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!
Specializes in ICU/community health/school nursing.
On 2/1/2019 at 9:28 PM, LibraNurse27 said:
Thanks for the replies! I will definitely document when patients do things that go against medical advice... for example shooting meth into a picc line! I will document that I educated them and they chose not to follow advice, etc. I had not thought about contacting law enforcement or regulating agencies but I think that will be the next step if things don’t improve.
That’s unbelievable that facility is allowing that type of behavior even if those patients have discharge planning issues and have behavioral issues. It’s such a huge liability. It’s not safe for anyone.
I know for a fact the current hospital system I’m at would never give those long term care patients all those privileges especially if they have done something inappropriate like you have mentioned above.
I would say get out of there fast. You’re putting yourself at so much risk. There has to be somewhere else you can work at. Wish you the best.
Wow, just wow! What an insane place to work. How can an acute care facility be expected to keep violent patients indefinitely without strict safety measures in place? It's beyond unacceptable for staff to be assaulted with what sounds like zero consequences. There has to be a better way to provide secure housing for unplaceable patient's than allowing them free range to come and go as they please and having no secure place to contain a violent patient.
The last hospital I worked at had much the same issues. The unit was med-surg but we got everything and anything. Active detox pts who would attack staff, drug users leaving the unit and come back with their friends and do drugs (meth etc) in the pts bathroom, a psych pt who admin (for whatever reason) let stay on the unit who attacked a staff member (still nothing from admin) and then attacked another pt (punched him in the face), had a patient who had a PICC and was told he could not leave AMA with it so he pulled it out and was swinging it around the room like he was getting ready to lasso something, patients breaking/stealing equipment, and patients were constantly coming and going. There was a policy that if gone for 2+ hours the patient would have to go through ED process and be readmitted but it was rarely enforced. As others have stated I would document meticulously to CYA as some admins (like yours?) wont do much about the issues. Good luck!!
ruby_jane, BSN, RN
3,142 Posts
Sweet Baby Moses!!