Injuries related to contraband in psych

[psychnurse1016]

I was wondering if anyone has any stories about injuries to staff or patients within a psych setting r/t overlooked or missed contraband or contraband slipped to a pt by family members/friends.....

Anything would be helpful. How do other facilities conduct possession searches?

[CharlieRN]

On our methadone treatment program for detox from opioid dependence we have had 6 near death events due to patients either hiding benzos or having them smuggled in to them. The combination of klonopin with methadone is particularly likely to cause depressed respirations. I personally found one of these face down in a pool of vomitus with an SpO2 in the low 60's. We do a full body strip search on admission as well as a search of the patients pocessions. We do not do a cavity search.

Helpful hints:

Don't trust the supportive family who brought the patient in for treatment. I once took a vial of klonopin from a woman and gave it to her husband to take home, only to have it found by other staff the next day. As soon as my back was turned, he gave them back to her! You can never know the family dynamics that are going on. Enablers don't come with lables.

Watch for suspicious behavior. I had a patient who insisted she had to have her change purse at her bedside. It was stuffed, maybe 200 capsuls, of librium.

Take the cigaretts out of opened packages. The cigs can be torn in half and drugs hidden in the space under them.

Mail needs to be opened infront of staff and shaken out.

Stamped envelopes need to be disposed of by staff, things can be hidden under stamps and stickers.

[TitaniaSidhe]

I have had them sew pills into the hem of clothing & therefore we make every patient change completely into hospital pajamas & wash all of their clothing. Every single thing they bring onto the unit is searched prior to allowing them to have it & after any visitation the patient is physically patted down/searched before returning to the unit- all visits are supervised. Had several incidents in psych where a patient obtained a lighter & either set himself on fire or set something else on fire. I guess it goes without saying that there are no aresol cans allowed on the unit secondary to huffing, nor any mouth wash with alcohol. Make sure when searching to check/open all bottles & containers. I have found shampoo bottles filled with vodka. All mail or anything given from a visitor is opened in front of staff. The brims of caps/hats are another good hiding place. No cavity searches but as close to it as possible & always in the presence of security for the patient's protection as well as ours.

[elkpark]

As a surveyor for my state in acute psych, I have been involved in several investigations of deaths or near-deaths of clients who overdosed on drugs they either brought in with them (not found by staff on admission searches) or smuggled in to them by visitors. Many years ago, an acutely psychotic client on the psych unit I worked on set her bedclothes on fire with matches she had (not found by staff on admission searches) -- fortunately, no one was injured, but it was a close call. I have seen many other situations where clients or visitors smuggled in dangerous contraband but staff were basically lucky that the client didn't feel like hurting anyone ... I worked, many years ago, in an adolescent acute unit where cassette tapes were not considered contraband and all the kids had them in their rooms, but you can break open a cassette tape and find a small piece of metal with a sharp edge -- so, every time one of the kids felt like making a point or getting some attention, s/he would crack open a cassette and slash her/his wrists (usually just minor, attention-seeking scratches, occasionally v. serious). (Oddly enough, we nursing staff tried v. hard but could not convince the senior administrative people supposedly in charge of the program that cassettes needed to be contraband, despite the continuing parade of kids with bleeding wrists ...)

I agree with the suggestions made by the other two posters. You cannot be too careful doing searches. People (clients) who know how the game is played and are determined to get something past you can be extremely creative. Shoes are popular, and just glancing inside them is not good enough -- all kinds of stuff can be hidden beneath the insole, stuffed up in the very tip of the toe, between the sole and the rest of the shoe, inside the heel of the shoe ... Bottles of seemingly innocent substances (e.g., shampoo), besides possibly having been refilled with contraband (ETOH, as TitaniaSidhe noted) can also still contain the (shampoo) but have other stuff hidden in there (keep some kind of long probe handy to poke around inside the bottles ...)

Your state department of mental health and your state healthcare licensing agency have rules/regs related to client rights and search/seizure (different in every state) -- whoever is in charge of your program needs to be sure that whatever policy you decide on for searches is in compliance with the state and Federal (CMS) rules.

[psychnurse1016]

Thanks for the feedback! Anything helps. IF you have more stories I would love to here them...

thanks again

Jamie

On our methadone treatment program for detox from opioid dependence we have had 6 near death events due to patients either hiding benzos or having them smuggled in to them. The combination of klonopin with methadone is particularly likely to cause depressed respirations. I personally found one of these face down in a pool of vomitus with an SpO2 in the low 60's. We do a full body strip search on admission as well as a search of the patients pocessions. We do not do a cavity search.

Helpful hints:

Don't trust the supportive family who brought the patient in for treatment. I once took a vial of klonopin from a woman and gave it to her husband to take home, only to have it found by other staff the next day. As soon as my back was turned, he gave them back to her! You can never know the family dynamics that are going on. Enablers don't come with lables.

Watch for suspicious behavior. I had a patient who insisted she had to have her change purse at her bedside. It was stuffed, maybe 200 capsuls, of librium.

Take the cigaretts out of opened packages. The cigs can be torn in half and drugs hidden in the space under them.

Mail needs to be opened infront of staff and shaken out.

Stamped envelopes need to be disposed of by staff, things can be hidden under stamps and stickers.

[psychnurse1016]

Thanks for the info! Jamie

I have had them sew pills into the hem of clothing & therefore we make every patient change completely into hospital pajamas & wash all of their clothing. Every single thing they bring onto the unit is searched prior to allowing them to have it & after any visitation the patient is physically patted down/searched before returning to the unit- all visits are supervised. Had several incidents in psych where a patient obtained a lighter & either set himself on fire or set something else on fire. I guess it goes without saying that there are no aresol cans allowed on the unit secondary to huffing, nor any mouth wash with alcohol. Make sure when searching to check/open all bottles & containers. I have found shampoo bottles filled with vodka. All mail or anything given from a visitor is opened in front of staff. The brims of caps/hats are another good hiding place. No cavity searches but as close to it as possible & always in the presence of security for the patient's protection as well as ours.

[psychnurse1016]

Thanks for the feedback. It amazes me everytime we find contraband on the unit, even though we do very thorough searches. I am just hoping to find a way to improve our search policy and stay within the guidlelines of regulations already set in place. I am hoping that by taking a surreal approach with the staff to inform them of the possiblities that could have or that have already happened to someone else will be an eye opener! To get them to understand the importance of thorough searches. Thanks again for your input! jamie

As a surveyor for my state in acute psych, I have been involved in several investigations of deaths or near-deaths of clients who overdosed on drugs they either brought in with them (not found by staff on admission searches) or smuggled in to them by visitors. Many years ago, an acutely psychotic client on the psych unit I worked on set her bedclothes on fire with matches she had (not found by staff on admission searches) -- fortunately, no one was injured, but it was a close call. I have seen many other situations where clients or visitors smuggled in dangerous contraband but staff were basically lucky that the client didn't feel like hurting anyone ... I worked, many years ago, in an adolescent acute unit where cassette tapes were not considered contraband and all the kids had them in their rooms, but you can break open a cassette tape and find a small piece of metal with a sharp edge -- so, every time one of the kids felt like making a point or getting some attention, s/he would crack open a cassette and slash her/his wrists (usually just minor, attention-seeking scratches, occasionally v. serious). (Oddly enough, we nursing staff tried v. hard but could not convince the senior administrative people supposedly in charge of the program that cassettes needed to be contraband, despite the continuing parade of kids with bleeding wrists ...)

I agree with the suggestions made by the other two posters. You cannot be too careful doing searches. People (clients) who know how the game is played and are determined to get something past you can be extremely creative. Shoes are popular, and just glancing inside them is not good enough -- all kinds of stuff can be hidden beneath the insole, stuffed up in the very tip of the toe, between the sole and the rest of the shoe, inside the heel of the shoe ... Bottles of seemingly innocent substances (e.g., shampoo), besides possibly having been refilled with contraband (ETOH, as TitaniaSidhe noted) can also still contain the (shampoo) but have other stuff hidden in there (keep some kind of long probe handy to poke around inside the bottles ...)

Your state department of mental health and your state healthcare licensing agency have rules/regs related to client rights and search/seizure (different in every state) -- whoever is in charge of your program needs to be sure that whatever policy you decide on for searches is in compliance with the state and Federal (CMS) rules.

[CharlieRN]

I heard that we had a sweet elderly lady smuggle in a vial of meds inside a skeen of yarn in her kniting bag.

[Thunderwolf, MSN, RN]

Watch for store bought food items that appear to be in "sealed" bags. I've busted many a bag open (like potato chips) and found many surprising items that I know the manufactor did not include in them...pills, needles, little bags of heroin or coke, crack rocks, etc. Folks try anything after busting the seal and resealing them. Crazy glue has been often used when the person was confronted.

[elthia]

I don't work psych, but had a patient transferred from a psych facility to the medical facility I work at ( we recieve a large number of psych patients that aren't medically stable enough to be at the psych hospital). The patient wasn't confined to the unit, apparently against policy as he was not EOD, and did wander around the hospital. Had violent acting out behavior that culminated in one female nurse being held against her will in a bathroom by the patient, and a male nurse being stabbed 3 times when coming to the female nurse's aid.

Our policy states, and is posted by all entry ways that all bags and belongings are subject to be searched at any time, but it's hard to do random locker checks in an acute medical setting that is chronically understaffed. All patients belongings are to be inventoried, but we have an open campus policy, which defeats that purpose.

I admit it, I get scared sometimes, but I'm not too ashamed to scream loudly for help if needed. I've been choked once by a psych patient admitted for hyperkalemia, screaming is probably what saved my a$$.

[LuciGirl]

Razor blades hidden in bras, books - the bible