Intoxicated- does it mean incompetent?

markjrn · May 29, 2005

We had this discussion in our ED tonight. If a patient is intoxicated, are they incompetent?

Yes, temporarily, IMHO.

suzanne4, RN · May 29, 2005

Legally yes, they are considered impaired at that time.

mommatrauma, RN · May 29, 2005

Depends...there is a fine line between clinically sober and legally sober...hence we don't draw alcohol levels unless absolutely necessary because then we are bound by the numbers...when it is deemed you are clinically sober...every doctor has their own criteria...then you are deemed competent...until then..you are not competent. Being in a level one trauma center...that tends to jam up the system more often than not....after a while it feels like we become babysitters not nurses...

ryoung0302 · May 30, 2005

Depends on the patient, just like if you are stopped for a DWI, you can be under the legal limit and still be impaired. We constantly tell our teens to be responsible and the dangers of drinking since it impairs your judgement, I think that the same should go for our patients. Now the problem would occur, do you withhold treatment or not if the patient is refusing due to being an angry drunk. That is one that we have pondered many a time, and sometimes have even had the police come and get them and take them to the county hospital. That always seems to do the trick when someone has a horrible attitude to the staff.

needsmore$ · May 30, 2005

this is a huge legal gray area- what to do if the intoxicated pt that the police or well meaning friend brings to the ed who refuses care?

are they competent enough to let them leave? what are liabilities of the hospital if you let them leave and they get injured or cause injury to someone?

i question risk management on this all the time--this is the answer i usually receive...

if you are restraining or forbidding an intoxicated pt from leaving- make sure your documentation demonstrates level of incompetetence--slurred speech, unsteady gait, poor coordination, loc, orientation status-whatever to cover yourself!!! if you cannot document these findings, then chances are your patient is competent enough to leave your facility but still may be impaired -(like someone who just got dilaudid for back pain and is going home). the patient should have a responsible person available to provide transportation and to review discharge concerns.

anne

MAGIK GIRL · May 30, 2005

I question Risk Management on this all the time--This is the answer I usually receive...
If you cannot document these findings, then chances are your patient is competent enough to leave your facility but still may be impaired -(like someone who just got Dilaudid for back pain and is going home). The patient should have a responsible person available to provide transportation and to review discharge concerns.
Anne

and if there is no one to come and pick them up and they are impared and insist on leaving, the police can be called because getting behind the wheel on narcs is just as bad as etoh. police departments have drug specialist officers who can come to a scene and document whether or not a person meets the standards for their criteria to be considered "to impared to drive".

even if they are released, they will not have gotten behind the wheel that night and may be sober after all of the hoo ha is over.

MedicalZebra · May 31, 2005

When I started dialysis, I was so uremic that I had trouble balancing my checkbook-- and yet I was made to sign tons of paperwork during my first in-center dialysis treatment. I felt loopier while uremic than I ever have when drunk, and yet no one gave all the paperwork-signing a second thought. I sure didn't feel that I was giving 'informed consent' at the time... everything was a blur and I didn't remember a single thing they told me that night.

MAGIK GIRL · May 31, 2005

how 'bout when that abdominal pain is given narcs and then asked to sign consent for surgery? that cracks me up. "well, he needs the surgery anyway....."

Thunderwolf, MSN, RN · May 31, 2005

Incompentency is a legal term...NOT MEDICAL. You may wish to say, impaired. But, incompetency is a ruling handed down "by a judge", not a medical professional.

caroladybelle, BSN, RN · May 31, 2005

how 'bout when that abdominal pain is given narcs and then asked to sign consent for surgery? that cracks me up. "well, he needs the surgery anyway....."

Not to mention some Oncology patients who are on large doses of narcotics at all times. They are never going to off of the meds long enough to clear the system (and if they were, they would be in so much pain, they couldn't think straight), and yet they have to sign many legal documents. I would consider many of them more competent than some unmedicated patients.

MAGIK GIRL · Jun 1, 2005

Not to mention some Oncology patients who are on large doses of narcotics at all times. They are never going to off of the meds long enough to clear the system (and if they were, they would be in so much pain, they couldn't think straight), and yet they have to sign many legal documents. I would consider many of them more competent than some unmedicated patients.

morphine.....jack daniels.....morphine.....jack daniels......

hmmmmm. tough choice.

worked at a place where this friend of mine had to dc a pt with oxycontin to go. well, he gave it to the lady because she said she was going to drive right home (duh!). wellllllll, this lady took the med and decided to wait around 20 min or so to talk to her doc. she did, got in the car and had an mvc in the parking lot. bad part was is she had to sign back in for back pain! (different thread all together!!) :roll :roll