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5150 patient absconded from the ER........

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West_Coast_Ken, BSN, RN

Specializes in Case Manager, Home Health.

He...had absconded from a halfway house in another county yesterday morning.

RN = Medical care

CHP = Enforcement

Seems clear to me who's responsible for this pt running off and it's not you. Also, did the officer know about the pt running off the day before? If so that's another stike against him/her.

RN = Medical care

CHP = Enforcement

Seems clear to me who's responsible for this pt running off and it's not you. Also, did the officer know about the pt running off the day before? If so that's another stike against him/her.

Oh yeah! He even called the facility and they told him he was not welcome back. His reasoning for leaving was that the pt was cooperative (to a point...we had to explain everything very clearly and rationalize it before he would let us touch him) so we should be able to handle it.

5150's are supposed to be placed in the room closest to the desk but we were full. Plus I was overextended because my fellow nurse was tied up with a 1:1. Yes, I know that I did all I could personally but I'm kicking myself because I should have either insisted the cop stay, or I should have insisted the house supe find me a sitter. I did neither because I let myself be talked out of it.

My opinion is that this is entirely the doctor's fault. The doctor should have properly assessed pt's mental condition and ordered one on one care if this was needed. The doctor should have also ordered the proper restraints if pt was a harm to himself or others. I actually dont feel this way but since all the blame seems to go to nursing, it just makes sense for me to play the game too and pass the blame.

The whole situation is ridiculous. Law enforcement (yes I love them, and have family members who are police) have some responsibility for the emergency crisis we are facing now. Somewhere along the line, one of them thought, wait a minute, why should we spend our time and money monitoring a drunk pt, the ER is open and they have to take patients! Or lets take this pt to get a drug screen at the ER. Ultimately law enforcement and other community resources are misusing the ER along with the general public.

You arent the policeman's supervisor. You cannot and should not have to tell him what to do. You were pretty much alone after he left. So what would you have done if the patient had become violent and ran toward the door? Would you have took him down and arrested him? How can you provide one on one care to this man when there are other patient's who need you?

I probably wouldnt have given the man silverware, but hindsight is 20/20 you know. I did work the ER and I dont feel that anyone should be eating in it, as it for the most part is nasty as can be. I also feel that if you have to go to the ER you really should be too sick to eat (for the most part, yes I know there are exceptions such as pt's who are hypoglycemic).

Anyway, in no way can I see how you are responsible for this mess. You along with most of your patients are the victim of a failing emergency care system where you literally have pt's dropping dead in waiting rooms, have sick people waiting often for hours for a bed, etc.

I did work the ER and I dont feel that anyone should be eating in it, as it for the most part is nasty as can be. I also feel that if you have to go to the ER you really should be too sick to eat (for the most part, yes I know there are exceptions such as pt's who are hypoglycemic)

Oh, I have to comment to this. Here's an example. I had a woman who had been bitten by a cat. She came in the late afternoon and had to be there for several hours because a medication that she needed we didn't have and had to send to another facility for it. She was there over the dinner hour and was hungry. We shouldn't feed her? And this 5150 had not eaten since the night before, so he was going on 24 hours. He was medically fine. We shouldn't feed him?

ERNP

Specializes in ER, critical care.

I wouldn't beat myself up about this. I don't live in CA but as far as I am concerned whoever initiated the involuntary psych paper trail has the responsibility for seeing that the patient remains in the intended environment.

When I initiate such a paper trail, I also initiate an order for security to monitor the patient one on one. If it is something security can't handle the police are called to assist with the situation.

In your case, if the paperwork was initiated by the CHP, then they had the responsibility for seeing the proper environment was maintained. Even if that meant they had to sit there for 3 days.

For goodness sake, the police sat for 12 hours the other day with a dead body that was a coroner's case. They can certainly sit with the living in need of assistance.

Oh, I have to comment to this. Here's an example. I had a woman who had been bitten by a cat. She came in the late afternoon and had to be there for several hours because a medication that she needed we didn't have and had to send to another facility for it. She was there over the dinner hour and was hungry. We shouldn't feed her? And this 5150 had not eaten since the night before, so he was going on 24 hours. He was medically fine. We shouldn't feed him?

I said there were exceptions ;). Unless you have a top notch housekeeping crew that disinfected everything after each pt, I still would never eat in the ER. There are just so many bugs (mainly causing gastroenteritis)you can pick up. The examples you bring up though are my whole point and to be honest that is another post and argument which has been fought too many times. Unless someone has developed cellulitis from a cat bite, it really isnt an emergency. A routine medical evaluation for a psych pt isnt an emergency.

I will use this case as an example, the pt that eloped needed psych treatment. He needed counseling, possible medication change, close monitoring in a protected environment, etc. But what happened? He didnt get the treatment that he needed because he was in the ER. A RN cannot babysit another pt in the ER, unless you want someone to die--it is that simple.

My whole point it to not beat yourself up over this. You are doing everything you can, the system is a failure, that isnt my opinion that is from recent studies. The pt should not have been brought there unless there was a medical need, if the patient was brought there with the police, the police sure shouldnt have dumped him and left.

NurseCherlove

Specializes in Med/Surg; Psych; Tele. Has 3 years experience.

5150 is the CA state code for someone who is a danger to himself or others and needs to be commited involuntarily. No, he was not free to go. I say it was CHP's responsibility since they were the one who initiated the hold. Doc says CHP didn't need to stay because he wasn't under arrest. No, we do not have a written policy. Manager is going to a seminar next month about 5150s and is going to bring up this situation and ask what our liability.

I have never heard of a 5150 before (of course why would I, I live in GA) and I had always heard of those type cases referred to as a 1013. I guess I learned something new today....I thought 1013 was some official code that everyone everywhere used (in the US) - I did not realize it was a state code.

I have never heard of a 5150 before (of course why would I, I live in GA) and I had always heard of those type cases referred to as a 1013. I guess I learned something new today....I thought 1013 was some official code that everyone everywhere used (in the US) - I did not realize it was a state code.

Same with me! When I first started nursing I thought 5150 was used everywhere, until I found out it was the code in California!!

Unless someone has developed cellulitis from a cat bite, it really isnt an emergency. A routine medical evaluation for a psych pt isnt an emergency.

The cat bite is an urgency, which qualifies for an ER visit. She needed IV abx as well as a HyperTet, neither of which the PMD's office would carry/do. Cat bite cellulitis, as I'm sure you are aware, can result from a bite within hours, so quick treatment is essential.

Psych pts on a hold are considered an emergency also. They have a medical problem that, if left unattended, can escalate (or decomp, depending on how you look at it) to a life-threatening problem if not dealt with.

I am not trying to argue with you, but you and I just see things differently. I understand your point of view, I just don't agree with it.

As for feeding pts, it's not something we do routinely, believe me!

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