How would you have handled this pt?

jmgrn65, RN · May 26, 2006

if she is alert and oriented you can only tell her that she can't go off the floor due to policy or whatever but if you call security they cant' do anything to keep on the unit unless she is mentally imcompetent or suicidal. Otherwise you would be violating her rights. For your own butt, you will need to chart that you had explained to the patient to not leave floor and she understood but left anyway. Legally that is the only thing you can do.

I just saw that your are in the Phillipines, so I don't know how much of what I said will apply.

hrtprncss · May 26, 2006

If this patient wants to smoke, then refer her to her own attending so that her attending can talk to this patient. Either to convince the patient of not smoking while in the hospital, or give the patient permission to smoke at regular intervals. This will lessen burden on you and your senior nurse, unless the attending makes you go with the patient outside.

wonderbee, BSN, RN · May 26, 2006

It is not safe to let the pt. leave the floor unsupervised, particularly for you and your license and it is your responsibility to let her know that her request is against hospital policy and you cannot approve. No, you cannot hold her against her will if she becomes insistent unless the pt. is on a psych hold. The charge needs to be informed of the situation and interventions should be documented. The attending should be informed as well. Some docs might threaten to sign off the case for noncompliance. If staffing permits, (ha ha what a laugh), an order might be written by the doc to allow assistive personnel to take the pt. off the floor.

I'm new too but have seen a similar scenario with a truly nasty pt. when I worked as a tech on a tele floor. We had to let the pt. go despite all nursing attempts to keep him on the floor but we did try everything. Lord knows it would have made my job a lot easier to see him AMA himself out altogether. The minute he was the least bit stable, he got booted out.

benette · May 26, 2006

I am from the Philippines, but I practice in the east coast :) It was questionable what the pt wanted to do off the unit. We suspect that she's a druggie (I guess I left that pertinent info abt the pt), but there is no history nor could we prove that she was. We searched her belongings right after someone claimed they smelled her smoking in the bathroom.

hrtprncss · May 26, 2006

Offer an alternative for this patient, order a nicotine patch if it isn't contraindicated. She's young so you might be able to get away with having a nicotine patch ordered.

babynurselsa, RN · May 26, 2006

If you are practicing in the US then patients cannot be stopped from leaving by security unless they have been EOD (emergency order of detention)

You can advise her that it is against policy, you can advise her that if she leaves the floor that she will be considered leaving AMA(against medical advice). If the patient smokes you can offer to obtain an order for a nicotine patch.

Security probably will not even show up unless you do have an EOD. To physically impede a patient from leaving would be considered false imprisonment.

christvs, DNP, RN, NP · May 26, 2006

Bottom line is if the pt. is alert, oriented and competent and not suicidal or harming anyone else she has a right to leave and you cannot force her to stay. You can only explain to her that it is in her best interest to stay on the floor, and that smoking will definitely make her sickle cell crisis worse to say the least!!! And then make sure she understands the risks of leaving the floor and smoking, document all of this, and then notify the MD (s) that this is what is happening. But you are right, you cannot force a competent person to stay put.

Daye · May 26, 2006

i faced a similar situation one day with a pt who had left the hospital the day before to walk himself downtown...in his hospital issued pj's... to buy a pack of cigs. the following day when i got report on the pt i decided right away to have an agreement w/pt that if he needed cigs i would personally go get them when i went out for lunch if he would agree not to run off again. i was so relieved at the end of the day that the pt didn't run off under my watch!!

Daytonite, BSN, RN · May 28, 2006

Here is the U.S. we would most likely get into trouble if we forbid a patient to leave the nursing unit. We would tell them in a much more tactful way. However, you are right. The patient is not a prisoner and if they want to wander off, you are not a policeman. One of the things I learned about working with some of the sickle cell patients is that (1) they can be very manipulative, and (2) when they don't get the pain medication they need it was not unheard of for them to either have illegal drugs delivered to them in their hospital rooms or to meet their drug supplier elsewhere in the hospital to get their "fix". And, that is possibly what was going on.

I worked in a Veteran's Administration hospital for some years. The patients are all former soldiers who served in wars. One of our biggest aggravations was tracking down patients when we had to give them medications, do a treatment on them or their doctors were there to see them. The hospitals were set up so that there were plenty of activities for these men to engage in throughout the facility. So, we either had the hospital page the patient to come back to their room or else we or someone on the staff had to go traipsing all over the facility (all 11 floors!) looking for our patients. The difference between that place and what you experienced is that no one at the V.A. got upset about all this wandering around. It was expected and they were mostly glad the guys were up and ambulating.

EricJRN, MSN, RN · May 28, 2006

I don't deal with adults (I'm a sheltered NICU nurse), but is it common/accepted practice to search a patient's belongings?

Iluvhospice · May 28, 2006

I don't deal with adults (I'm a sheltered NICU nurse), but is it common/accepted practice to search a patient's belongings?

No, never at our hospital.