Just wondering what the policy is at other facilities about admitted patients leaving the hospital and coming back in. Because I work at a county hospital, in addition to our acute patients we also house about 40 long-term stay patients who we are unable to place in nursing homes, group homes, and shelters because of their behavioral issues. Some of these patients have dementia with severe behavior disturbances and others are alert and oriented but are homeless and either ineligible for shelters due to behaviors. These patients have caused our hospital many issues, including acute patients spending multiple nights in the ER hallways and acute patients being disturbed and even in some instances attacked by long-term patients. Staff are often attacked as well.
It is difficult to contain people in a hospital room long-term and some of the patients stay for months or even years (record so far is 3 years, 7 months for extremely violent TBI patient). Sometimes staff take confused patients out for fresh air or at least walk around the unit with them to prevent agitation. Alert patients are allowed to leave the unit unsupervised as long as they sign out and return within 30 minutes (although this is often not enforced). When they leave they often use drugs, sell drugs, drink, go to Wendy's while NPO with an NG tube... so many other examples. We have had patients fall and also get their belongings stolen or get beat up in a drug deal. Then we become liable for the injuries sustained because they were still "under our care". Does this exist anywhere else and does anyone have any suggestions? We are trying to enforce the policy that patients who don't return within 30 mins or who commit extreme violence against staff (nurse got STABBED by a placement patient last week and he is still living in our hospital). Thanks and sorry for long post!
^ Yes. I would find that mentally intolerable. I'm a fan of letting other people accept responsibility for their insane choices - and in this case I'm not even talking about the patient, I'm talking about the idea that I would continue to hear the employer's angst about something like CLABSI while they tolerate this absolute circus. I understand their position isn't easy, either, but they aren't helping themselves.
We've had similar situations with PICC lines, etc. Since our patients are not allowed to leave the floor it's their visitors bringing that crap in. So their consequence is no visitors and our security enforces this. Pisses them off but too bad. Your management really needs to get a handle on this and they especially need to make a more safe environment for their staff. We call PD when people get rowdy and that usually takes care of the problem.
How in the world do they keep your hospital staffed with all that craziness? Seems like the kind of place where staff would be bleeding through a sieve.
Our patients aren't allowed to leave the floor for liability reasons. If they want to go they have to leave AMA. Anyone who is safe to ambulate independently is free to walk the hallways on their own. For longer term patients we sometimes will take them outside but there has to be a staff available to do it and its not realistic for everyone. We sometimes have people for weeks or months but nothing like what you have.
I work in acute care. People who aren’t a fall risk and don’t have a known drug, tobacco, or alcohol issue will sometimes be allowed to go to the cafeteria or outside patio. That is a very small group of people... We usually get an MD note saying it’s ok from their standpoint and get nurse manager approval. If anyone abuses the freedom they are not allowed to leave the unit (or room) depending on what they did (ie if it earned them a room search or sitter, etc).
Specializes in Community Health, Med/Surg, ICU Stepdown.
The Med/Surg floors do tend to have a high turnover but surprisingly there are many nurses who have been there for years. The staff is wonderful and I think that is why people stay, as well as the fact that some of our patients are really wonderful as well and we have the opportunity to help vulnerable patients. But we are definitely getting tired of the constant violence. I considered all the thoughtful advice and decided to call The joint commission to make a safety complaint. Hopefully they can help! Never thought I’d actually WANT them to come to my hospital! Thanks everyone
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
The hospital I worked in would NEVER let a patient leave with an IV, especially a PICC. If a patient left with one they were made AMA and the police were called. Sounds like your hospital is playing with fire. I don't understand how risk management is ok with this since the hospital is taking on a whole world of risk.
I recently resigned from a 500+ bed academic center, and we encountered those very same patient populations, with similar LOS due to behavioral issues. The solution at this particular facility was to have a secured wing of the hospital, about 25 beds, for these patients. They were able to ambulate within the unit, and there were psych trained RNs and techs that WANTED to work that unit. Only those that were truly bed confined would be placed on other units to make room for those ambulatory pts who needed to be secured.
There was also a security officer stationed in the unit 24/7, but they rotated out every 4-5 hours so the patients couldn't get too comfortable. Another reason for security was the doors to the stairs on that unit were locked, and only security and the charge nurse carried the key to unlock it at all times.
Wow, Libra - that is a hot mess and a lawsuit waiting in the wings. I never worked in a facility that allowed people to leave for any period of time. At best, I can remember the days where you'd jump through a few hoops and take a patient out for a smoke, but even that was a big pain in the patootie and the patient was accompanied the whole time.
Do these patients just get up and leave? I think that risk management really needs to take a long, hard look at this practice and consult with the facilities attorneys to come up with a policy and procedure that works for this situation.
JKL33
7,038 Posts
^ Yes. I would find that mentally intolerable. I'm a fan of letting other people accept responsibility for their insane choices - and in this case I'm not even talking about the patient, I'm talking about the idea that I would continue to hear the employer's angst about something like CLABSI while they tolerate this absolute circus. I understand their position isn't easy, either, but they aren't helping themselves.