smcRN2592

Haha I figured at the very least a medication could've been given and the BP could've been reassessed before transfer but apparently, that was too much to ask for since the physician in psych triage determined the patient was medically cleared for us! That is one of the more minor occurrences I've encountered with this issue, too.. which is why I'm trying to present a policy that can be implemented and give us a leg to stand on when accepting/declining a transfer ?

Topic: Medical Clearance In your experience, what have you seen that constitutes “med clearance” for a psych unit? Particularly, at a free-standing psychiatric facility. Geriatric patients. I’m trying to brainstorm to present some type of policy that constitutes med clearance and can give our staff some back-up in the future if an appropriate admit presents itself. Backstory: I work on a geriatric psych unit that could once handle some level of patients being medically “unstable” due to the unit being part of a medical hospital. Last year, all of the inpatient medical units closed. More recently, the emergency room closed. We are now the only unit in a building that is essentially empty aside from some outpatient offices. We now have to call 911 if a patient is appearing to be medically unstable or suffers an unwitnessed fall/fall with head strike (which can be common given the population). It is understandable for this population to not but 100% healthy (obviously) but we have an extensive history of having to transfer patients to a higher level of care within 24 hours of admission, even when our ER was open. I think this could be avoided with policy that requires medical intervention for abnormalities before transfer. Example: Report from a medical hospital’s psych holding in their ER for a new admission. The intake paperwork said the BP was 157/101. In report, I got that the BP was now 167/122 and they had not given any BP meds or other intervention since the patient arrived (day before). They did give patient tylenol for a headache. Patient has a history of stroke/TIA, 60s year old M, full code, schizophrenia dx. Would this be acceptable in your experience? Or would you require some type of intervention first?

Topic: Medical Clearance In your experience, what have you seen that constitutes “med clearance” for a psych unit? Particularly, at a free-standing psychiatric facility. Geriatric patients. I’m trying to brainstorm to present some type of policy that constitutes med clearance and can give our staff some back-up in the future if an appropriate admit presents itself. Backstory: I work on a geriatric psych unit that could once handle some level of patients being medically “unstable” due to the unit being part of a medical hospital. Last year, all of the inpatient medical units closed. More recently, the emergency room closed. We are now the only unit in a building that is essentially empty aside from some outpatient offices. We now have to call 911 if a patient is appearing to be medically unstable or suffers an unwitnessed fall/fall with head strike (which can be common given the population). It is understandable for this population to not but 100% healthy (obviously) but we have an extensive history of having to transfer patients to a higher level of care within 24 hours of admission, even when our ER was open. I think this could be avoided with policy that requires medical intervention for abnormalities before transfer. Example: Report from a medical hospital’s psych holding in their ER for a new admission. The intake paperwork said the BP was 157/101. In report, I got that the BP was now 167/122 and they had not given any BP meds or other intervention since the patient arrived (day before). They did give patient tylenol for a headache. Patient has a history of stroke/TIA, 60s year old M, full code, schizophrenia dx. Would this be acceptable in your experience? Or would you require some type of intervention first?

I havent started working in psych nursing yet but I too had similar views as you when it came to addicts. During school we attended a few AA/NA/Al-anon meetings and it completely changed my perspective. It's important in my opinion to see them as humans 1st and remember that nobody grew up wanting to be an addict. They are people who had/have dreams and aspirations. They have families being affected as well. They just need alot of help to recover, which may be difficult to get.

Long time lurker of this site but just made an account to say thank you for this post! As a new grad who has her 1st interview tomorrow at a psychiatric facility this helped me realize I'm making the right choice. I, too, thought about getting med surg or long term rehab experience first "just incase" because that's what I was always told. In school I got a clinical associate job on a geriatric psych floor and my nurse manager there pushed me to pursue psych first because it was the main reason I went back to school for nursing! As she said, if your heart is in psych then why bother with something you hate just because other people say you should do it. I can only hope that my experience will be as positive as yours. Thank you