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

[epg_pei]

I'm having issues with what's happening on my unit right now...when I first started we had levels of observation with privileges that were well adhered to by staff.....in the past year the situation has changed to the point where we are no longer adhering to these policies and there is significant variation regarding patient privileges and enforcement of the smoking policy. Anyway, I have some questions for others working in adult in-patient acute care units:

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

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

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

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

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

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

[goettin98]

To answer your questions, blackstarryskye, we get just about everything. Overdoses, detoxes, "3 hots and a cot," schizo, bipolar, suicide attempt, MR/DD, geri, MDD, you name it. We do have a few, and I emphasize A FEW patients who progress. Sadly, many of them just don't have the insight to realize that a. they do need help, or b. they need to play an active role in their care (such as going to group therapy when on the step-down side, take their meds, etc.) Our unit is so backwards to me. There's no structure and no expectation. If they want to lie around in their messy room without showering for days, so be it. On the acute and geri units, there are no group therapies so these poor people wander around the unit all day, or sit in the lounge watching tv and bothering staff every few minutes for a drink or snack, etc. I tell you, if I were homeless or very stressed out, I could see where coming to our floor would be like a vacation. You can sleep when you want, complain about the food, ask for expensive meds when you feel like it, and generally veg out. I think it's appalling. I think these people need structure and routine, but of course, no one asked me what I thought. Our director (who is not a nurse at all btw) believes that these people are not "patients," but "customers" so we need to satisfy their every whim. I only agree to a certain extent. It's not good when you have psych patients basically running free reign over the floor. It's frustrating for me, because I feel that they're not getting the treatment they deserve that may actually be beneficial for them.

Where I did psych clinicals, the patients were dressed and out of their rooms by 8 am. They all ate breakfast together, then had community meeting. This was followed by group sessions all day long, even into the evening (even if it was something simple, such as watching a movie and talking about the positive message or the problem-solving abilities of the characters, etc.). Patients were required to attend (unless they were ill, of course). And you know what? Those patients thrived. They felt like they had a purpose. They were much more hopeful towards their future. Plus, they had a feeling of community on the floor amongst each other. They supported each other in a good way- they made positive alliances. The patients on my floor just sit around and complain how much they hate it there and how the doctors are "dumb." It's frustrating, really.

[blackstarryskye]

How very sad, but I bet very profitable. There must be plenty out there waiting to get in for 'Hotel Hospital', not to mention the ones hiding from the law/court. Wonder how joint commision feels about it?

[Saoudishabiba]

Here is the protocol for our inpatient adult unit:

1. No smoking for the 1st 24 hours.

2. No street clothes for the 1st 24 hours.

3. No access to your personal chart without a doctor reviewing it with you.

4. No cell phones, radios, mp3 players, etc.

5. No outside food or drinks.

This policy is for voluntary and involuntary admissions.

[epg_pei]

I just wanted to thank everyone for their input. We certainly seem to deviate from policy too often. I'm glad I have some options as far as what to do in some of these situations.

[NikkiRN_BSN]

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

No one may leave the unit voluntary or involuntary unless they are discharged or have a doctor's order for off unit services. We are non-smoking also.

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

No. They must go to their doctor to request to view the chart.

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

No. Patients can wear their own clothing with the exception of belts, strings, shoelaces.

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

Yes. same as above.

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

They may not have cell phones. Mp3 players, laptops, and other electronics need a doctors order. These are nurse discretion as far as when they may use them but it is never during group times.

[Thunderwolf, MSN, RN]

In psych/on a psych unit....policy and SOP really needs to be applied consistantly in your facility....it is the very "structure" that holds things together for you, helps dictate what is done, and helps protect you as a staff member. Not only is structure good for the patient...it is good for staff. So, the message here is: your policy should easily tumble from your lips in psych. If you are unfamiliar/unsure, seek the answer....in writing.

Great feedback everyone.

[KrissyPRN]

There is absolutely no smoking in our Mental Health and Addictions Facility whether the pt is voluntary or involuntary.

The pt's are allowed to look at the chart after they are d/c'd and request them from medical records.

Pt's are placed in hospital gowns and then searched for contraband.

Pt's belongings are given back after they have been searched for contraband whether they have been seen by the physician or not.

Pt's do not have access to cell phones, MP3 players, ect

[2bnursenikki82]

Our smoking areas are attached to the unit and a member of staff is ALWAYS with the patients. Pretty much anyone who wants to smoke can, unless they've been acting afool and have been put on unit restrictions.

If a patient wants to see their chart they have to go through medical records to do it and even then I don't think they see the whole thing.

We put our patients in gowns and then search their clothes on admission and we usually give their clothes back to them unless they are nasty dirty. Then we wash them and give them back.

Absolutely no cell phones or mp3 players. I usually work the kids unit and they always tell me "but I get to have it at home miss..." to which my reply is "well, this isn't home is it?"

[ZippyGBR, BSN, RN]

from the right pondian point of view , if a patient is on a section i.e. detained they aren't going to be allowed out unsupervised on an acute section, once of a different section later on in their treatment then depending on the risk assessment and the provisions for leave i nthesection they are detained under ...

access to records needs to be in accoradnce with the approrpaite legislation and the facility / organisational policy.

taking clothes off people - only if they aren't fit to be worn or the item of clothing poses a risk and the risk assessment says thecontrol measure is to remove that item of clothing ( e.g. belts etc )