Mental health pt in ER...

[natrgrrl]

I need opinions from ER staff about caring for mental health patients in the ER. Is your facility equipped to handle these patients? If not, how do you handle them?

[teeituptom, BSN, RN]

Give them all geodon and ativan

[TXTraumaRN]

The ER I currently work in was just opened in Jan 07 with 1 "psych holding" room designed for it. The idea was that all psych pts would be placed into the "holding" room in chairs with a room next door for the psychiatrist to do psych evals. Needless to say, the nursing staff (the ones who actually take care of these pts) did not have input into this decision. Placing the crazies together makes sense to me. Both rooms have now been outfitted with stretchers and security is assigned to both rooms at all times. This does not address the other psych pts who have to be put in regular rooms (they get security presence if they are under an emergency detention). This hospital does have inpatient psych and is a private facility and the security is the rent a cop hospital security.

Now, the last ER I worked at had 2 seclusion rooms with 12 inch thick doors that locked like a bank vault. These rooms had absolutely nothing in them except for a chair and stretcher ( no outlets, nothing). :)There was law enforcement officer in uniform (PD, SD, State Trooper) in the ER at all times, at the nurses station. They sat in front of these two rooms. This hospital was a county hospital with no inpatient psych.

Most days, we don't have too much trouble with security and the psych pts at the ER I work at now. However, there are times when I would prefer to have the presence of law enforcement.....something about the uniform tends to make the crazies behave a "little" better.

The one that uses actual law enforcement as ED security did so only after we had 2 nurses held hostage and raped in the ER by a prisoner. (That particular ER is in a city that is home to a maximum security psychiatric prison). They also implemented what we called the "cage"; a 2 cell holding area that was only big enough for a chair in each that could then be padlocked until the pt was stripped searched. This was just inside the EMS bay. It literally looked like a jail cell. This was were most of our Miranda pts were placed.

[AirforceRN, RN]

1 room with Audiovisual and the garage door thingy. 1 door that locks and a "bubble" window so you can see all four corners of the room without opening the door.

[mamalle]

we do not have set rooms for pysch patients. any given day we can have 10-20 patients coming in for medical clearance to go over to the mental health institute on our property. They come from all over the county. we do have them undress in to a gown and have security stand by. Its quite a bit of our patient population in our ER. we do have restraints and geodon for those agitated individuals. I feel its a growing epidemic here in our area. some days we are holding due to facility being full besides the ones waiting for medical clearance. Im just waiting for another sentinal event to happen in our ER. We had one a few years back when a guy barricaded his room with a chair and proceeded to bang his head up against a glass picture and used the glass to filet himself, it was right out of a horror film.