Involuntary Admissions in Inpatient unit

[Cookchow]

Hi, all!! I an Assistant Nurse Manager who works in a Baker Act (state of Florida's term for involuntary admissions) aggregate unit in a PCU level medical floor in Florida Hospital - Orlando. I am just wondering if there's anyone out there who works in a unit or hospital similar to mine.

These patients are the ones who are involuntarily admitted to be treated i.e Tylenol overdose but are not medically cleared yet to go to an inpatient psychiatric unit. These specific patients are targeted and admitted to my floor (PCU medical) in the meantime.

Any Baker Acts to be admitted from the ED are targeted to come to my unit (not unless they are ICU bound). They go to any medical floor if we don't have the bed available. Once we start having discharges, we start doing the lateral move to transfer them to my floor.

Our hospital made the decision to pool all Baker Acts in the same unit to streamline responses from security (directly come to a unit or location as opposed to running around from one end of the hospital to the other) response granted our patients starts acting out. Also, the plan of care is more followed through since the charge nurse participates in daily conference calls with the medical physician, psychiatric physician and the intake personnel (who are assigned to find psychiatric placement in the community) thereby decreasing LOS. All our nurses (we are not primarily psych nurses) in our unit undergo training in terms of how to handle patients who are starting to escalate, how to talk, how to listen...

Anybody?

Thanks!

[Been there,done that, ASN, RN]

No specific experience in a unit like that. I am wondering what the staffing ratio is.

Are the nurses trained to never turn their backs on these patients?

[Cookchow]

our ratio is typically 1:4, some might go to 5. taking in to consideration that some of our patients have higher acuity PCU or medical... we never brought something specific up in terms of turning their backs... each patient has a psychiatric tech/sitter with him at all times. the sitters call the nurse if the patient starts getting anxious, starts hearing voices... etc. the patients are never left alone...

[Been there,done that, ASN, RN]

Seems like a satisfactory ratio. What is the difference between a tech and a sitter?

Even with another person in the room , for the nurse's safety, they must never turn their backs.

Has the staff received CPI training?

[Jules A, MSN]

Interesting but also odd. There is a medical unit at a state hospital that seems to operate similar to what you describe and the nurses are trained in psych as well as med surg. I have worked a a few major medical centers in my time but never did we have enough medical floor patients in need of certification to staff an entire unit. They are just kept on whatever medical unit they require.

I'm wondering if your cert regs are different than ours? Ours are pretty narrow and in my experience we usually don't certify our patient while they are on medicine unless they decide they are leaving AMA and meet involuntary criteria. Even intentional ODs in ICU or tele are given the option to sign in voluntarily to the locked unit after they are medically stabilized so while they often have a sitter for suicide risk while on the medical floors they aren't usually a huge security type aggressive problem. It seems delirium is more of a behavioral problem on medical floors and despite how much they want it to be a psych problem and have me admit their patients to the locked unit it isn't.

Might it be easier to add an additional locked psychiatric unit for medical patients if you have so many? It would cut down on the need for 1:1s for all patients. Also since you are basically operating as a locked psych unit, without the luxury of locks, I would have staff trained in psychiatry to make sure the patients are kept safe and there aren't rights violations to patients who are certified.

[blondy2061h, MSN, RN]

My current hospital doesn't have an ED, so we don't get this type of patient at all. Another hospital on this area had a locked med/psych unit, which has psychiatric patients that would require psychiatric inpatient treatment regardless and a med/surg admission level of treatment regardless. They had far better ratios than normal med surg or normal psych, they had the locked unit and special restraining priveleges of normal psych, plus tighter access to psychiatry/psychology and therapy. Worked out pretty well from what I heard.

[MunoRN, RN]

I've never known anything different than what you describe since I've never known of an inpatient psych unit that accepts patients that have not been medically cleared. So if they are a patient who is both a psych hold and requiring hospital care for medical reasons, they are always treated for their medical needs first prior to being admitted to a psych unit.