Imminent danger

[fworkentin]

Greetings Fellow Nurses,

I'm relatively new to nursing in a Psychiatric Evaluation and treatment facility. We have the ability to give Emergency Medications (EMEDS) but you have to be able to justify "imminent danger" What things do you note that justify imminent danger? Do I have to literally wait until someone puts hands on another client or staff? We had a client that had been progressively getting more agitated and he would jump up with his fist balled up by his chest, yelling, threatening, staring at staff. He tried knocking medication out of the med nurse hand and hit her hand. When that is happening that can be so scary for staff. That feels so powerless as a staff member who can't make the decision to emed someone. I make the decision to emed and after a long time of this its wearing for everyone. I feel so bad for my staff who are out on the floor the whole time. I feel bad for the agitated ckient who has been that way for days and getting worse. Regardless, I need some help with determining imminent danger. Thank you for your thoughts. alwayslearnin

[brownbook]

I'm confused. You're new to this facility and you're responsible for making the decision to call EMEDS?

I only occasionally floated to a locked in-patient psych facility. I was never in charge of anything there. The regular staff were educated, in-serviced, thuroughly trained, on assessing imminent danger. I never heard of any repercussions on calling what we called "Mr Mann", which assume that's similar to EMDS?

[B52, ADN, BSN, MSN, RN]

There are too many variables, written rules, and unwritten rules to answer your question.

[deza, MSN, NP]

Often it depends on the situation and the specific patient especially if they have a history of violence on the unit. If they do enough to attempt to harm someone or themselves we give them EM meds. I have given emergency meds before because a pt was disrupting the milieu. We had already attempted verbal deescalation, zydis 20mg PO and taking the pt to a quiet room. The pt remained highly agitated and did not stop the behavior and was given IM medication while in personal restraint.

[pixierose, BSN, RN]

So many questions here ...

We don't use emergency medications unless a variety of measures have already been utilized (i.e., verbal deescalation, decreasing stimulation, diversionary techniques, offering PO medications already approved and discussed between the patient and their psychiatrists). Your post makes it sound as if you're not using these strategies.

The on call physician is also usually the one making the final call for the emergency IM meds (not the charge nurse or nursing supervisor, although we generally make the call to the physician that we've exhausted all other options and it's time for them to either come down now to evaluate the patient or put in the order and come within the hour to evaluate).

So many options before immediately medicating though...

[alwayslearnin]

pixierose,

Thank you for replying. Yes, Ideally you take all of the above measures you mentioned in your post before hand. But when you have done those interventions, what finally says, ok, we need to do emeds. Yes, we have to ask the provider for the order, but we are the ones that basically say, "hey, we are at that point (Emed) here is the situation. The providers are not there to see the situation, So I try to make sure I have good reason to take that step

[alwayslearnin]

I apologize if I was unclear in my post. No, the Psych Provider is the one that orders the med. They are not always in-house so I have to determine when do I need to call the provider to request an emed. Or at least call with the situation. Just wanted other nurses experience/thoughts around making that call?

Thank you for addressing my question.

alwayslearnin

[alwayslearnin]

Thank you for reading my post and replying.

[pinkiepieRN]

I work with kids right now so YMMV but with kids there are often few warning signs that something is going to get out of control until a child places their hands on staff or another patient. There are often warning signs in my experience with adults but kids are impulsive AF. Generally speaking, if someone requires a physical restraint, that's almost always a time where IM/emergency meds are indicated but your mileage may vary. I find that if I can de-escalate someone and move them to a quieter space (even if just the "calming room"), PO meds might still be an option but there's a threshold for danger that warrants emergency meds. Does that make sense? Often my providers don't order PRNs so it's a call to the on-call even for a PO PRN and then they might give the order "give PO chlorpromazine 25 mg. may give IM if pt refuses PO."

[TerpGal02, ASN]

I would agree that alternate methods should be tried first just like previous posters have said. If the docs are on the floor, I would let them make the call but the psychiatrists IMO spend on about an hour or 2 on the unit seeing pts then they bugger off. "Imminent danger" is so vague. I will tell you what an old nurse manager of mine said. If you feel threatened by a pt, or you feel a pt is threatening to others, that would qualify as "Imminent danger". IE they are screaming with balled up fists and cant ge redirected, verbal threats (technically, that is assault), lunging, posturing ,etc. It all boils down to your documentation on the incident. Things if TJC pulled the chart, is your documentation sufficient to support your intervention.

[BeenThere2012, ASN, RN]

I apologize if I was unclear in my post. No, the Psych Provider is the one that orders the med. They are not always in-house so I have to determine when do I need to call the provider to request an emed. Or at least call with the situation. Just wanted other nurses experience/thoughts around making that call?

Thank you for addressing my question.

alwayslearnin

Same where I work. We take measures to calm the patient, re-direct, give

pO Meds first (if they will take them), try quiet room, etc...Essentially, when the patient is no longer re-directable, is disturbing the other patients, escalating and threatening, and of course if they are assaultive, we call the doctor and tell him the situation. Depending on the doctor, they automatically order the Meds or sometimes we have to explain more and ask for them.