We have recently had a few patients in our unit that have been evaluated by the psychiatrist and the psychiatric consult note states something like "Patient is not allowed to leave against medical advice because he lacks insight into his current condition. Patient has been cleared for suicidal or homicidal ideation and does not require a 1:1 sitter." These patients have generally been detoxing from alcohol, either because they presented to the ED asking for help with detox resources (rarely), or people they were admitted for acute pancreatitis (usually). My concern is when a current patient became belligerent and agitated we had to put him in four point restraints and use medications like geodon to keep him and our staff safe. At the time he appeared alert and oriented to person, place, time and situation. He was demanding to leave AMA and threatening both physical violence to staff and legal actions to sue us for unlawful detention. He has a relative who is a lawyer that called into the unit and threatened similar action. Now, as a nurse I have a progress note from a consulting physician with a line in it that says patient can't leave AMA. I don't have an order, and as it has been explained to me, a PEC is not valid for patients receiving medical treatment, only patients that have been medically cleared and are receiving inpatient psychiatric treatment. I don't feel like a line in a progress note is sufficient to protect my license if one of these patients sues us. If a hospitalist writes "patient needs lasix administration" in a progress note, I don't administer lasix, I followed the prescribed orders in the chart. When I questioned the psychiatrist about this I was dismissed with a condescending statement that "I don't know how your nursing license works, sorry, but if you read my progress note you can see he can't leave". I was told there is no order associated with that note, but system wide that is sufficient to keep a patient against their will. I've tried numerous Google searches and checked scope of practice guidelines, but I don't see anything that appears to cover this issue. Does anyone have any insight? Thanks for any feedback.
