I'm currently in the process of processing the events of this past weekend's three 12 hour shifts working in the psych division of Wrongway regional Medical Center. Processing does not always follow a chronological timeline so, like doing art, I tend to start at point a of reference and work from there.
Chronologically, I need to digress to about two weeks ago when it was mandated that I attend...
A portion of this mandated inservice entailed a CPI training where we learned to deal with acting out psych patients. Wadley, a tech, certified us in CPI for years but he passed away recently and is sorely missed...
So now one of the instructors who I don't really know all that well, Clark, teaches CPI. Clark was once a tech, now has the title of art therapist, is a well built man in his early thirties, solemn, and possibly possessing a vertically-challenged syndrome.
The book portion of CPI, where we learn and/or review legalities, policy & procedure, etc that was taught by Clark was a real bore. Basically, all Clark did was to read from the handouts in a low monotone.
However, the actual physical portion was a real hands-on learning experience. I have taken CPI since the mid '80's and I learned a new thing or two and I let Clark know that I appreciated the tidbits. At the end of the training, I led a round of applause for Clark.
Actually, I was relieved to be done with the day, for it truly was...
Okay, that's enough of the background information.
Sunday night, I was assigned to work the adult women's psych unit. I don't think it was my turn to be pulled, but as I told Mandy the house sup, "The next time it's my turn to be pulled, I want a Get Out of Jail Free card!"
After getting shift report at about 1920, I introduced myself to the patients in the day room, and met them each personally. Then, in the company of the LPN, I went looking for the infamous patient, Marie A, who had been responsible for at least six staff injuries. Marie A truly was, the Psych Patient From Hell. I could go on and on and on, but please accept my label.
At 1925, the LPN and I found Marie A on the floor, laying face down, between the beds, unresponsive. We couldn't see her breathing, she did not respond to our shake n shout, so we log rolled her to a supine position, as she was wearing a neck brace. The LPN did sternal rubs while I checked for a radial pulse to no avail. I told the LPN to go call a Code Blue and I tilted the patient's head back as best I could and got an sound like a snoring suck of air. Spontaneous respirations were present, I found a pulse, so I yelled, "Make that a Rapid Response!" and I checked her pupils and lightly patted her cheek.
Marie A was groggy and slow to respond when the RR team arrived, we assessed her, backboard, gurney, yadda yadda yadd, and she left the unit at 1945 for one of her many trips to ER.
At about 2200, I was in the process of admitting and getting med orders for a suicidal patient sent from ER suicidal positive for heroin, amphetamines, and cocaine who was yelling profanities and acting out when she knocked over a WOW. The tech and I assisted her into the locked seclusion room.
About that time, Marie A returned from ER via wheelchair. I advised that she return to her room when Clark started some ramma lamma ding dong with her. I got between Marie A and Clark and proclaimed, for safety's sake, she needed to return to her room.
In assisting Marie A to her bed, she became threatening and combative. A code Green was called and, with the assistance of Clark, techs, and security guards, Marie was therapeutically held. I recited, in a voice to be heard by everyone from rote memory, my spiel about the reason for the therapeutic hold, the legal process, and the criteria for the restraint to cease. I also said that I was going to contact the doctor for a chemical restraint.
I went back to the nurses station and Mandy the house sup, God bless her, had gotten an order from the psychiatrist for Thorazine 50/Ativan 2 IM now. I set up two syringes and returned to the room to find Marie A out of a therapeutic hold. I said, looking at Clark, the staff member who certified me in CPI, and recited, "Only a licensed practitioner can discontinue the restraint process"!
Or, "Do as I say and not as I do".