ER policy/unresponsive pts

[gonzo1, ASN, RN]

What is your ERs policy on unresponsive patients. In the last 3 weeks we have had female patients being brought in unresponsive from local bars and a couple of times the people who came with them and stayed with them turned out to not be friends or family after patient was lucky enough to respond to treatment and recover. In the meantime we are giving them updates on patient and letting them sit with patient (if they are sober and behaving). So far we didn't even think to call police when amb brings patient in, but now I'm thinking we need to call police when patient comes in. Maybe they could do something to verify people with patient actually have a right to be with patient or at least start to keep track of how many times this is happening.

Thanks in advance for your help with this matter. My ER needs to develop some quidelines and we don't have a clue.

[Altra, BSN, RN]

What is your ERs policy on unresponsive patients. In the last 3 weeks we have had female patients being brought in unresponsive from local bars and a couple of times the people who came with them and stayed with them turned out to not be friends or family after patient was lucky enough to respond to treatment and recover. In the meantime we are giving them updates on patient and letting them sit with patient (if they are sober and behaving). So far we didn't even think to call police when amb brings patient in, but now I'm thinking we need to call police when patient comes in. Maybe they could do something to verify people with patient actually have a right to be with patient or at least start to keep track of how many times this is happening.

Thanks in advance for your help with this matter. My ER needs to develop some quidelines and we don't have a clue.

I understand what you're saying, but I'm not sure how you can limit "friends" at bedside. Some patients truly don't have any family anywhere in the area.

If you think about it, no one has a "right" to be with a patient. Ideally patients decide who their visitors will be, but when they are unable to do so, visitors are allowed according to the facility's practice.

In my experience with intoxicated patients brought into the ER ... if the accompanying "friends" are those he/she just met tonight while drinking, they're usually gone within the hour. If they're unruly or interfere with patient care in any way, they're escorted out immediately.

[gonzo1, ASN, RN]

I quess I need to clarify what happened. Pt is unresponsive therefore can not tell us who her friends or family is. A couple of days later when she became responsive she told staff that she didn't know the person claiming to be her boyfriend, so we let a stranger sit with her for I don't know how long. We are wondering if perhaps he gave her date/rape drug and was waiting to find out what was going to happen to her. We have had more than a few instances where people that come in by amb have people with them that are not who they say they are and we don't find out that until much later. Want to know how to avoid this happening. Not too long ago a pt came in and the two guys with her said they were her brothers. She died and we told them and when real family showed up they said that the two guys were just someone she "sort of knew".

[brianaerrn]

I work weekend nights in the ER closest to the University here, so I frequently deal with this situation. Our policy is not to let visitors back with patient unless they are immediate family (mother, father, sibling, etc) if the pt comes in extremely intoxicated/unresponsive. Several reasons- the pt is not in any shape to say who can/can't visit and may not want friends to see them in this state, friends are frequently also intoxicated and tend to create more of a disturbance, etc etc...

[Altra, BSN, RN]

I totally understand where you're coming from.

I'm aware of a situation where the cousin of a GSW was at bedside ... he was truly his cousin, but he was also the shooter.

I'm just trying to think through how guidelines can be developed, and this gets sticky. No patient who cannot identify visitors can have visitors? Unworkable -- this would also exclude the family of grandma who has a head bleed. Only blood relatives can visit? Also unworkable -- how are you going to determine who is actually related & who isn't?

Do you have a social worker? At my facility, the SWs have some additional resources to try to trace family members. At times, we've contacted the employer of a patient who had some kind of employee ID with them in an effort to see if they will provide us with any info they have on the patient's designated next of kin or emergency contact. Sometimes it works, sometimes it doesn't.

We serve an urban/homeless/indigent population. There's just no way we could ever come up with a uniform plan to limit visitors when sometimes all the patient has is the "friend" who also has no ID, no address, etc.

Food for thought - let us know what your facility comes up with.

[Altra, BSN, RN]

I work weekend nights in the ER closest to the University here, so I frequently deal with this situation. Our policy is not to let visitors back with patient unless they are immediate family (mother, father, sibling, etc) if the pt comes in extremely intoxicated/unresponsive. Several reasons- the pt is not in any shape to say who can/can't visit and may not want friends to see them in this state, friends are frequently also intoxicated and tend to create more of a disturbance, etc etc...

I'm curious -- how do you determine that Jane Smith really is Sarah Brown's mother?

[gonzo1, ASN, RN]

All valuable questions MLOS. Perhaps there isn't an answer to this problem. Looking forward to what everyone else here on allnurses has to say. We too have a large homeless, indigent population, and want to treat everyone with respect and dignity.

[pkapple]

We have the advantage, being very rural, to usually know who is who. We allow a friend or whomever to sit with unresponsive as long as there is no disruptive behavior, even if we are unaware of the identity. we have a lot of vacationers and sometimes the "guest" is our only chance to contact family.

Just to really confuse everything...I guess the only way to prove Jane Smith is the mother of Sarah Brown...You'd need to prove Sarah is really Sarah and then her birth cert. and marriage certificate/divorce papers also Jane'sproof positive ID, divorce and remarriage papers and a good attorney to verify they are all certified and correct!!!!

Maybe just wait for the DNA test on maternal line????

[Altra, BSN, RN]

Just to really confuse everything...I guess the only way to prove Jane Smith is the mother of Sarah Brown...You'd need to prove Sarah is really Sarah and then her birth cert. and marriage certificate/divorce papers also Jane'sproof positive ID, divorce and remarriage papers and a good attorney to verify they are all certified and correct!!!!

Maybe just wait for the DNA test on maternal line????

:rotfl: Don't go there!!!!

[BabyRN2Be]

:rotfl: Don't go there!!!!

I was thinking that, too. Instant DNA tests for whomever accompanies pt to the ED. :rollYou know, the ones that the mother of the baby asks to show whoever is accompanying her is that he is the father! Always done as soon as the baby goes to the nursery. (just kidding)

[TazziRN, RN]

If the person is not a relative we ask if s/he knows how to reach family. In either case, s/he would not be allowed to sit at the bedside and the only information given would be along the lines of "Yes, she'll be okay" or "She's not doing too well right now." That does not cross HIPAA lines.

[Altra, BSN, RN]

If the person is not a relative we ask if s/he knows how to reach family. In either case, s/he would not be allowed to sit at the bedside and the only information given would be along the lines of "Yes, she'll be okay" or "She's not doing too well right now." That does not cross HIPAA lines.

TazziRN, do you mean that only family members are allowed at the bedside of patients in your ER?