Involuntary commits in ED and VS requirements??

[welnet66]

Hi Everyone,

My director has asked that I rewrite our Seclusion policy for our ED. The reason is when a psych pt. comes in and is either an involuntary commit or becomes one while in our care, we continue assessing their vital signs as often as the other acute patients in the ED....which is every hour unless more frequent vitals are needed. The issue is, we are a critical access facility with no psychiatric beds nor a psychiatrist. We clear the patient medically and transfer them to a psychiatric facility. The psych facilities are always too full, have too high an acuity ect ect. so we end up housing the patient in the ED for days.

Why take an hourly vital sign on a medically cleared psych patient waiting for a bed in another facility? Well, my director wants our vital sign frequency the same as what's required by CMS. CMS has requirements for many things we do in hospitals, how often to take vitals on a stable, medically cleared ED psych patient isn't on the list.

What does your ED do? How often do you assess vitals on a medically cleared psych patient? Do you determine an acute phase for the first few hours till all the lab tests come back and then change them to an observation phase??? Do you assess vitals just as often as a chest pain? If there is a CMS requirement for vital sign frequency on ED psych patients or for any ED patients...does anyone know where I can find this info?? Thanks!!

[chloecatrn]

Could you contact the psych facilities in your area and find out what their procedures for vital signs are? I know that the psych hospital in our area does vitals daily. Given that you're an acute care medical facility, you may want to do them more frequently just to justify care. The medical directors of those facilities may be able to give you a better idea of what would be appropriate for your setting.

[megalynn1219]

In our ED: Once a psych patient is medically cleared vitals are obtained q4hrs.

[emtb2rn, BSN, RN, EMT-B]

We also go to q4 vs once medically cleared.

[GGT1]

Q4h where I work

[nuangel1, BSN, RN]

we do q 2 hrs in my ed

[WonderRN]

Q4 whether or not they are medically cleared. Unless the initial set was unstable or they are an intentional ingestion.

We take all the vital sign machines, cords, "stuff" out of the psych rooms and often have 3-4 watched by one sitter. Taking VSS every hour would be crazy to have one sitter do. Plus, I would think this would contribute to the patient's agitation- they really have no time to rest/sleep when they are being squeezed hourly.

[welnet66]

Thanks everyone. I agree with the Q4 hours after medical clearance...it just makes sense. I still can't find what medicare/medicaid requires. I will propose the q4 and appreciate all your help!!