Intoxicated- does it mean incompetent?

RNin92 · Jun 14, 2005

This comes up a lot in my ER as well.

What happens when an intoxicated person refuses transport to the ED by rescue?

What happens when a well intentioned friend brings them in drunk and they refuse treatment?

Our "legal people" don't have clear cut rules either but we try to use the right terms and document until the cows come home...

If they are drunk but "decisional" they can sign out AMA.

Decisional is the ability to understand the consequences of your actions. Some of our FF drunks are decisional no matter what the BAL says.

"Competent" is a legal term, as another poster stated. We try to avoid that term because competence is decided in a court of law not an ER.

As far as people who are given narcs and then try to drive home...

Direct line to the PD...thank you very much!

Gotta love those boys/girls in blue!

lil'nurse · Jun 14, 2005

I think the word of choice is incapacitated rather than incompetent. We go though this all the time. Legally in our state, we have an incapacitated hold where an MD can hold a person on our locked psych unit until they sober up.

Our unit uses a criteria where the BAL drops 0.04/hour, example admit BAL 0.40 at 0100 will be 0.36 at 0200 and so on until BAL is estimated at 0 and pt is showing no signs of intox. Can be difficult to judge, some long term alcoholics can have a BAL of 0.35 and seem o.k. other than slurred speech, while another pt is passed out cold. More difficult to judge with illicit drug use.

mommatrauma, RN · Jun 14, 2005

This comes up a lot in my ER as well.
What happens when an intoxicated person refuses transport to the ED by rescue?
What happens when a well intentioned friend brings them in drunk and they refuse treatment?
Our "legal people" don't have clear cut rules either but we try to use the right terms and document until the cows come home...
If they are drunk but "decisional" they can sign out AMA.
Decisional is the ability to understand the consequences of your actions. Some of our FF drunks are decisional no matter what the BAL says.
"Competent" is a legal term, as another poster stated. We try to avoid that term because competence is decided in a court of law not an ER.
As far as people who are given narcs and then try to drive home...
Direct line to the PD...thank you very much!
Gotta love those boys/girls in blue!

Just to play a little devil's advocate...Just because your drunk is "decisional" doesn't mean legally they aren't drunk, which is very possible in your chronic alcoholics...so when they sign out AMA...do you allow them to get in their vehicle (if they have one) and drive themselves home? I'm sure there could be huge issue made for the drunk that drives home that was "decisional" and god forbid gets in an accident and kills someone and that family finds out his was at your hospital...you can bet your behind that someone will be coming to the hospital legal dept with dollar signs...This is such a gray area its really difficult, there are so many fine lines it really makes you think...It can really make for a bad time.

nursemike, ASN, RN · Jun 14, 2005

Well, this is fun. So...isn't calling the police to report a d/c a HIPAA violation?

Nurse Ratched, RN · Jun 14, 2005

Well, this is fun. So...isn't calling the police to report a d/c a HIPAA violation?

I can see calling the police and suggesting that you may have seen someone staggering toward a car in the hospital parking lot... The car has no right to privacy and may be described.

nursemike, ASN, RN · Jun 14, 2005

I can see calling the police and suggesting that you may have seen someone staggering toward a car in the hospital parking lot... The car has no right to privacy and may be described.

Seems reasonable. Quoting blood test results would be clearly unethical. Reporting what any passer-by could see seems more legit. Still, I think I'd use a pay phone.

mommatrauma, RN · Jun 14, 2005

Well, this is fun. So...isn't calling the police to report a d/c a HIPAA violation?

You wouldn't have to say anything about the patients information...a simple I see a subject who appears to be intoxicated attempting to get into a car...nothing hipaa about that

JessicRN · Jun 23, 2005

I think the word of choice is incapacitated rather than incompetent. We go though this all the time. Legally in our state, we have an incapacitated hold where an MD can hold a person on our locked psych unit until they sober up.
We are the local drunk tank for three towns in Boston MA anyone who comes in with alcohol on board is tested and they cannot leave until their BAL is less then .80. EVERY drunk is stripped of there clothing and jewellry whether they like it or not forced to have a Tox screen. If their BAL level is high (.200) they recieve thiamine and an banana bag. If they refuse they are restrained with 4 pt leathers and the stripping (done by nurse) lab or IV is done against their will and they stay restrained until they comply or until the ativan and haldol we give them kicks in. On a rare occassion if a family member is present the patient can go home but most of our doctors do not allow pt to go home until they are sober. As a result we can have up to 12 people in our unit at a time all with elevated BAL
If they refuse. Many of our pt are walking talking without difficulty and it does not matter. Anyone see a problem with this. I do and there is nothing I can do according to administration.