Policy on pain medications and patients leaving the floor?

[Billy_Ruben]

What is the policy regarding this where you work?

We have a patient that is a regular. When she is with us she always signs "the form" that allows her to leave the floor. She's a smoker. It's never been an issue as long as she signs the form.

Recently, she was with us again and I was told not to let her leave within an hour of pain medication administration. This supposedly came form the nurse manager, but I can't be sure as I work nights. The following morning the DON for our unit was in and asked me how the patient had done the previous night. I explained and she asked if the patient had been leaving the floor. I reiterated what had been explained to me and the DON said no leaving the floor period.

Honestly, I hadn't had time to read the form closely the previous night and didn't stay over to look at it before I left. I plan to look at it when I go back to work.

It seems a bit off to not allow a patient off the floor period.

Curious as to others policies.

[imintrouble, BSN, RN]

About 90% of our docs do not allow pts to leave the floor. Period.

It has nothing to do with pain meds. None of the MDs have shared their reasoning with me, but I suspect it's along the lines of "If you're sick enough......

We have a few frequent visitors, who are known smokers, who know their MDs well enough to wheedle the consent out of them.

[Altra, BSN, RN]

It's not unusual at my hospital for there to be an order that the patient may not leave the unit.

[MunoRN, RN]

It's not unusual for patients to have MD orders that say a patient cant' leave the unit or to have policies about patient's leaving the unit, but I would strongly caution Nurses that this doesn't give us the authority to keep them there. I've only known of one Nurse who has had their license taken away, and it was because they enforced an MD order despite the patient's own wishes. Unless the patient is on a legal hold or has had decision making abilities taken away, they can leave the unit whenever they want, they only legal option is to discharge the patient.

[SnowboardRN]

Hmm, we have to have an order if the patient CAN leave the floor. We never let them leave because we are responsible for their health. There have been two instances that I can think of that I've gotten orders for a patient to leave the floor. One was because her daughter was in a car crash and was in our ER. Another time a patient was going to be discharged later that day, and wanted to go to the gift shop. Both times a PCA went with them.

We also don't allow smoking at all. All smokers get a nicotine patch.

(also just wanted to add I've never had someone demand to leave, and if they did I would just give them AMA papers I guess? I wouldn't stand there and MAKE them unless they were on a 72 hr hold)

[DalekRN]

I can't imagine not allowing patients to come and go as they wanted. They aren't in jail! When our pts go out to smoke they sign AMA papers because we advise against smoking, and they can never take their babies off the unit, but these are consenting adults.

[SnowboardRN]

I can't imagine not allowing patients to come and go as they wanted. They aren't in jail! When our pts go out to smoke they sign AMA papers because we advise against smoking and they can never take their babies off the unit, but these are consenting adults.[/quote']

I should have mentioned our patients are on telemetry monitors which require monitoring at all times. Also, our facility is completely smoke free including the parking lot so there is no where that they would be able to step outside for a smoke.