intentional overdose

Noryn · Dec 8, 2005

The hospital capabilities and procedures are really going to come into play as well. For instance in our hospital we didnt have a psych unit so there were no psych nurses to call. Hospitals that do have a specialized unit may in fact have a team to respond to these issues however I still think it is upon the ER staff to assess the sexual assault. There is also a branch of nursing that is becoming more popular which would help deal with this. I think Forensic nursing is a field that deals quite a bit with this.

Also when we transferred patients like this to the psych ward at another hospital they would never accept the patient after an overdose unless the patient had been medically stable for approx 24 hours.

Noryn · Dec 8, 2005

would admittance to a psych ward be advised? or would it be better to discharge to family member?

That depends entirely on the situation. If the person took 100 Lopressor then probably not. They will need to be monitored medically probably on a telemetry floor or critical care unit. Some hospitals may have psych floors that do this but the ones where I live do not. They wont even take patients with IVs.

If everything was ok from a medical standpoint then I think a psych evaluation would be advised. The appropriate staff need to evaluate the patient and/or the doctor needs to talk with the psychiatrist to see what they want to do. I honestly hated to see people that overdose leave the facility.

Most of the time we kept them however at times the doctor or psychiatrist may discharge them to another adult, making sure the adult knew they were responsible if anything happened to them (although I am not sure how well this would ever hold up in court).

RNCENCCRNNREMTP · Dec 17, 2005

what would the procedure be for a female adult who presents to the er having taken an intentional overdose, and who then discloses a recent (
Treat the overdose, this may be more physically serious at this time
Offer counseling with a rape victim advocate
Offer exam for evidence collection
Offer empiric treatment for STD's as well as "morning after" pill
Offer contacting police
Offer follow up physical and psychiatric care
Just my thoughts.
AJB

rn/writer, RN · Dec 17, 2005

You would treat her medical issues (both the overdose and the assault) and call the police. It is NOT the job of the ER staff to assess the criminal aspect of the situation. It isn't the job of the ER staff to even determine the veracity of her claim. Law enforcement personnel are trained to work with sexual assault victims in the areas of verification, protection, and possible prosecution. We are not.

Yes, it can be terribly upsetting for a sexual assault victim to have to submit to further questioning and the gathering of evidence (a rape kit), but it can be much MORE damaging for her to repress and retreat out of shame or fear. A trained counselor can be present to help the patient through the experience, but the sooner the forensic wheels are set in motion, the better the chances the attacker will be caught and stopped. Even if that doesn't happen, it's far better for the patient to actively take the direction of her life away from the person who violated her. Shame is best dealt with by shining a light on the darkness and surrounding the wounded one with acceptance and support. The last thing she needs is to hide in a corner, feeling dirty and alone.

If the claim turns out to be false, that is a crime of a different sort. Such behavior would certainly indicate some serious psych needs and might generate some legal issues as well.

It certainly sounds like a psych eval would be in order, no matter what. Was the overdose a one-off committed in a moment of shock and revulsion? Or were there previous issues which the assault only triggered or aggravated? How stable is she now? What kind of support system does she have? These questions can all be addressed, as well as the need for medication and counseling.

Again, if the claim turns out to be false, the patient's mental status and her psych history would definitely need to be looked into.

All of this can take place AFTER the medical stabilization and the initial contact with police officers.

We become rightfully indignant when law enforcement people make medical pronouncements regarding accident victims or jail inmates. But just as they shouldn't be venturing into territory where they lack training and expertise, neither should we.

If we don't respect these boundaries, we might end up robbing the patient of legal protection and exposing her and other potential victims to further assaults, even as we're trying to protect her.