lala589

absolutely I have seen many that can continue going through withdrawal after taper is done. Just like everyone has different blood pressure, pulse rates, people also have different livers that many detox substances and at different rates. We typically put both ETOH withdrawers and benzo withdrawers on a serax taper and vital sign schedule of q 2 hrs or q 4 hours depending on cumulative scoring of factors such as heat rate, anxiety, flushing, etc. The taper lasts 5 days. We continue with frequency of vitalls though, and if pt continues to get high score they get PRN serax until the doctor d/c's the frequent vitals.

lease bear with me...So I work on a psych unit and we do paper charting. We don't do many restraints or seclusions on our floor at all. Awhile back, I remember being involved in a restraint/seclusion. I recorded on the "flowsheet" for the documentation of what was going on (q 15 min)--the patient becoming physically aggressive, the takedown, etc. The patient was originally manually restrained then taken to seclusion awhile later. I recall filling out the paperwork and ending it with the patient being released from manual restraint. Doc signed pt released from restraint and time out. However, then the patient was taken to seclusion on another floor because that's where it is located. Another staff went down to monitor the patient and the patient ended up coming back to our unit one hour after my shift was over. In hindsight, (and because I am a worrywart) I am wondering if the staff that went down with pt to seclusion recorded for their observations of pt while in seclusion. As I mentioned, my charting on the flow sheet ended up with "pt released from manual restraint. To be taken to seclusion room" on such and such floor. I will still trying to furiously catch up the last of my charting when they took him down, so I still had the flowsheet I was writing on and at the time assumed that since the pt was released from restraint and was not in restraint while they were taken to seclusion floor that that was a separate "episode" and that the staff going down with them would start their own obs/flow sheet (not even sure if this would be a seperate episode, but I thought the change from manual restraint to seclusion with time in between would be considered 2 episodes). Now, literally a few months later, I am wondering What if they didn't take a flowsheet to document on while they were observing him down there? Granted our nursing boss went down with the staff to take the patient to the floor as well as signed off the restraint order from the doc PLUS a charge nurse was on that day and as part of their role are supposed to make sure all documentation is complete and correct. I also think that there is someone at the hospital who reviews all the paperwork once restraint or seclusion happens to make sure it is complete. So my question is--should I be worried? The patient was with us for a quite awhile after this and was not harmed at all in the process. It's literally been quite awhile so I don't want to bring all this up now (I'd probably get looked at like I'm nutty), but I guess I am wondering how responsible I would be in this equation if the staff that went down with the pt to monitor him did not fill out the paperwork for observing him while in seclusion room? And this was later reviewed? I know JCAHO comes every few years and I am just worried that this chart would be pulled. I'm a stickler for adhering to everything to assure the best possible patient care and since I know from seeing this patient after the fact and talking to him he even thanked everyone for taking good care of him and showing him respect and trying to maintain his dignity through everything. So--I'm not worried about patient care but I am worried that if every little "i" isn't dotted, a nurse who truly cares for their patients can get dragged out onto the carpet. Increased stress at the job could be causing me to go back in my mind and think of possible errors I've made; I realize this. But I just wanted everyone's take on this. Surely nurses are human and make mistakes, I just always worry about what's to come down the pike (could be because I'm a newer nurse and have heard horror stories).