is this normal? (tmt of pt)

[beachbum3]

So I'm graduating in a couple of weeks and have a job lined up in the ER. I did my capstone experience in the ER (follow a nurse for 3 12 hour shifts) and saw something I was wondering about. I will try to condense this so its not incredibly long.

Pt comes in for chest pain. No abnormal findings as far as I know (wasn't my patient). Pt is incredibly intoxicated. Pt is not allowed to leave (this is what I was told) unless someone comes to get them. Wife was at work, could not come. Pt decides he is leaving. Have to call security, put in restraints. He is in room right across from nurses station, and was being a serious PITA. Every 2 seconds hollering out for a nurse, asking for the restraints to be taken off, to go home, for a drink, for food, for the phone, to apologize, to cuss us out etc. You get the idea. Finally he calmed down a bit, they took off all the restraints except the one on the ankle. So he is sitting up in bed, complaining about his heart burn and kept asking (begging practically) for a drink of water. Dr says no because then he will have to pee. A nurse did give him a cold lunch box after awhile, but nothing to drink. I guess finally after 6 hours or so they decided he was ok to discharge, but he'd be on foot. His wife was on the phone and said she could be there in an hour and a half or so. It was not busy, we basically had most of the beds open. The staff decided that he needed to leave anyway, couldn't wait for wife to get there. They discharged him dressed in a undershirt style teeshirt and a pair of jeans and it was in the 30s outside, knowing he'd be on foot.

I know the guy was a PITA, (I was as irritated with him as everyone else) but it kind of felt not right that he wasn't allowed anything to drink for hours, and that they sent him out like that with it being cold outside. I figure I'm inexperienced and don't know anything, so perhaps its just the inexperience talking and wanted to ask others who had more experience their thoughts on it. What do you think? Is this standard life in the ER?

[nightmare, RN]

well to be cynical, having worked in casualty and been equally irritated and abused by drunks they were probably glad to get rid of him. Casualty staff have a fairly low tolerance to self inflicted injury/illness.

[beachbum3]

I wanted to add, I didn't judge, and won't, I just wondered if this is part of the difference of real world and school, or if it could/should have been handled differently.

[Blee O'Myacin, BSN, RN]

I can only say that in the ERs where I've worked, we could not discharge an intoxicated patient. But we do give them a banana bag and let them sleep it off. If a danger to self and others, restraints are applied and security is called. If they leave without being pronounced "sober" and discharged by the MD or PA, then we call the cops to have them brought back.

As for discharge on foot without a jacket, well, he could have waited in the waiting room following discharge for his ride, or called a cab. It is not the nurse's responsibility to ensure that all AAOx4 discharged patients are properly dressed for the weather. I do, however, make sure they are wearing pants! (If they had to be cut to be removed, etc.)

Personally, I would have given him a drink and a urinal. Better that than having him urinate in the bed.

Blee

[nightmare, RN]

I would like to add it was a bit mean not letting him drink water.Alcohol makes you dehydrated anyway.

[Larry77, RN]

Also our policy is to have any person in restraints a 1:1 with a tech so they can watch for distress. It is especially dangerous to have a drunk in 4 point restraints d/t aspiration risk.

In bad weather we are more likely to give patients a taxi voucher as well.

[beachbum3]

now that you said that about the voucher, I overheard his nurse say she told his wife we were out of vouchers, then said "I'm not giving him a voucher, he can walk"

As far as the 1:1, He was in a room right across from where I was sitting, and I was watching him pretty closely to make sure he didn't get out (he actually did once). we had no other patients during the time he was in restraints.

[MBCRNA]

Part of the required assessment/treatment in restraints for any reason is with medical restraints q2 h to offer water, to urinate/bm, etc. In his case, he is in behavioral restraints which require 15 minute checks for these same things (I didn't list all). So to answer your question, not offering food or drink to a patient that is not NPO is ILLEGAL. I hope this answered your question. Yes, you were right...something wasn't right about this.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Beachbum

When I transfered to ER a little over a year ago I too was amazed at the way many of our intoxicated (ETOH or other drugs) pts were treated. Even though I'm not a new nurse I was the one who thought "hey these are people too", "he/she is someones brother/sister, Mom/Dad, etc". I felt sorry for pts that had such crappy lives that they stayed drunk most of the time.

While my compassion for these pts hasn't changed over time,.my thoughts on the proper treatment has. All of our intoxicated pts get a bannana bag and if they will leave their IV in will get TKO fluids after that. They are almost always NPO because they often vomit and choke. I have seen many, many pts that come to ER intoxicated several times a week,.and have had several regulars who will be there twice in one day. Many of our regulars will c/o chest pain rather than go to jail. Most of these pts have no home address, no health ins., no medicaid. It isn't unusual for some of these pt to owe the hospital several hundreds of thousands of dollars.

I do feel bad for these pts,.and as a christian I feel it's my duty not to judge and to help as much as I can. That said,.the hospital resources aren't mine to give away. I must do my charity work outside the hospital,.through my church etc. I do get very frustrated when my time and the hospitals resources are taken up with a pt who doesn't want my help,.has done this to himself, is often very rude and even violent. When my waiting room has 40 people waiting to be seen and 4 of our beds are taken up for hours by an intoxicated pt that will be here again in a day or too,.it just doesn't seem fair. Many of these pts want food,.warm blankets and a free taxi ride. I have had many occasions where I have provided all, to a pt who is crying and just wants to go home. I have also had that same pt return to the ER 6 or 8 hours later,.in worse shape than he was earlier only to find out the taxi voucher I gave him dropped him off at the local liquor store up the street. Did I really help this pt? I was kind and understanding and made myself feel better,.but I'm not sure I did much for him.

I guess my point is that the ER is not the place for detox,.sleeping it off,.or a place for a free meal and a warm nap. It may seem to outsiders that ER staff is rude and uncaring to these people,.when in reality we become frustrated that in a world with limited resources and a lack of quality health care for many hard working citizens, we are forced to spend so much of our time and resources on folks who will not even help themselves.