Last night we had a pt who said she had a ride home, received 100mg of demerol and then proceeded to leave after sitting in waiting room for a few minutes. I did not know at the time she went to her car and drove home. I was told after the fact. What would you do if you saw a pt you had given narcs to get in their car and drive home. BTW, this pt is a frequent flier, requested 150 of demerol and was not happy with script for vicodin 5's, wanted 7.5's.
If I had known I would have tried to stop her, but failing that I would have taken her license #, description of car and called the police to stop her and do whatever they could.
What would you do?
Edited to add the word "not", what a difference 1 word can make!!
Last edit by 2ndCareerRN on Apr 27, '02
Apr 28, '02
I would have done the same. I previously worked at an outpatient mental health facility. A similar question was asked of me during the interview for the position I had. Definately call the cops. I have done so as needed. The decision is easy - I ask myself - what if this person causes an accident that injures or kills themselves or others? I feel I'm liable not only as a health care provider, but as a human being as well. As far as confidentiality laws - well when the safety of others is a concern - forget confidentialty.
Apr 28, '02
I agree 100% with you Mary ! We in our dept have called the police with descriptions of the vehicle and stated the driver may be under the influence. I don't think the police arrest the person on that information alone, but they can at least follow the vehicle closely and if they do anything wrong like swerving or not coming to a complete stop, they will be able to pull them over for a sobriety test.
I would never give out the patients name to the police or what they had for drugs, because that may be crossing the line. But I feel we also have a responsibility to do what is necessary to keep people safe if it is within our power. Everyone in our department agrees with that.
May 1, '02
We actually have police in our ER and they watch the pts. If they don't seem right when gettinginto the car they are first cautioned to not drive, if they persist, the cops follow them and about 50-100 feet later pull them over. I have seen them do this numerous times and it is very effective, but of course, it helps to have the cops just waiting there to do that (as well as some other things).....
May 1, '02
I always write on the d/c instructions, NO driving for 24 hours.
May 1, '02
We had such an occasion, the pt ran into a bridge abutment and died!!!! I always write on the d/c instructions no driving, no activities which require concentration and no ETOH after narcs. Have also reported people to police.
May 1, '02
When I first began in ER, I had a woman with a "migraine." She got Demerol 100 & Phenergan 25 IM. Her husband was with her, and when I gave them the D/C instructions, wrote that I had cautioned her against driving, and that the husband SAID he would be driving her home. OTD they went.
About 10 mins. later, the radio squawked, and Paramedics from the station nearest the hsopital said that they would be bringing us 4 victims of a head-on MVA, a very short distance from the hospital. They further stated that one of the victims had just been tx at our ER. All heads swiveled and looked at me, the most junior nurse. I quickly got my chart, and showed the Doc and the others my documentation.
When the husband and Migraine woman came in, he said that when they got to the car, she hit him in the head and grabbed the car keys, insisting on driving home. He let her, and less than 2 blocks from the hospital, she got on the 4 lane, driving the wrong way, and bam! We suddenly had 4 victims. Fortunately, no one was seriously injured.
Ask me if I learned anything about thorough patient teaching and documentation that day! From then on, I even included the NAME of the person who said they were doing the driving!
May 1, '02
I agree with everyone here. CYA, good documentation is the key, and if you know they got in the drivers seat, turn them in, you may be saving someones life.
May 2, '02
from deep in the heart of texas
This is an event of major liability risk to all of us. Unfortunately our resources are limited in what we can do. All we can do primarily is document and CYA,the best we can. But if they get a 2 or 3 minute headstart even, then the possibilty of the police even catching them is remote, unless an incident occurs.
keep it in the short grass yalll
Apr 6, '03
I don't care how busy I am, my patients do not leave the treatment area if I am trying to observe them after medications. I have had too many bolt from the waiting room. I also do not discharge until their driver brings the car to the ER doors and I put the pt in the passenger seat. Of the few that got away from me, I have called the cops.
Apr 8, '03
Hello, everyone! We also do not allow the patient to be discharged from their treatment room until their ride is physically present. Then the usual documentation as to who is driving the patient home.
Apr 12, '03
I love our ER's discharge form. There is a spot for me to sign, for the patient, and for a designated driver if the pt has had narcs. The d/c form also has pre printed drug warnings so I can check the right ones. This hospital is very careful about it's liability, that is for sure. I not only don't have to let the pt leave the bed, I have the added coverage of having that person present and signing for them before they leave....usually before I take out the IV, BP cuff, etc. It is a good way to keep from triaging an MVA....
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