Patients that interfere with another patient's medical treatment

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Specializes in Emergency.

Hello everyone,

First of all, big thank you to everyone who has taken time out of their day to read/reply to this. I'm an ER nurse who works in a VERY busy ER and often encounter patients who interfere with other patients' care in one way or another, but a few days ago I had an incredibly stressful experience. One of my patients, who was AAOx4 the entire morning, suddenly became unresponsive after an incredibly large GI bleed bowel movement and a large amount of bright red emesis. This patient was obviously critical to everyone around, which was, surprisingly, not the stressful part.

The problem was the new ETOH patient on the other side of the curtain. This person had 0 compassion for his critical neighbor and continuously screamed for food, attention, and more narcotics. When I (and about half a dozen other staff members) tried to explain he would have to wait until there was time to give him more attention, he began to scream "I'm a fall risk and I'm just going to get out of bed and fall and hurt myself, then you'll all be sorry," along with other alarming statements.

This patient made multiple attempts to get out of bed while screaming "here I go, I'm gunna fall now!" as I was either elbow deep in GI blood, preparing/administering drips, and trying to communicate with the providers to figure out what's next. This forced me to leave my patient countless times. Even though my other coworkers tried to help as much as possible, we had several patients that were just as critical, and we were stretched thin. There were no extra EMTs or security guards to act as a sitter (we never get sitters in the ER, it's not even an option for us) to keep him in bed, or at least stop him from falling.

I wish I could have moved him to a different room (but there were none), let him leave AMA, or put him in an overflow chair, but I knew he was drunk, and he would definitely have ended up hurting himself. That day I was more scared then I ever have been of losing my license or, worse, causing an innocent patient to die because of this ETOH.

My question is what could I have done? Put him in restrains for threatening to indirectly hurt himself? Could I have called the police afterword to press charges for interfering with another patient's treatment? If this ever happened again, what rights do I have (besides refusing the patient) to stop one patient from placing another at risk?

I would really appreciate any advice/ legal knowledge. Thank you all again so much for your time.

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Specializes in ER, ICU.

Oh for the old days. I work with a nurse who told me this. They would sometimes suture a patient's ear to the bed sheet so they wouldn't get up. True story, (granted this was a long time ago...). Close your jaw, now close your eyes, imagine, and SMILE!!

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Is calling security not an option for you?

And why were they giving narcotics to an intoxicated person?

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Specializes in Psych, Addictions, SOL (Student of Life).

sounds like a good time for a 5-2-50 Booty Shot

Can you start CIWA protocol in the ER where you work?

Hppy

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10 hours ago, Mandy2016 said:

(we never get sitters in the ER, it's not even an option for us)

You must be kidding. How are you handling all the SI patients?

Well, I won't critique you - I'm sure you did the best you could under the circumstances. ?

In this situation what I typically do is confer w/ the physician/ask for re-eval of patient and plan, and, as necessary, utilize chain of command to report the situation of additional bodies needed. I do request in a straightforward manner that we find a way to care for the intoxicated patient that doesn't involve me leaving my critical patient. I document these notifications.

Other than that, unless intoxicated guy is being worked up for a separate condition >> ??‍♀️. He can make his choices but one of them is not to stay in that room doing those things.

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Specializes in Med-Surg, Geriatrics, Wound Care.

While a fall is a fall, there are such things as "intentional falls". They don't quite get counted the same way.

Recently, there was a guy that had one (or more?) intentional falls a few years ago. Came back to the hospital a few years later hoping for a psych admission. I think we basically had to give him a safety contract against the intentional falls.

Not saying your guy would be able to do that. But, perhaps some ativan and throw some graham crackers at him when he whines.

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Specializes in Critical Care.

I guess I'm not really why clear why the ETOH patient is being allowed to just hang out and be drunk without any apparent indication for being in the ER, my suggestion would be to get his MSE done and send him on his way.

We have an obligation to prevent risks of injuries to patients where they aren't able to comprehend the risks they are taking. It doesn't sound as though this particular patient could have better expressed their understanding of the risks they might be taking by getting up, to the point of even using the term 'fall risk', in which case it's on them and there's actually not a lot you can do to keep them from taking that risk.

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Specializes in Emergency.
2 hours ago, JKL33 said:

You must be kidding. How are you handling all the SI patients?

Unfortunately, the budget at our facility greatly limits our resources. We always have between 2-5 security guards present, but it's basically up to them and any available EMTs to act as sitters for SI/HI patients unless they're in restraints. The hospital doesn't want to pay for many sitters and, unfortunately, the other floors get priority because they (basically devalue) our security guards and EMTs by considering them to be "extra personnel," instead of the essential personnel that they are.

Starting now, I'm going to really push to get us sitters. I'm sure my coworkers will support me and I'm hoping for the best!

Thank you for taking your time to reply!

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Mandy - I think this would be a great project to work on. Although it would take some organization and policy-setting and people might tend to balk at the idea at first, check out the idea of a (new) work role that is solely sitters/attendants who do not have all the other duties of direct care providers. Their exact duties and allowances can be put into policy - there are many patients who just need an eye on them and someone to alert staff if there is a (non-medical) problem, and there are many patients who, for behavioral/psych/cognitive reasons, can benefit from simply being attended/distracted, etc.

This has come about as a solution in places where there is a desire to really limit the need for restraints, for example.

It can be done.

Hope for the best.

??

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Specializes in Emergency.
7 hours ago, hppygr8ful said:

Can you start CIWA protocol in the ER where you work?

I actually hadn't heard of CIWA before, it seems like a great tool! We often get drunk patients who fall below an 8 and end up taking a bed for a whole night while much sicker patients are stuck in the waiting room or an overflow chair. This patient was about a 5 but because his blood alcohol level was so high, they considered him to be a valid enough patient to warrant a bed : / Thank you so much for teaching me about CIWA!

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Specializes in Psych, Addictions, SOL (Student of Life).
2 hours ago, Mandy2016 said:

I actually hadn't heard of CIWA before, it seems like a great tool! We often get drunk patients who fall below an 8 and end up taking a bed for a whole night while much sicker patients are stuck in the waiting room or an overflow chair. This patient was about a 5 but because his blood alcohol level was so high, they considered him to be a valid enough patient to warrant a bed : / Thank you so much for teaching me about CIWA!

CIWA has some wiggle room as the score is determined by both subjective and objective observations - Your patient's agitation alone could have been grounds for a higher score which would have allowed you to medicate him with Librium or Ativan. Scored for agitation, psychomotor disruption, was he sweating, hands shaking etc..... You can push them up a bit as the goal of CIWA is to keep the patient comfortable.

Hppy

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Does your department have regular staff meetings? This is a situation to discuss. I wouldn't want my loved one's life to be further jeopardized by a selfish drunken jerk in the next bed. Having not enough security officers to help is a staffing issue. I think your higher-ups should help you and your coworkers develop a protocol for situations like this.

Behaviour problems shouldn't get priority over a true emergency. I think I would have let the idiot just jump out of bed and deal with it after I was done with the emergent patient. I hope you found the time to document all his behaviour and statements. If someone is repeatedly disruptive over several admissions, they can be given a letter telling them they are henceforth persona non grata at that hospital.

You can tell situations like this really frost my cookies. Hard to contain my inner Nurse Ratched.

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