem right.

[Baloo]

Nothing. Since my original post, I've actually found out it is common practice for EMS to be called to pick up the "just drunks" because the local county facility doesn't want the liability of keeping them safe until they sober up. That night I was told by an officer they wouldn't arrest the pt because technically, the pt was doing nothing illegal before ending up in the ED. They were just drinking at home. It wasn't like the police brought the pt in. And they weren't going to support any efforts to keep the patient in the hospital against their will since they were brought to the ED and held against their will simply for drinking at home. I keep thinking about how I would feel if I had a couple of drinks at home, that effected me strongly for some reason (sluggish liver) and I ended up locked in a concrete room against my will. Doesn't seem right.

Agreed. It isn't right. It all starts with the person initiating the 9-1-1 call. If they aren't willing to assume care/responsibility for the patient, the cops don't want the liability, EMS doesn't want the liability, so the end of the line is the ER. it's all because 'what if', and no one wants that on their hands.

[Lev, MSN, RN, NP]

We also dont want to keep them for so long that they start withdrawing and we need to treat their withdrawal. Sometimes its a fine balance. I had a drunk guy who was sleeping it off and ended up being admitted because his HR was elevated. Which is why its important that they get a couple liters of fluid at the beginning. I think he had only gotten a liter of fluid (I inherited him from another nurse) and could have been on an ativan sliding scale instead of getting a couple one time ativan as he became agitated.

[Racer15, BSN, RN]

They are free to leave at my ER. From our door to the back of the cop car that is. Most opt to waste a bed and sober up when presented with those options.

[ProgressiveActivist, BSN, RN]

I have to admit that I have not worked ED in about ten years. There was a time when the police took people to jail for public drunkenness and people died in a holding cell from DKA, alcohol poisoning, aspiration or a head injury. I thought of holding drunks in the ED as part of the job for that reason.

[AZQuik]

I have to admit that I have not worked ED in about ten years. There was a time when the police took people to jail for public drunkenness and people died in a holding cell from DKA, alcohol poisoning, aspiration or a head injury. I thought of holding drunks in the ED as part of the job for that reason.

Yup. We have many regulars who have ended up tubed, in the ICU with dt, or after they arrived we found out there was spice/cocaine/heroin/bath salts involved and it was another adventure all together. ie: rhabdo, mci, acute liver failure. Or they hit their head the last time they fell and now have a bleed of some kind.

Dangerous to think its the regular drunk here to sleep it off. Can't get complacent with these people, and it's so easy to want to sometimes, especially when they are being real jerks!