Intoxicated Crisis Patients

Nurse Ratched, RN · Jun 21, 2005

Our psych units routinely detox folks, so someone could well be in full DT's by the time a BA dipped to that level. Does your psych service not see people who may be dealing with active withdrawal? (I am aware of places that are not equipped to do that.) Where do such people go - your regular med floors?

elkpark · Jun 21, 2005

Although some psych units are set up for and accustomed to doing detox, not all do. I have worked in a number of psych units, and on the psych consultation-liaison team responsible for doing the CD evals in the ED at a big teaching hospital, where the psychiatrists took the position (with which I have no argument) that acute detox is not a psych problem, it is a medical problem. In those cases, there was either a separate detox unit or detox patients were admitted to medical beds for detox (or observed in the ED until the possibility of acute withdrawal had been ruled out, as the OP describes).

In fact, now that I think about it, of all the places I've worked over the years, the majority of them have refused to admit acutely intoxicated folks to the psych unit.

mommatrauma, RN · Jun 21, 2005

We have to hold on to them until "clinically" sober, which often times happens before the patient would be considered "legally" sober...We do not draw BAL for the simple reason we would then probably end up keeping them longer...Our psych does set up for detox, however they still have to be clinically sober prior to being sent...

Thunderwolf, MSN, RN · Jun 21, 2005

As you see, it depends on the hospital set up and the philosophy of care of the institution regarding intoxicated patients. It is not uncommon for these patients to be seen as "undesirable"...in ED, med floors, or even in psych sometimes. Intoxication and withdrawal are medical issues, with the degree depending upon the substance, with psychiatric underpinnings being often present. Due to the undesirability, many health care workers and/or settings are often ill prepared or not willing to treat it adequately. As a result, issues that might be deemed "genuine" health care issues that the person may have may be overlooked and untreated.

Altra, BSN, RN · Jun 21, 2005

We see numerous mental health patients who are intoxicated. Our psych services refuse to see these patients until we prove that their blood alcohol is less than 0.10 Is this typical practice in most hospitals?

This was also the practice in the ED where I just finished working as a tech. Pts. are not evaluated by the psych RN until their BAC is

mommatrauma, RN · Jun 21, 2005

As you see, it depends on the hospital set up and the philosophy of care of the institution regarding intoxicated patients. It is not uncommon for these patients to be seen as "undesirable"...in ED, med floors, or even in psych sometimes. Intoxication and withdrawal are medical issues, with the degree depending upon the substance, with psychiatric underpinnings being often present. Due to the undesirability, many health care workers and/or settings are often ill prepared or not willing to treat it adequately. As a result, issues that might be deemed "genuine" health care issues that the person may have may be overlooked and untreated.

Not sure how that was directed...I think as an institution we are very compassionate to the needs of those with psych emergencies, and or alcoholism and/or withdrawl issues that need to be addressed. What we are not compassionate to are those that abuse the system and/or those that got drunk and passed out on the side of the road that the authorities brought in to us because they just didn't know what else to do with them. I am a healthcare worker, not a babysitter for someone that is making bad decisions...if you are there for help, I am there to help you. I do not believe that intoxification is a medical issue...I believe it is a bad choice. I believe that you can have medical issues due to your bad choice which point I am certainly there and willing to help you with. However, where I don't understand is, if I can "babysit" a drunk until they sober up and all I am providing for them is a warm bed and a hot meal so they can go somewhere else to be treated for their withdrawl or alcoholism or psych issues...then the place they are going to is just as capable of babysitting as much as I am. Because to be honest with you. If I have put back the unsteady intoxicated patient back to bed for the fourth time because he feels like going for a walk and I miss someone having an MI because my attention is diverted, well you can see how it can make you a little jaded...

rjflyn, ASN, RN · Jun 21, 2005

Could not have said it better. Sady most the drunks we deal with also have psych problems but the vast majority of them dont want any help. The police bring them to us instead of throwing them in the drunk tank because of the fear of being sued when one of them dies there. So we ring up a several thousand dollar bill that the hospital will never collect except by increasing my insurance cost and charging me more to make up the difference.

Rj

Not sure how that was directed...I think as an institution we are very compassionate to the needs of those with psych emergencies, and or alcoholism and/or withdrawl issues that need to be addressed. What we are not compassionate to are those that abuse the system and/or those that got drunk and passed out on the side of the road that the authorities brought in to us because they just didn't know what else to do with them. I am a healthcare worker, not a babysitter for someone that is making bad decisions...if you are there for help, I am there to help you. I do not believe that intoxification is a medical issue...I believe it is a bad choice. I believe that you can have medical issues due to your bad choice which point I am certainly there and willing to help you with. However, where I don't understand is, if I can "babysit" a drunk until they sober up and all I am providing for them is a warm bed and a hot meal so they can go somewhere else to be treated for their withdrawl or alcoholism or psych issues...then the place they are going to is just as capable of babysitting as much as I am. Because to be honest with you. If I have put back the unsteady intoxicated patient back to bed for the fourth time because he feels like going for a walk and I miss someone having an MI because my attention is diverted, well you can see how it can make you a little jaded...

needsmore$ · Jun 24, 2005

Our crisis workers also wait until BAL is less than 0.1. They feel they cannot do an accurate mental/behavioral assessment on an incapacitated person. Anne