Management of violent Patient's in ED ?

  1. Hi everyone!
    I have a generalized question on how you manage violent patients in an emergency dept that does not have its own seperate psychiatric ED.
    I am wondering about :
    meds
    use of restraints
    1:1's
    Also any involvement from local police depts?
    Such as:, handcuffing pts , use of a tazer gun (spelling?) for violent outburts etc
    Thank you so much.
  2. Visit fawnsternurse profile page

    About fawnsternurse

    Joined: Jun '03; Posts: 227; Likes: 53
    R.N.; from GA , US
    Specialty: 24 year(s) of experience in psych, medical, drug rehab

    16 Comments

  3. by   Katnip
    When I worked ER a few years ago and before the psych unit opened, the police would often bring the patient in in handcuffs, but our security would then take charge of 4-point restraints.

    Anyone in restraints had a 1:1 and documented every 15 minutes. The nurse was responsible for checking every half hour if things were normal, and signing off the check sheet for his/her own checks.

    I have never seen anyone tazed in the ER. They would come in after tazing once in a while, but once they got to us, they'd be in 4-points and medicated immediately.
  4. by   fawnsternurse
    Hi
    Thanks for responding.
    I guess I am wondering if violent patients are managed in the ED by handcuffing them to beds while waiting for a psych opening? Or tazing them while in ED or even on medical units in hospitals?
    I am asking because it has been brought to my attention that this is common practice in some areas of the country and I am wondering how common.
  5. by   BrnEyedGirl
    Our security carries tasers as well as a gun. We use 4 point restraints and yes I have seen the taser used in the ER,..more than once, but it wasn't on a "psych" pt, just a couple of mean drunks!
  6. by   Pixie.RN
    We manage violent patients with assistance from security, as well as law enforcement. We had a patient brought in by sheriff's deputies, and he was nice as pie -- I think his complaint was drug abuse. Once the officers left, he took off his "nice" mask and started to tear up our psych room -- there is only a stretcher in there, but he managed to cut his foot on the stretcher, put a huge hole in the wall, and bleed all over the place. We can lock the psych room from the outside, and we did, while calling the police. I have never seen police cars slide sideways into our parking lot before. They came in with tasers, and suddenly the pt. was docile again -- he laid on the floor and said, "Don't tase me! Don't tase me!" (I guess he'd been tased before? ) After our doc sutured his foot, that patient went off to jail. We weren't about to go in and try to put him in restraints, or anything like that -- he was a huge guy. We put our safety first and locked that room door.

    If a patient is in handcuffs in our ED, they are under the watch of law enforcement, and that is their business. We rarely have to use 4-point restraints, thank goodness, but we have a time or two, and we follow policy protocol closely in those cases as far as monitory and assessment. Most of our security guys are great, but a couple ... I think I could take 'em. Seriously. Thankfully law enforcement is quick to respond to us. (Probably because we feed them Sunday brunch every other week. LOL)

    And yes, chemical restraints from time to time -- some docs love the Haldol/Ativan cocktail, other choose Geodon. (My complaint with Geodon -- it takes a minute or two to reconstitute! What a pain. It's not really ever a med you don't need quickly, you know??)
  7. by   morte
    Quote from LunahRN
    We manage violent patients with assistance from security, as well as law enforcement. We had a patient brought in by sheriff's deputies, and he was nice as pie -- I think his complaint was drug abuse. Once the officers left, he took off his "nice" mask and started to tear up our psych room -- there is only a stretcher in there, but he managed to cut his foot on the stretcher, put a huge hole in the wall, and bleed all over the place. We can lock the psych room from the outside, and we did, while calling the police. I have never seen police cars slide sideways into our parking lot before. They came in with tasers, and suddenly the pt. was docile again -- he laid on the floor and said, "Don't tase me! Don't tase me!" (I guess he'd been tased before? ) After our doc sutured his foot, that patient went off to jail. We weren't about to go in and try to put him in restraints, or anything like that -- he was a huge guy. We put our safety first and locked that room door.

    If a patient is in handcuffs in our ED, they are under the watch of law enforcement, and that is their business. We rarely have to use 4-point restraints, thank goodness, but we have a time or two, and we follow policy protocol closely in those cases as far as monitory and assessment. Most of our security guys are great, but a couple ... I think I could take 'em. Seriously. Thankfully law enforcement is quick to respond to us. (Probably because we feed them Sunday brunch every other week. LOL)

    And yes, chemical restraints from time to time -- some docs love the Haldol/Ativan cocktail, other choose Geodon. (My complaint with Geodon -- it takes a minute or two to reconstitute! What a pain. It's not really ever a med you don't need quickly, you know??)
    lol, all 4'10" of you? but the red hair counts for something......lol
  8. by   Pixie.RN
    Quote from morte
    lol, all 4'10" of you? but the red hair counts for something......lol
    Hey, I'm 4'11", not 4'10"! That extra inch does it every time. I'm a scrapper!
  9. by   morte
    Quote from LunahRN
    Hey, I'm 4'11", not 4'10"! That extra inch does it every time. I'm a scrapper!
    lolololololololol.......yup
  10. by   matthewjdouma
    I'm in the process of writing an interdisciplinary guideline for managing violent / aggressive patients in our Trauma Center. If anyone has any SOP / policies / guidelines that can be emailed to me, please PM me for my email address. Also if anyone can share any helpful tips that would be great too. Thank you colleagues.

    Matt
  11. by   JStyles1
    seclusion room with nothing in it other than a mat to lay on
    changed out of street clothes and into a hospital gown if they are suicidal
    no IVs
    IM geodon or versed for sedation
  12. by   nuangel1
    we manage the psych/etoh pts .the only time they are cuffed is if pt is in police custody and the cops are there.but when cops bring in the drunks they just drop em off in er and the the cops leave.pts brought in for psych we restrain and sedate as needed.if the pt is 4 pointed in leathers then there is a 1 to 1 sitter and we chart as nurse q 15 min .we only have security on days .we call a code grey if we in the er need more help .rarely we call police help .
  13. by   mwboswell
    Quote from matthewjdouma
    I'm in the process of writing an interdisciplinary guideline for managing violent / aggressive patients in our Trauma Center. If anyone has any SOP / policies / guidelines that can be emailed to me, please PM me for my email address. Also if anyone can share any helpful tips that would be great too. Thank you colleagues.

    Matt
    Matt,
    Having "been there, done that" as far as the P &P goes, I'm gonna tell you when it comes to this topic, the BEST place for you to start for guidelines (and probably in this order) is:

    1) your state BON (look for scope of practice, patient safety, environment of care stuff)
    2) you ENA (they have several position papers and recommendations on this - and they are respected as a leading organization that defines "standard of care" in some circles)
    3) local law enforcement; you need to know the local/municipality laws/codes regarding restraint and seclusion as well as less-than-deadly use of force
    4) a good local attorney (not hospital attorney) - some law firms specialize in medical liability (which is what your P&P is trying to limit) and some will do pro bono lectures, educational inservices and the like regarding restraint/seclusion

    I would do all these BEFORE looking outside of your county/state because guidelines/legal codes may differ.

    Daunting task for sure, but good luck!
  14. by   hherrn
    Taser good, pepper spray bad.

    hherrn

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