It always amazes me the stories & experience we get each day. Here's another. How would you handle it?...
A gentleman has been in the ICU for *only* a week after suffering a cardiac arrest at home, in which he was resuscitated by EMS and had no neuro sequalae as determined by an MRI. Skipping to the chase, he is developing ICU delirium (in my opinion), becoming more agitated with his stay and noticeably irritated whenever family arrives. He is sassy and mean to his wife, and he is mocking the care he has received. He eventually pulls out his PICC line, demands to leave AMA, and says the doctor is allowing him to go outside for 2-puffs of a cigar. He now gets a Sitter. He does have psychiatric disorders, and a psychiatric consult is ordered, of which he refuses the evaluation. After getting downgraded from the ICU to his new room, he refuses it, complaining of small details.
After a short stalemate, the supervisor brings him back into the ICU room, where he was demanding to go back. Now the fun begins: the ICU doctor says the man was downgraded, and there was no medical reason to bring him back in and that it was wrong to do this. The patient is not under ICU service any more and he is someone else's problem .. the Hospitalist. The Hospitalist doctor arrives and says he cannot offer the man anything we have not already done. The 2 doctors discuss options and both state that the man has no choice and can be physically removed by Security and restrained if need be.
Now, I may not know much, but I'm pretty certain if that route were taken, you would be learning about this on CNN and not thru Allnurses.com; eventually the Supervisor finds an "acceptable" option of another room, and the patient even mocks this, but is willing to go while continuing to say he has called a Taxi and he knows what we cannot do: detain him. The ICU doctor states the man is not under psychiatric certification, but that he is medically delirious and cannot be allowed to leave because he lacks capacity, and that he will continue to attempt to manipulate us into believing he is okay.
Now, again, I may not know much, but after caring for the patient for 4 days and watching him progress, etc, I'm pretty certain the patient was not mentally incompetent and, although I do not impress upon AMA, in this particular instance ... let him .. we've done what we can in a week, he's stronger, and maybe all this poor behavior/ attitude/ decisions is simply HIM.
Nurse SMS, MSN, RN
6,843 Posts
Sounds like a case for the ethics committee to determine proper course of action.