How do you prevent psych/etoh elopements?

[mmutk, BSN, RN, EMT-I]

Just wondering how you guys handle your patient's who come in and are seen by the ER MD, are treated but have a condition that warrants their being held against discharge. I'm not talking about 6404 psych commitals, I'm talking about patients that fall into one of these categories...

1.Drunk without a ride.

2.A patient who got pain meds but now wants to leave with no ride.

3. Pt who is dissatisfied and attempts to leave with their IV in.

Now assuming for 1. and 2. you tried to get them a ride but they drove themselves and this has failed.

I know security is an option, but does that always work at your facility? Our security if good at holding them when they get there, but it can take them 2 or 5 minutes to get to the ER sometimes. What do you do yourself as the nurse till security gets there? Do you hold these patient's and how?

[Kyrshamarks, BSN, RN]

You hold these patients against their will and you are commiting a crime. these pateints can leave at any time they choose. Even if they have a hep lock in, try to convince them to wait the one minute it will take to get it out. If they elope without telling anyone, just document fully.

[bjaeram]

I disagree. If you let these people go you are held liable. They are considered incompetant if they are drunk or drugged. We have several rooms with camaras and have a security guard in the ER watching them. They will restrain them if needed. Personally as a nurse I will not physically restrain them...I don't want to get hurt. Some of our staff do but I don't think it's worth it.

The other day we had a person leave with a saline lock in place. We sent the police to their house to bring them back so we could remove it. Do you want to be liable with they OD on their IV drugs?

[Kyrshamarks, BSN, RN]

being drunk is not considered incompetent. Big differnce between the two. As for calling the police, here in Houston they would not go out and bring them back. They are way to busy to do that. Also you hold anyone against their will that has not been legally committed you are kidnapping them and committing battery if you restrain them

[bjaeram]

being drunk is not considered incompetent. Big differnce between the two. As for calling the police, here in Houston they would not go out and bring them back. They are way to busy to do that. Also you hold anyone against their will that has not been legally committed you are kidnapping them and committing battery if you restrain them

I still say a drunk person is not capable of making their own decisions. They are considered a threat to themselves and others if they drive. We restrain them daily. Now I'm not talking a little drunk I'm talking stumbling bumbling drunk. I guess another option would be to call the cops the second they drive off the property and have them arrested for drunk driving.

[mmutk, BSN, RN, EMT-I]

I still say a drunk person is not capable of making their own decisions. They are considered a threat to themselves and others if they drive. We restrain them daily. Now I'm not talking a little drunk I'm talking stumbling bumbling drunk. I guess another option would be to call the cops the second they drive off the property and have them arrested for drunk driving.

I agree with both of you, first of all I have never worked at a facility where drunks and people drunk off narcotics I have given them are allowed to leave without a ride (or public transportation sometimes). The MD always backs us up. And we have always held them, always. I've only been to court once and he was found to have assaulted me which is a felony and he ended up pleding guilty. I was never charged.

I don't believe it's kidnapping (period) if it were we would all be guilty. Because drunks usually don't walk themselves in the ER. They are usually brought by EMS (because they are too drunk to refuse) or by friends or random people. They are never there by choice, so if this was kidnapping they'd already be kidnapped already just by being here.

And yes the cops in my city are too busy for that go to their house BS.

But there is only so much you can do to restrain them, without getting the battery charge i've believe. Which brings me back around to my original question. What do you do, will you do to keep these people around while waiting on secuity or in the presence of security?

[diane227, LPN, RN]

This is a major problem for all emergency departments across the country. In my experience, the courts expect that you will do everything possible to secure the pt. Let me give you an example of a case that I worked on in Texas as a legal consultant.

A fifty year old female came into the ED with a migraine headache. She had come to the ED there multiple times for the same complaint. She was given an anti nausea medication (phenergan I think) and Nubain for pain. She was awake, alert, oriented X 3. She had no one with her during this visit and it was charted all over the chart that she was told not to drive her car after getting this medication. The nurse took her out to the ED dock and was going to take her to her car. The patient refused, pointing at her car in the parking lot and telling the nurse that her husband was asleep in the car. This went back and forth for a while. It was 3 am. Finally, the patient insisted and walked to the car alone.

About 45 minutes later the pt returned to the ED by EMS following a MVC where she suffered a critical head injury. She was in a vegitative state.

By the time we went to trial, she had died. The jury found that the nurse and the patient both shared liability in this case and found each 50% responsible.

If I had a patient that insisted on leaving I would call the police and report them for public intoxication. If you can get a license plate number, all the better. The police in most areas will pick them up. Often I have had two doctors eval the pt and determine that the patient was not safe to leave and we placed the pt in restraints or in a locked psych room. My opinion is that I would rather go to court and defend myself against assault of the pt by holding them against their will than allowing the pt to leave and get run over by a truck. It is not an easy answer. The bottom line is that you have to do everything that you can to assure that the pt does not leave without an escort. Diane:yawn:

[mwboswell]

Interesting topic so far.

I understand the disparity and I understand "illegally detaining" someone...

BUT, figure this....

Which one would have the WORST possible outcome for the patient?

Obviously the pt is not "harmed" by being made to stay for a while until they are deemed safe to leave.

However, if we let them leave, there is a VERY REAL possibility that something harmful could happen (injury, OD, death etc.)

I would think that nursing's paramount responsibility is to protect the patient regardless. If you have "reasonable" grounds to suspect that the pt poses a danger, then you (I believe) are justified to do what you can to protect the pt from harm. I have to believe the board of nursing would back you on this and some bull**** legal charge of "detaining"/"kidnapping" would be futile.

If someone shows me one case where an individual nurse was found legally responsible and charged, and indicted for "kidnapping", I'll show you one where the nurse and/or hospital were found guilty for a bad outcome when a pt was allowed to leave while they posed a risk to themselves/others.

[mwboswell]

I might even postulate that the individual nurse "might" be accountable to the board of nursing if they let the patient go while they posed a potential risk to themselves/others...regardless of the outcome. This might even be a reportable behavior against a colleague ????????

[ERn21]

a pt that has rec'd narcs or has an IV can't be held against their will. aslo, there is nothing the police can do even if you do call to report a pt is driving after recieing narcs. just like the police cant pull a person over because you call and report you saw them drinking at a restaurant or bar and then drive off. now im not saying the police can't pull the person over for other reasons and then find out they are DUI.

[mmutk, BSN, RN, EMT-I]

In my general practice I have found that I can do a couple of things to prevent these issues from the start. Several ERs I have worked at have supported this practice as do the MDs. We will hold pain meds or mood altering drugs in the abcense of a driver.

This is for patients without acute conditions, or suspicious patients. "When your ride gets here I will give you your pain medicine" When the ride gets there the MD will order it.

In the mean time we will utilize drugs such as Ibuprophen and Toradol and Zofran. The heavy stuff doesn't come out until a ride arrives or the patient agrees to d/c by cab.

[Carlitos]

Interesting topic so far.

I understand the disparity and I understand "illegally detaining" someone...

BUT, figure this....

Which one would have the WORST possible outcome for the patient?

Obviously the pt is not "harmed" by being made to stay for a while until they are deemed safe to leave.

However, if we let them leave, there is a VERY REAL possibility that something harmful could happen (injury, OD, death etc.)

I would think that nursing's paramount responsibility is to protect the patient regardless. If you have "reasonable" grounds to suspect that the pt poses a danger, then you (I believe) are justified to do what you can to protect the pt from harm. I have to believe the board of nursing would back you on this and some bull**** legal charge of "detaining"/"kidnapping" would be futile.

If someone shows me one case where an individual nurse was found legally responsible and charged, and indicted for "kidnapping", I'll show you one where the nurse and/or hospital were found guilty for a bad outcome when a pt was allowed to leave while they posed a risk to themselves/others.

I'd bet that for every one "kidnapping" charge you would find hundreds of "negligence" charges.

My take on it is this... it has nothing to do with whether or not they were drinking, doing drugs or whatever. It all boils down to your assessment of the patient's condition when they decide they want to leave. AAOx3 is a poor indicator of a patient's condition and whether or not they are "ready" to leave.

If you are going to make a mistake when it comes to patient safety, err in favor of the patient. I don't think any BNE would hold it against you if you decided to err in favor of the patient, even if it means holding them against their will.

'Los