Privilges and other policies in adult in-pt acute care units

Meraki · Aug 10, 2007

if a patient is admitted involuntarily, do they receive permission to leave the unit unaccompanied for short breaks? ie smoking breaks

no, the only exception is if a pt is involuntary for a long time due to inability to care for self then we have made exceptions

do you allow patients immediate access their chart on verbal demand?

no, never, there is a process involved in seeing a chart

do you place patients in pj's on admission if they are deemed a flight risk? no

do you return a patients clothing to them when they have not been assessed by a psychiatrist? if a pts belongings have been removed it would have been done as a team decision and it is a team decision to return them, but nurses do do risk assessments and make decisions based on those assessments

do you allow patients to have unrestricted access to mp3 players or cell phones? no, no cell phones on the unit, mp3 players they can sign out for the day and return by 9:00 pm

i will think of more i'm sure, but i would really appreciate guidance and advice from others working in this type of environment.....

NPAlby · Aug 17, 2007

If a patient is admitted involuntarily, do they receive permission to leave the unit unaccompanied for short breaks? ie smoking breaks

WTF? Absolutely not especially BECAUSE they're involuntary and most likely need supervison. Oh and what are smoke breaks? I'm a travel nurse and only have been to one hospital where they had that (in a state facility in VA)Do you allow patients immediate access their chart on verbal demand?

I've yet to see a patient access to their chart. Most hospital have set policies on how patients are to access their records and usually not while they are inpt on an acute psych floor. Refer them to their treatment team. I would never just give a pt their chart.

Do you place patients in pj's on admission if they are deemed a flight risk?

In most hospitals yes.

Do you return a patients clothing to them when they have not been assessed by a psychiatrist?

Most places have some 24hr rule that you have to wait until 24hrs are up before allowed street clothing and/or an evaluation by their team (not the resident who eval'd them upon admission)

Do you allow patients to have unrestricted access to MP3 players or cell phones?

Again, definiely not. especially cell phones that may have cameras in them.

My question to you is : where the heck are you working? I mean that state and pt population-wise.

NPAlby · Aug 17, 2007

if a patient is admitted involuntarily, do they receive permission to leave the unit unaccompanied for short breaks? ie smoking breaks

[font="lucida console"]wtf? absolutely not especially because they're involuntary and most likely need supervison. oh and what are smoke breaks? i'm a travel nurse and only have been to one hospital where they had that (in a state facility in va)

do you allow patients immediate access their chart on verbal demand?

i've yet to see a patient access to their chart. most hospital have set policies on how patients are to access their records and usually not while they are inpt on an acute psych floor. refer them to their treatment team. i would never just give a pt their chart.

do you place patients in pj's on admission if they are deemed a flight risk?

in most hospitals yes.

do you return a patients clothing to them when they have not been assessed by a psychiatrist?

most places have some 24hr rule that you have to wait until 24hrs are up before allowed street clothing and/or an evaluation by their team (not the resident who eval'd them upon admission)

do you allow patients to have unrestricted access to mp3 players or cell phones?

again, definiely not. especially cell phones that may have cameras in them.

my question to you is : where the heck are you working? i mean that state and pt population-wise.

epg_pei · Aug 18, 2007

My question to you is : where the heck are you working?

Somewhere I may not be for much longer LOL

canuckRPN · Aug 19, 2007

wow, sounds like a major systems failure going in your work environment. I've heard of patient driven care but this sounds a little extreme. Hard to believe this is happening in Canada?

flpsychnurse · Sep 5, 2007

All the responses are correct. There is a difference between "rights" and "privileges".

Please read HIPPA regarding charts and your risk mgt dept has policies.This also applies to phones---cameras, pt privacy.

Read and follow your hospital policies. Otherwise, if something should happen, you are liable because you did not follow policy. You guys really need a staff meeting. Inconsistnecy amongst staff on a psych unit is a killer.

blackstarryskye · Sep 7, 2007

hi! sorry to hear of the inconsistencies on your unit, makes it hard to manage the unit well. i work on a 23-bed inpt unit taking adolescent to elderly patients, voluntary and not. here's what we do:

if a patient is admitted involuntarily, do they receive permission to leave the unit unaccompanied for short breaks? ie smoking breaks

we are not a free-standing unit, only a unit in the hospital. so, pts don't leave except for a rare pass or for d/c. we use nicotine patches.

do you allow patients immediate access their chart on verbal demand?

no, they must wait until after d/c, then go down to medical records, sign the approp. consent and get the records, not sure if $ involved.

do you place patients in pj's on admission if they are deemed a flight risk?

all pts go into gowns on admit and for 24 hrs for safety.

do you return a patients clothing to them when they have not been assessed by a psychiatrist?

not usually

do you allow patients to have unrestricted access to mp3 players or cell phones?

no; the thought is they need to be in groups. at free time, there is a radio system in each pt's room, there are puzzles/games, and a unit pay phone (which we control-turn off during groups).

hopes this helps!

bss

elkpark · Sep 7, 2007

All the responses are correct. There is a difference between "rights" and "privileges".
Please read HIPPA regarding charts and your risk mgt dept has policies.This also applies to phones---cameras, pt privacy.

The OP is posting from Canada, and HIPAA is US Federal law -- doesn't apply in Canada (although I'm sure they have similar confidentiality protections in place).

(To the OP --)

I can't imagine a US psych facility allowing an involuntarily admitted client to leave a unit unaccompanied, for any reason -- the facility could get into legal trouble for that (a judge has ordered that the client be detained; if you allow them out without staff, you're not following the judge's order. No different (legally) from a jail deciding to unlock the doors and let prisoners go!)

US hospitals are rapidly going completely smoke-free, so smoke breaks (for any clients) are becoming less and less of an issue. Much more use of nicotine gum and patches to manage clients' addiction while they're inpt.

I've worked on a number of adult psych units (in the US), and none has allowed clients personal (cell) phones -- the unit provides a "public" telephone (a direct, outside line not connected to the hospital's own telephone system) that clients can take turns using to make and receive calls. With so many (all?) cell phones now having built-in cameras, that would be a huge confidentiality issue, as flpsychnurse noted. Maybe, occasionally, if there were some v. special/important reason (like needing to call Europe?), a person would be allowed to sign out her/his personal cell phone and use it in her/his therapist's office, or something like that. But that would be v. rare and strictly controlled/supervised.

US clients have a legal right to have access to their own medical records, but there are also many restrictions that physicians and facilities can (legally) impose -- there's no such thing here as handing over a client's chart to her/him on the spot just because s/he asked you to. It's usually a fairly lengthy, tedious process for a client to get access to a record.

I agree that inconsistency among staff on a psych unit is a serious problem! It's much better to all be enforcing a bad policy/rule (unless it's illegal, of course!) -- while working within the treatment team/staff to get the policy changed -- than to have each staff person "do his own thing." Good luck with either improving the situation where you are, or finding a new job!! :icon_hug:

Levin · Sep 9, 2007

Based on my experience at one psychiatric facility I worked at.

If a patient is admitted involuntarily, do they receive permission to leave the unit unaccompanied for short breaks? ie smoking breaks

There is an internal self contained garden for that.

Do you allow patients immediate access their chart on verbal demand?

Generally as a rule, no.

Do you place patients in pj's on admission if they are deemed a flight risk?

In general the only patients who get put in PJ's are the ones brought in naked or in dirty clothing.

Do you return a patients clothing to them when they have not been assessed by a psychiatrist?

Depends on the clothing and nursing assessment of patient.

Do you allow patients to have unrestricted access to MP3 players or cell phones?

Mp3 players I don't know, it's never really come up.

Cell phones, nah. Especially not with cameras on them.

Levin

goettin98 · Sep 9, 2007

if a patient is admitted involuntarily, do they receive permission to leave the unit unaccompanied for short breaks? ie smoking breaks

absolutely not. can't leave the floor without a doctor's order (and that includes our geropsych patients who want to take the elevator up one floor to the beauty shop). besides, you can't smoke anywhere on our hospital's campus. even if a patient is voluntary, they can't leave the unit! this question is baffling to me.

do you allow patients immediate access their chart on verbal demand?

never. the patients and families are never allowed to see or have a page copied from their chart. like a previous poster mentioned, after discharge, they can take that up with medical records.

do you place patients in pj's on admission if they are deemed a flight risk?

yes, we have 15 minute elopement precaution checks, and those who are on them are wearing our lovely hospital gowns and are not allowed to have their shoes. i think every patient in the acute and step down areas are initially on eps.

do you return a patients clothing to them when they have not been assessed by a psychiatrist?

we inventory everything then lock it in the closet in their room. only staff has the keys that access their closets.

do you allow patients to have unrestricted access to mp3 players or cell phones?

usually no mp3 players because of the cords, but they are allowed to have cell phones. we either have to charge them in the nurses station at night or lock them in their closet. we also have a wall phone that patients can use free of charge. our unit is like a hilton- no structure, no expectations, patients have free run of the floor and demand snacks and sodas and movies all day. it's ridiculous.

blackstarryskye · Sep 10, 2007

Wow, very interesting..the Hilton part. What kinds of comments do you hear from the patients? Do they percieve they are getting better in this type of environment? What kind of populations do you see?