medpsychRN

DOrothy, The place to check the law in Indiana regarding restraints is through The Department of Developmenatal Disabilities. At least that's what it's called in Illinois. There are specific laws which may vary from state to state which provide the law regarding the use of restraints, ROM, toileting and hydration. In Illinois, the physician is required to see and document at the beginning of the restaint and every eight hours. There also must be a restriction of rights completed every 4 hours. In this restriction, a copy which must be provided to the patient, the nurse must state the reason for the restraint. In addition, in Illinois, the nurse must document every 15 minutes the behavior of the patient. If the patient is sleeping, he is no longer a danger and the restraint must be removed. In addition, the patient must be monitored one to one by staff. Meaning a staff memeber must be present at all times. In Illinois, complaints are filed with guardian and advocacy. I'm sure Indiana has a similar agency. On the back of the restriction of rights, in Illinois, the location and phone numbers of the offices are listed. I have never heard of "forensic restraints". Hope this helps.

Help with isolation precautions for MRSA and C-diffby medpsychRN Registered User Age: 54 Received 14 Kudos from 9 posts Join Date: Jan 2005 Posts: 123 -------------------------------------------------------------------------------- New isolation procedures on the med/psych unit where I am employed state patients from a nursing home or those on dialysis must have a nasal swab for MRSA. If the swab is positive for MRSA, the patient must have a private room. A sign indicating contact precautions is posted on the door and PPE is available outside the door. HOWEVER, if the patient has no draining wounds, they are allowed outside their room and are free to roam the milieu. This includes all patient common areas like the TV room and the lunch room. They are not allowed in the kitchen. The same applies for C-diff. Even though the patient is allowed out of his room, I must gown and glove before I enter his room. Simply, I'm just not getting it. Does this make sense to anybody else? Thanks

New isolation procedures on the med/psych unit where I am employed state patients from a nursing home or those on dialysis must have a nasal swab for MRSA. If the swab is positive for MRSA, the patient must have a private room. A sign indicating contact precautions is posted on the door and PPE is available outside the door. HOWEVER, if the patient has no draining wounds, they are allowed outside their room and are free to roam the milieu. This includes all patient common areas like the TV room and the lunch room. They are not allowed in the kitchen. The same applies for C-diff. Simply, I'm just not getting it. Does this make sense to anybody else? Thanks

I have had some bad experiences giving Dilaudid in the past so it's not on my favorite list. In regards to drug addicts, they can be near coma and still complain of pain and demand more meds. Recently, when an addict was admitted to psych and on IV Dilaudid, I asked for specific parameters, e.g., respirations above 8. Even if the patients respirations were above 8 there were many times when I told her I wasn't giving her any more Dilaudid. Just because it's ordered doesn't mean I have to give it. I cannot financially afford a lawsuit because the patient gets what she wants and then falls flat on her face because she's sedated. Since it's highly unlikely the patient will be discharged on IV meds, the pain service needs to see ASAP and recommend a plan for a patch or for oral meds. Drug addicts can be needy and demanding folks. If it's safe for them to get meds, they can have what's ordered. However, I have five (or more) patients to take care of and the majority of them think their problem requires immediate attention. Thus, the addicts have to get in line and when I can get to them I will. This isn't an attempt to make anyone suffer. I can't ignore other patients. Sometimes it's okay for addicts to have an awareness of delayed gratification.

Been there ten years and it's been the best learning experience of my life. Mds are outstanding. Nurses are fantastic. I work nights and I can call any floor and ask for help with procedure or medical problems. I work hard. I have seen illnesses I have never heard of! Patient's with multiple, complicated diagnoses. It's a challenge but that''s why I love it. Pharmacy 24/7. Most of pharm have their doctorate. Night pharmacy rocks. Almost completely computer charting. Another challenge but this has really reduced the number of errors. Would not consider going anywhere else for my medical care. The worst part of the job is the attendence policy. You are allowed so many occurances before you are written up. Best advice: don't be late (one minute late is a tardy) and don't forget to swipe. I think you'll love it.

For my patient who drops the f bomb every time I ask him to do something..."right back atcha!" LOL

Because we are a psych unit, we don't have those wonderful dispensers outside each room for handwashing. We were instructed we must wash our hand upon entering a patient's room. However, because of some new, unknown JC reg, (I'd like to meet the person who thought this one up) the faucets have no handles, come on by tapping the underside of the spout AND only stay on for about 30 seconds before shutting off. The showers are on for ten minutes and you have to wait another ten minutes for the water to go back on! We were asked to stop emailing the IC nurse in the past when we had questions about MRSA. I'm sure I'd get called on the carpet if I asked her about c-diff. The MD was very clear about not testing. Patient could get Immodium 2mg TID PRN. I asked for an increase in the dose and it didn't happen. Can't send a stool without an order and if this is the policy, I won't be able to sneak an order from the resident. Some of our patients are street folks and haven't had a bath in forever. Some are too depressed or psychotic to care. I'm worried about getting it and infecting my family. Also, would be hard to prove I got it at work if we're no longer testing. Thanks for the responses. Would be interested to know if this is happening at other hospitals. BTW, I work in a large university hospital. Thought they'd be better about taking care of patients and their employees.

Cared for a woman on nights over the weekend. She had an episode of massive diarrhea (bed, floor,toilet). This was the third night she had diarrhea. Saw her attending Monday morning and I mentioned it to him suggesting we get a stool for C-diff. He told me the hospital wasn't testing anyone for c-diff who'd been hospitalized longer than 48 hours. They don't want it to look hospital acquired. I'm thinking of a million reasons why this policy is a problem. Does this increase the potential for c-diff spreading to other patients and staff? Since it's a system wide policy, it's a system wide problem now and in the future. Am I wrong about c-diff being so contagious? Any info would be appreciated.

Just wondering about the anticholinergic effects of combining Clozaril with antihistamines, scopolamine, atropine?

Thanks for all the responses. I believe when a serious error occurs there needs to be some consequence. However, we are being verbally reprimanded for forgetting to sign something, date something or miss a section/spot on a form. Staff has been told repeatedly we must make do with less. This translates to fewer staff and more responsibilities. I work on a med/psych unit. We do everything but vents/cardiac monitoring. Ages 18 and above, taking the overflow from geropsych. Elderly patients are already at risk to fall. Put them on psych meds and it's worse. When I've asked to have patients placed on 1:1 for safety/fall risk, this has been denied. If the patient falls and breaks a hip I am the person responsible. It's tough to do that AND take care of the rest of my patients. I haven't been written up. It's been implied I needed to manage my time better. It's very stressful. The constant message is if you do something or don't do something you will be demoted, written up or terminated. We've been told "somebody's watching you" or "we'll be making surprise visits" on other shifts. Staff is paranoid and discouraged, demoralized. Wondered before I quit, if it's just this place or if it's all over. Thanks

Wondering if anyone else has noticed employers being less tolerant of errors? Didn't know if it was related to medicare refusing to pay for hospital acquired infections/illness/accidents. Most of what I have seen is an increase in the number of write ups (in general, not specifically related to patient care) and terminations. Makes me want to think of employment elsewhere but wonder if it is the same all over. We also have a new attendance policy and have been told our job descriptions are changing. In the outline, the first thing they mention is how you can be demoted! It's been discouraging.:uhoh21:

A lower dose of seroquel is not going to increase sedation. I don't know why the MD would say this.

I guess you can try it out. There isn't enough staff for 54 patients. Our ratio is at the highest 6:1 (RN- not including support staff).

If they can't get anyone, someone is forced to stay. We try to rotate it so it's not always the same person.

I work in a magnet hospital. Either we all work in the same place or our managers were trained by the same people! My manager only micromanages when SHE believes you've done something wrong (God forbid you ask for advice) and not only will tell you about it but tells everyone else whether your present or not. You can work your buns off, get rave reviews from patients and MDs but according to her, you are only doing your job.If you want a raise you have to serve on hospital committees, volunteer for the hospital, conduct inservices and develop a unit quality improvement project. All of this is on your time. Staffing is cut daily and we are obligated to take PTO or no pay for call offs. The new hospital motto is "do more with less". They aren't kidding. Her latest method of improving staff morale is to develop a policy for the unit regarding tardiness and attendance. If you are one minute late, you are late and subject to a written warning. I hear it's no better on the other units. Everyone I've talked to is wondering how we can get the union in. There are some great reasons to stay...for now. Wonderful, compassionate physicians and I love working with patients. BUT, I have to admit, I'm having a bit of a problem showing gratitude to this (evil) woman for my job on a daily basis. White Castle is looking pretty good for my next job!