Privacy and Covering My Arse.

[TsavarenaRN]

Just in short, had a doc treat one of the psych inpatient children with blatant disreguard to apropriate restraint and seclusion technique. We use CPI, not sure if many other facilities do. Pt was turning over furniture and loudly swearing. Def disruptive to milieu and poss danger to other pts, so def a reason for restraint/seclusion according to our facility guidelines. Doc placed the pt in seclusion using a very less than apropriate technique to 'escort' pt while I chased behind them asking the doc to stop, support staff was on the way, we could easily carry pt. Doc refused, told me to get out of the way, chunked pt in the room, closed the door and gave me a VO for some PRN med for agitation. Where I work, VO orders for seclusion are not allowed, no exceptions. I attempted to ease into the docs office a few mins later with the chart to quietly remind her/him to please write the order for the restraint/seclusion (had the doc order page flagged so she/he could flip it open and write what was needed easily, I knew docs temper was still pretty up there) and was given the irritated 'wave' of the hand meaning, "get out I'm busy." So I slipped the chart on the desk and got my butt out of there.

Few mins later I see the pts pushing the chart cart back to the nurse's desk and catch the doc slipping down the stairs. No orders written. I called to have doc paged with no response.

Sooooo what I did write was an inter-facility incident report and chart a narrative progress note on the pt. on what I saw, and who did what. No personal opinions, accusations, or assumptions inserted; just the very blunt, objective type of charting I was taught in school and have always used. Incident report was for the way the pt was handled, progress note just to detail the circumstances of restraint/seclusion, when the pt was released, were they hurt, behavior on release, etc. We typically have a form for when we have to call the doc to restrain or seclude, but it is set up for TO ONLY. So I just wrote a narrative, feeling that filling out the TO order packet would be just plain lying. I didn't point out the doc and say "She/He abused a pt!!" or even write the word at all. Just the bare bones facts. I also told my nursing supervisor and left a voice mail to our facility pt. advocate that I needed to speak with her about pt. #00000.

Monday morn I get a call to come in and meet with the higher ups to talk about the incident, but after a 30 min wait past our agreed appointment time, I told them we would just have to reschedule, I had to be at my other (full-time) job. They were not very happy.

Phew. Not so short. Anyway, my real question is, since our facility has a problem with 'losing' important paperwork I copied the work I had done that night blocking out all identifiable info except for the pt account and medical record number, which is unique to the facility and is only accessed by staff. Just in case I may have to go to court or whatever. Is this info usable? Was there a better way to handle this situation?

[Thunderwolf, MSN, RN]

I would have printed out/copied the incident report just made as my back up copy of reference.

[Orca, ADN, ASN, RN]

I believe you handled it well. Document only the facts, what you saw and heard. I hope that you also documented somewhere the doctor's reaction when you tried to obtain an order. I find it odd that your facility doesn't allow VOs for seclusion - I used to take them all the time, if the doc happened to be on the unit when an incident occurred. As far as the form for routine seclusion orders, unless your facility prohibits it I would just line out TO, write in VO and initial the change.

Keep your copy of the incident report.

[Whispera, MSN, RN]

I tend to make copies of anything I think I might need later, and keep them in a very safe place.

[johnsavv]

i wish you the best of luck... i feel very disenfranchised with Psych nurrsing.... not the pt's or type of work but mostly the 'higher' ups..... You'll be in my thoughts and one thing always pick your battles with the docs carefully....

John

[aloevera]

You handled this situation appropriately....we can use VO's at our facility so I think I would agree with above post and change TO to VO and fill out the necessary paperwork. Copy everything, as you did, just in case....

I wouldn't be so quick to use the word "abuse"......At the time, it may have been the most effective way to get the pt in the room....and away from other pts........you didn't say that pt. was harmed in any way so that is good...where is the abuse??

good luck.....

[Valerie Salva, BSN, RN]

So, what happened?