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Patients that interfere with another patient's medical treatment

Emergency   (1,852 Views 28 Comments)
by Mandy2016 Mandy2016, BSN (Member)

Mandy2016 has 2 years experience as a BSN and specializes in Emergency.

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

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6 hours ago, TriciaJ said:

 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.

 

I have found that the so-called "Do not readmit" list does not really exist. We have several psych patients that are on the so-called black-list but we legally cannot turn away a patient brought in by legal authorities and the patients and their families know this so when a respite is needed they manufacture a crisis the call the police. 

Hppy

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When things start to get out of hand a call to management is indicated.  I wouldn't wait until TSHTF.  Certain decisions have to be made by management, either the house supervisor or someone with higher rank.  Staff could be pulled from other units. But, management must know what is going on and the risks involved, or else, the staff nurses take the responsibility.  This is called "share the blame" if something goes wrong.  If I were house super and this was going on, I sure as heck would want to know about it.  I mean that is their job.

Since the shift is over, write down everything that happened and what could have happened and how this impacts patient care and REIMBURSEMENT for services.  I would consider it a near miss.  It should go to QI for analysis, etc. So procedures can be put in place to prevent this kind of chaos.

Just my take on it, maybe an idea or two.  

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OH, yea, I once had a drunk that hit someone head on in a car accident, he was not hurt, wouldn't you know ended up on my post-op unit. Getting out of bed, yelling where am I? etc. Keeping all my other patients up.  After about the 10th time of going into the room and quieting him down, I said, " If you don't shut up and go to bed and stay there, I will tie you in it."  Never heard another word, but another patient next door heard me and thanked me.  

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On 3/31/2019 at 10:15 AM, hppygr8ful said:

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

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

Hppygr8ful

What is CIWA and 5-2-50 Booty Shot?

 

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1 hour ago, brownbook said:

What is CIWA and 5-2-50 Booty Shot?

 

CIWA is an alcohol assessment scale. There’s also COWA (though they changed it to COWS), an opiate assessment scale. Based on the score, protocol can be put into place for the patient to detox safely (i.e score of 5-7 2 mg of Lorazepam can be given, 8-9 3 mg of Lorazepam, etc). 

The 5-2-50 might be 5 of Haldol, 2 of lorazepam and 50 of Benadryl.

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1 hour ago, pixierose said:

CIWA is an alcohol assessment scale. There’s also COWA (though they changed it to COWS), an opiate assessment scale. Based on the score, protocol can be put into place for the patient to detox safely (i.e score of 5-7 2 mg of Lorazepam can be given, 8-9 3 mg of Lorazepam, etc). 

The 5-2-50 might be 5 of Haldol, 2 of lorazepam and 50 of Benadryl.

 

 

Thanks

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RobbiRN has 25 years experience as a RN and specializes in ER.

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One more example of how the ER has become the catch-all for every other failing in our system . . . The cops used to haul drunks away, now they drop them off and leave. 

Can you get help if the patient across the curtain from your crashing GI bleed is an acute MI or CVA instead of a belligerent drunk who seems to be more manipulative than drunk? I'm just curious what qualifies for a re-allocation of resources.

 

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

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6 hours ago, brownbook said:

What is CIWA and 5-2-50 Booty Shot?

 

CIWA stands for Clinical Institute Withdrawal Assessment for Alcohol it is an assessment protocol used to assess levels of sedation/agitation along with Physical symptoms and how to medicate appropriately. It is a great help when dealing with patients that are intoxicated or in withdrawal.

5-2-50 stands for 5mg Haldol, 2 mg Ativan and 50mg of Benadryl given IM into a deep muscle - sends patient nighty night.

hppy

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sounds like your disruptive patient was scoring!!Librium To The Rescue!! Nighty night!!

 

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TriciaJ has 37 years experience as a ASN, RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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14 hours ago, Forest2 said:

OH, yea, I once had a drunk that hit someone head on in a car accident, he was not hurt, wouldn't you know ended up on my post-op unit. Getting out of bed, yelling where am I? etc. Keeping all my other patients up.  After about the 10th time of going into the room and quieting him down, I said, " If you don't shut up and go to bed and stay there, I will tie you in it."  Never heard another word, but another patient next door heard me and thanked me.  

You never know if they're going to thank you or rat you out for being "unprofessional".  Luckily by now they were all sick of him and were able to appreciate you looking out for them.

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Hoosier_RN has 20 years experience as a MSN and specializes in LTC, home health, hospice, ICU, ER, dialysis.

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On 3/31/2019 at 3:21 PM, MunoRN said:

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.

Where I live, if police bring (and usually drop off, then leave), hospital is keeping them for detox before jail. They do this to avoid lawsuits in the case that intoxication is more than ETOH, and so that pt can detox safely, for safety to other inmates and jail staff. Sometimes ER gets to be their holding area, as other beds are full 😡  

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Persephone Paige has 15 years experience as a ADN.

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Many moons ago we had a drunk patient who was admitted, he was even restrained, he still managed to loosen the restraints enough to pitch forward out of the bed and onto his head, severing his cervical spinal column. He was revived, but died a few days later. Luckily, his family was so sick of him, they didn't sue. I say this only because ETOHs are no joke. At an AA meeting a drunk woman was disturbing the meeting, they threw her out for being disruptive. She promptly falls down the front steps and cracks her head on the sidewalk. She sues...

These people will ruin your day. The company needs a better policy... But, the hospital will always err on the side of the patient and not the nurse. 

Too bad you can't send them to a padded cell with constant monitoring until they sober up.

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