How many staff are needed for code greens?

[darcieg]

The psych hospital I work for is pretty small. (We only have one RN on at a time and are on diversion if census gets too high) When we have a code green (for violence) it is policy that all staff respond. This includes everyone in the offices, therapists, secretaries, etc. Basically, this reults in one patient and about 15 staff members. The theory is that the pt will see how many people are there and decide it would not be a good idea to escalate. I think however, that the patient might feel trapped or backed into a corner and lash out more. Any thoughts?

[TitaniaSidhe]

Usually a show of force is better

[UM Review RN, ASN, RN]

At the point that the patient is becoming violent, I don't really care what they're thinking. I want them to stop and so far, nothing else has worked.

A couple of examples are the patient who is in DTs or the agitated dementia patient.

So in the interest of safety for all, I want as many staff members there as possible.

[z's playa]

Seems a bit strange to me to have everybody respond to a code and leaving their posts so to say. But hey...whatever works :)

I'm guessing any kind of forced submission is what you're trying to avoid. That and any meds. A good idea. Only then I'm back to the "empty posts" thing.

[Blackcat99]

The more staff at a code green the better and safer it is for everyone. When I worked at the state psych hospital we had certain patients who would require much more staff than other patients. Don't be fooled by the patient's size. We had a tiny petite young woman who was stronger than an ox and required so many extra staff to be around when she became agitated.

[Chad_KY_SRNA]

I don't work psych but many of the residents in my LTC alzhiemers unit have been violent and when we need help we are forced to pull the fire alarm and all but one person on each unit comes to help. Only happened a couple of times. :redlight:

[Psych*msn]

Generally it is a good idea to have a lot of people. Where this can break down though is if everyone that comes to the code wants to talk to the patient. This is not a good thing...it's best to have one communicator giving the information to the patient...less confusing to the patient and more direct. Also everyone that responds to codes should be appropriately trained in whatever method you use for violence managment. I have had plenty of patients who don't get the whole 15 of them...only one of me....thing and act out in a big way. It's good to have people who can open doors and secure the unit if they don't feel comfortable with the up front violence managment part of things. Just my two cents. Have a great day.

[elkpark]

Generally it is a good idea to have a lot of people. Where this can break down though is if everyone that comes to the code wants to talk to the patient. This is not a good thing...it's best to have one communicator giving the information to the patient...less confusing to the patient and more direct. Also everyone that responds to codes should be appropriately trained in whatever method you use for violence managment.

ITA. The OP makes a good point about feeling trapped or backed into a corner -- but the "show of force" element only comes into play after 1:1 talking and persuading hasn't worked (or the situation is so dangerous that it's not appropriate). You don't call a code and gather up extra staff until the client has passed the stage of the two of you working things out ... Although nothing works all the time, often (typically, even), when the client sees that a large number of people are available to help subdue her/him, s/he backs down and cooperates.

[TitaniaSidhe]

Also everyone that responds to codes should be appropriately trained in whatever method you use for violence managment. I have had plenty of patients who don't get the whole 15 of them...only one of me....thing and act out in a big way. It's good to have people who can open doors and secure the unit if they don't feel comfortable with the up front violence managment part of things.

Excellent & valid point

[chris_at_lucas_RN, RN]

Patients who are that out of control usually need and want an excuse not to continue the path they are on. Typically they are very angry and maybe haven't experienced the degree of emotion that is underneath their behavior.

Having a lot of people show up and surround them is often the very thing that gives them a chance to slow down and catch their breath. All but the very, very out of it realize that they cannot buck 10 people, five of whom are 6'1" and 220.

Training is very important--it's easy to injure a patient, and it's easy to say things that just make matters worse.

Interesting--they are code purples at my hospital.