Published Jul 23, 2005
After working 19 years on the same acute adult inpatient unit we have just gone to plastic cutlery as the result of an incident which didn't even involve utentsils. I have been asked to research this from a safety perspective. So, does your acute psych unit have plastic or metal cutlery? Have there ever been incidents of aggression using cutlery? If the patients are opposed, does the research support use of plastic cutlery? Any and all comments welcome!! :smiley_ab
The airlines all use plastic utensils, you would think that a psych unit has always done the same.
P_RN, ADN, RN
The last time I looked was still metal, with a eagle eyed aide who kept count. Of course most of the patients were there for ECT and couldn't remember anything much less what to do with a knife.
Where I worked in psych they used plastic. I was new to psych so there were some clinical things I had not seen or considered. Now I am of the opinion whether it is metal or plastic utensils they should be counted. That was not the policy or practice of this facility.
Amazingly, I had a young schziophrenic patient find a novel place to hide a plastic knife. She was also a self mutilator because the voices told her to do it. She would cut her arms, legs and stomach. After she was found to have cut herself a room search per doctor's order was done but nothing was found. It took us about 6 hours to figure out where she hid the utensil.
Off topic - I had another schziophrenic patient who found comfort in having rock in her pockets. She would pick them up during smoking breaks. There was one psych tech for 14 PICU patients. Eventually, I saw her solution to our confiscating and redirecting her from putting in her pockets. Guess where she started carrying them?
In both cases, they hid them in the vagina.
Whispera, MSN, RN
I've worked in two psych hospitals. In the first, we switched from metal to plastic silverware after a patient tried to cut herself with the metal. And, we always had to get a correct count of silverware after meals before the cart could leave. Of course, a person can hurt him/herself with plastic silverware pretty easily too.
In my second psych hospital it's all plastic, but probably to avoid having to wash things...
The facility that I work in uses plastic untensils. We have had pts.
use even the plastic utensils to cut on themselves.
As other posters have mentioned, the important principle with either type of utensil, is a good count at the beginning and at the end.
On the unit where I used to work, we tried both. We ended up using metal for normal days and plastic when the unit (child and adolescent) was in lock-down and everything had to be disposable.
Personally, I think plastic is more hazardous. Metal butter knives take a heck of a lot of pressure to cause damage. Forks cut more easily. Spoons don't do much at all. But with plastic, all you have to do is break a piece off any of them and you have a lethal weapon. Even breaking a tine from a fork can be cause for concern.
On really scary days, the kids had to have finger foods--no utensils at all.
There is no substitute for good counting and observation, no matter what the patients are using.
I don't work in psych but we have a few psych patients anyway, one of whom managed (despite a vigilant patient attendant) to bend down three tines of his fork, leaving one of the centre tines pointing straight ahead.You really wouldn't need to use much force to do real harm.
On the unit, we use plastic spoons. We very rarely use plastic forks, but when we do, each and every one is accounted for after it's been used.
When the patients go to the dining room, they use metal cutlery (no serated knives). Not everyone is allowed to go to the dining room.
I'm a nursing student, just finished a rotation in a state children's hospital. In the cafeteria, there were metal utensils, which I'm sure were counted. In addition, not every patient was permitted to eat in the cafeteria. For those eating on the unit, metal was not allowed--plastic or finger food, depending on the patient and condition. I realized that someone who really wants to hurt themselves can be quite creative, after seeing self-inflicted wounds that resulted from plastic utensils, pencils and ball point pens.
Many things can be turned into weapons - personally I'd prefer to struggle with a patient over a plastic knife than a metal shank anyday. I've seen weapons created from many items - ballpoint pens, plastic combs, brushes, spatulas, toothbrushes, popcans, the metal tag inside a doorframe, screws & tools left behind by careless workers. They have all frightened the bejeebers out of me when they were discovered.
It isn't only what a patient can do in attack mode. Some of our most creative device makers were the self-mutilators. We had gone over our unit well, removing glass-covered pictures, trading metal curtain hooks for plastic button fasteners, substutuing plywood sheets for sharp bedsprings, etc. We thought we had found everything. But one of our cutters was determined. She found a spring inside the roller bar for toilet paper and had at her inner arms. Then there are those who head bang or bite themselves. Where there's a will . . .
For a while, we were doing exit interviews--low key and non-threatening--with child and adolescent patients to get them to tell us how they smuggled in contraband and committed other infractions right in front of us. They knew we weren't going to keep them in longer, even if they confessed to handing out cigarettes to the five year olds and it became a kind of badge of honor and pride for them to brag about how they bested us. We didn't believe all they told us, but they did give us tons of good info for things to keep an eye on in the future. They didn't realize that some of them would be coming back to us so they were, in effect, narcing on themselves down the road.
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