Injury from teenage psych patient

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Specializes in Pediatric Emergency Medicine/Trauma.

I was injured about a week ago by a 17yo, 240lb, autistic patient who was brought into our ER for new violent behavior and not sleeping in 3 days. He was restrained during the midnight shift both physically and chemically. He required high doses of medications to calm him down and he slept most of the night. On day shift, he remained restrained x4 limbs due to increasingly violent behavior as he became more awake - both self-injurious and threatening towards others. We did our best to involve Child Life and utilize distractions but were unsuccessful.

At one point, he successfully got one arm out of his restraint (I did not apply them so it was probably an error on the part of that nurse). I was unaware this occurred as he kept his wrist to the side of the bed. There was no sitter present (she was on break) and his parents had wandered away. We're very short-staffed so I was monitoring him along with my other 8 patients (yes, high numbers for an ED). He had already thrown himself off the side of the stretcher and tipped it so he had been re-medicated. I thought he appeared calm, so I entered the room to cover him with blankets (he was naked as he tried to hang himself with the gown). Suddenly, he jerked out with his unrestrained arm and I became trapped between him and the wall. I utilized the skills I've been taught and was uninjured in this attempt on his part. I yelled for help and when 5 other people were in the room and holding him down, I began the task of re-restraining him. We all remained calm and tried to speak in soothing voices.

Suddenly, he broke free of the hold they had on him, grabbed me by the neck and shook me around before throwing me into the wall. I've never been so frightened.

Long story short, I'm still out on leave for a neck/shoulder muscle and nerve injury. We're having a very hard time getting the adult hospital next door (we're a children's hospital) to take our teenage, violent psych patients and had always said "well, just wait til someone gets hurt". Well, now that has happened and I'm not sure if or how I should proceed as my boss seems to be a bit clueless as to what to do next. Does anyone have any thoughts on this topic?

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Specializes in ICU/CCU, Med Surg.

I'm sorry to hear you were hurt...I'm kind of facing a similar situation on my unit, but management is well aware of the problem and currently "working on it", I suppose. In the meantime, staff get assaulted frequently as a result.

My advice to you (and I'm new at this, so take it for what it is...) is document, document, document.

I'm sure you've had to do a lot of documenting already, but I can't stress it enough, since outside consultants from an adult ward or some other entity will likely investigate these things as you encounter more violent behavior from this pt. And if he remains on your unit, it unfortunately sounds like staff assaults might be a recurring theme.

Have you filled out an incident report or something similar?

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What do you have for security in your area? If they refuse to let you send these pts to adult ED I would see if you can have more security available. Having an officer present at all times just for your area and when you have pts like this one maybe increasing to two. Then they can radio for back up if they need it. When I worked in psych ER and we took all ages 4 to 104 we would get autistic kids. The only time I was ever actually struck was by a 10 YO autistic kid in the knee. Thank god no injury, just a little sore. But they are a whole different ballpark and have quite unique needs. We were lucky enough to have out psych ER just above the medical ER where they always had security stationed 24/7 so they were literally a flight of stairs away. When we had really violent pts on the unit we would have them either get an officer to sit outside that pts room or at least they would come and walk through/check on us like every hour. It did help. We did the same on the inpatient unit when we would have an all female staff of 4 on for the shift we would call at the start of shift and tell them this and that we had a pretty violent pt. they would do hourly walk throughs. Their presence helped.

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Specializes in Acute Mental Health.

Teens with adults would probably not be a good thing either, but he needs to be transferred to a facility/hospital where they can deal with those types of behaviors. I work if a facility that houses child/adol as well as 3 developmentally delayed units. Sounds like he would fit right in there. I'm so sorry this happened to you. We sure do work in scarry situations that most other professions don't have to worry about. Be well and I hope you have no permanent injury.

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I am currently doing a paper on this subject and was wondering if any of you knew of any literature on the safety of nurses when it comes to dealing with autistic patients. As of right now I can only find information on how to properly care for pediatric patients with autism but have been unsuccessful on finding any actual studies on the dangers of working with a patient like above if not trained properly.

Thanks for any insight,

Tristan

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Specializes in Family Nurse Practitioner.
I am currently doing a paper on this subject and was wondering if any of you knew of any literature on the safety of nurses when it comes to dealing with autistic patients. As of right now I can only find information on how to properly care for pediatric patients with autism but have been unsuccessful on finding any actual studies on the dangers of working with a patient like above if not trained properly.

Thanks for any insight,

Tristan

Tristan try researching neuropsych but please be mindful that stigmatizing patients based on diagnosis is a slippery slope.

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First and foremost, know that your employer is not "working on it" and doesn't care anything about you or any other staff. You are all replaceable. And if you do get hurt and are out of work long enough, you'll be fired in a New York minute. Period, amen. Base your actions on these sad facts.

Also, I must say that I am surprised that your restrained pt wasn't 1:1. He could choke, turn the cart over again, etc.

Also, don't you have to do neurovascular checks q 15 ' or q 30 ' when limbs are restrained? Not that that might have made a difference, but maybe the loose limb would have been noticed when he was asleep and re-restrained before he could be destructive.

I hope you're OK. Pity the parents, what is that poor kid's future?

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Specializes in Med./Surg., Diabetes, Med. ICU, home hea.

If your boss is anything like the ones I've had in psych, I'm surprised they haven't taken drastic measures such as a mandatory class (taken on-line on your own, unpaid, time) about patient safety and posted another safety poster in the break room. Of course, I'm being silly about the poster as the only time I've been in the break room was to rush to the bathroom in there when I couldn't hold it any longer...

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Specializes in Family Nurse Practitioner.
Pity the parents, what is that poor kid's future?

With most all of my kids they are the ones that deserve the pity for drawing the short straw when it came to parents. :crying2:

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