medically cleared?

We generally take it to mean no IV lines and stable vital signs, but there are always those that end up being shipped back off our unit again.

we have become a de-facto

med-psych unit

so 'medically cleared'

now means

not currently coding.....

we have IVs, O2, etc.

no respirators yet!

I have had pts transferred to our psych unit from another hosp.

where the physician medically cleared the patient (pt with history

of COPD) said the pt was hallucinating. Asked for ABGs this

MD was offended asked about labs he said, "pt needs psych

she'll be there in 30min"

This hospital and the hospital I worked at r in the same corp.

The pt arrived to the hosp. When EMS was bringing pt

off the elevator the pt went into resp arrest we had to code

the pt--was successful and transfer to ICU. Pts ABGs were

out of whack. After pt was stable med. confusion and hall

miracleously vanished. This same doc sent us another pt

he said was medically clear and went straight into ICU

due to ABGs out of whack again.

We also established a policy that any pt we were going to

admit either brought with them a statement from their family

doc of med. clearance with routine set of labs: cbc, thyroid prof,

EKG, bmp, ua any abn doc was to address if not referred by

family doc they were seen by our ER and medically cleared

with the above labs done also. When we received a call

for referral we informed the referral source that we would

consider them for admission but they have to be medically

cleared prior to arriving on our unit that meant statement

and results of labs.

Any requirements do need to be supported by administration, and understood by administration, otherwise the education needed to maintain basic legalities and safety falls on the charge nurse. This is an exhausting proposition in many ways: sometimes the charge nurse is the everything (ie. only) nurse on a smaller unit, and the "teaching" involved is time and labor intensive.

There's also the stress involved in what seems to de-evolve into arguments. Example, I was recently given report on a "drunk old woman" that involved NO labs, not even an etoh level. My question about the level of intoxication (blood alcohol), was met with irritation and ER doc complaints about the demanding nurse, along with a tangential "the pulse ox is OK". The psychiatrist whom I notified advocated the path of least resistance, basically to let the ER doc take responsibility for declaring medical clearance and accept the lab-less patient. Certainly one way to reduce stress.

Anyway, one of many examples, where you just have to hope, it seems, that the patient will be OK on the non-medical psych unit and that on the issue of accountability, the RN will be able to place the budren of responsibility where it really is. Of course, I have taken to being very thorough in my documentation (on the nurse-to-nurse report sheet), jotting down what I ask about and the responses given. I consider this part of the admission paperwork if patient arrives to unit. I don't seek to make trouble for the fallible organization I'm employed by, but clearly, there is a need to protect one's professionalism and livelihood, along with patient safety.

I am a very experienced and capable psych nurse, have never been nor will ever be a critical care RN, and last worked on med-surg about 15 years ago. I make no bones about my strengths and non-strengths and refuse to be unreasonably exploited (just reasonably so? ;-) The guidelines and awareness shared by other posters on this thread are appreciated.

Dear Nurse Ratched

thanks for your support!

our unit has to take involuntarily detained patients

and over the years the interpretation and use of the law has widened.

I have had experience on this same unit for 21 years and 'mental disorder' now includes patients it did not in the past.

we are a dumping ground for nursing homes and DD residences

also, in this last year we cared for a full torso burn pt. and for pts. with broken bones [HIP, pre and post surgery] Many pts are detained for diabetic or renal non-compliance.

I'll say it is interesting, but the challenge of maintaining a theraputic environment is tricky!

yes, you've got it, there has been tremendous staff turnover

and psychiatry is a stepchild

But I am in it for the long haul

and am fortunate to be a part of a large group of mental health workers

[husband, friends] who have all been 'called' to the work.

Unfortunately, in the nursing "world" of blond-haired, blue eyed perfect specimens, we psych nurses have been the red-haired, bastard step-children. In the unit where I work, we receive ER patients for psych who have "medically cleared", but will code once they arrive to our unit. I think the docs don't give the psych patients any creedance because 1). they are afraid of the psych patients or 2) the patients have difficulty explaining what is wrong. We have had a number of elderly arrive to our floor, diagnosed as dementia, when they really have a delirium because they have a UTI ( or low potassium, or anemia, etc) and had the doc even done the minimum "medical clearance" (such as order a CBC, for God's sake) he would have found this.

I think that it's unfortunate, but we are going to see more medically compromised psych patients. Managed care has made it significantly more difficult to be admitted to a hospital. This will translate into a high incidence of medical co-morbidity for the psych patients that ARE admitted. Our unit not only takes IVs, we also are doing NG tubes, PEG tubes,TPN, tube feeds, PICC lines and Central Lines. Sometimes I think there's no such thing as "pure" psychiatry anymore. When I get a report from the ER stating that the patient has been "medically cleared" for admission to the unit, I ask for the name of the doctor who medically cleared him.

Our medically cleared get UDS and BAL prior to coming to the unit from the ER. Suffice it to say that does not medically CLEAR anyone and there are many problems with getting medical doctors down to our unit in a timely manner. Unless it is an obvious medical problem, it is missed until we pick it up on teh nursing assessment.

sorry, but what is BAL? basic....?