sassyann85

a voluntary patient came in to the psych unit and was suicidal and also using alcohol. They were detoxed off the alcohol, started on antidepressants, and was no linger suicidal at discharge. The pt wanted to go to a specific rehab at discharge but the rehab wouldn't accept him. So, the pt decided he didn't want us to schedule him any follow up. The Dr. said he was discharging him home then. My question is, was this ok? Was it ok to discharge this patient with no aftercare? The Dr. the patient was no longer suicidal so they could be discharged regularly, AMA wasnt necessary. They got a 30 day supply of meds but with no aftercare, they will have to find a provider on their ownwho will continue to prescribe the meds...

Hi everyone: So I often have patients on scheduled antipsychotics like risperdal or abilify and then they have PRN antipsychotics ordered. How do you know if these can be given together or how long you have to wait between meds? IE- a patient on scheduled PO risperdal comes and taken their med and then reports they are really agitated and wants their PRN IM Geodon? Or a patient on scheduled risperdal PO takes their med and then requests their PRN PO Haldol because they are starting to feel really agitated?

what if a patient chart is accodentally opened and immediately closed? can the hospital tell how long you were in a chart and what you clicked on and see you immediately closed the chart once you realized the mistake?

Hey everyone, So in my state, if a voluntary psychiatric patient wishes to "sign out" of treatment, they can sign a "72 hour notice" that they would like to withdrawal from treatment, but the form states they can be held up to 72 hours in the hospital for further observation. At your facility ,if a patient who has signed a 72 hour notice gets discharged, do you have them also sign a separate "AMA" paper that states they understand they are leaving AMA and that this and the risks of doing do have been explained to them? Basically, are signing a 72 hour notice and signing out AMA the same thing? Or can a patient sign a 72 hour notice to withdrawal from treatment, and then the psychiatrist says ok, you can be discharged and lets them go without it being considered AMA? There is confusion on this at my facility....practice has been that if a patient signs a 72 hour notice, the MD will specify whether they want the patient to also sign an AMA form. Other times, patients sign a 72 hour intent to withdrawal from treatment form and are NOT required to sign a separate AMA form. I was always under the impression from working at a previous facility that if a patient signs a 72 hour notice and then gets discharged, the discharge would be considered against medical advise, but that doesnt seem to be the thought where I am working now...

Hello, For patients that are inpatient in the hospital, when they get discharged, our MDs write for a prescription for usually 2 weeks of meds. Pts are encouraged to allow the RN to schedule them a PCP appointment within one week of their discharge from the hospital. Sometimes, pts will not sign a release to allow the RN to schedule an appointment with their PCP--they state they will call and make their own appointment bc they are unsure of their schedule, etc. We document in their discharge paperwork that they were informed of the need to see a PCP within a week of hospital discharge. My question is--would there be any liability on the part of the discharging RN/hospital if the patient DOESN'T end up seeing a PCP and say, runs out of their medications that we have them upon discharge? I would think that the responsibility is on the pt to follow up with the recommendations to see a PCP. Thoughts? thanks!

same with where I work. I am newer there, so I havent encountered this situation yet, but wasn't sure if this was considered a "nursing responsibility" or not....I didn't think it would be, as I have no idea how to go about helping them get assistance, but I'm sure our social workers and care managers and more knowledgable on how to help/get them assistance. thanks for your reply!

For Pts that are in the hospital and require insulin therapy but do not have insurance...who is responsible for trying to get them some sort of medical assistance to pay for this? The social worker or case management? Just wondered how this situation is generally handled. Thanks!

When you are working with a patient who will be d/c home on coumadin, is there a coumadin clinic in your hospital you have them follow up with, or do you make them an appointment with their PCP? Also, when you give the prescription to the pt for coumadin (or send electronically to a retail pharmacy), do you have to give them a copy of their lab results to take to the pharmacy when they pick up their coumadin? Do retail pharmacies require this before dispensing the med? thanks!

Hi everyone. So if a patient is ordered a peripheral IV start for a bag of fluids, after the bag is completed some RNs have been discontinuing (removing) the IV as soon as the infusion completes. My understanding is you need as physician order to d/c a peripheral IV (unless it's infiltrating or something like that). My thinking is-if you d/c it right away, how do you know they won't be needing additional fluids and have to get restuck again? thoughts?

when other pts get d/c to outpatient treatment or whatever, sometimes they really minimize the severity of their condition but they are able to care for themselves and I think recognize if the were decompensating, and I wonder about what to chart bc I was thinking if I do fair or poor insight, it means they shouldnt be getting discharged or that they wont be safe...

How do you typically document judgement and insight on patients signing out AMA? Specifically, patients with drug/ETOH problems that arent suicidal and so can't be held, but sign out AMA and plan to use again.

Hey everyone, So we have patients that are ordered to be on the WAS (withdrawal scale for alcohol or benzo withdrawal). It usually goes that they will get their vitals every 2-4 hours depending on their score, and be medicated with ordered Ativan 1-2 mg PO q 2 or q 4 hours based on their scores. Since the WAS is a little subjective (patients who constantly say they are super anxious can continue to score high enough to get a PRN even if their VS are stabilized) after a few days, our docs like to start cutting them down on the amount/frequency of Ativan they can get per day. I've even seen it go down to an order for Ativan 1 mg PO q 12 hours PRN withdrawal after the patient had been in the facility for about a week. My question is, if the patient only has an order for PRN Ativan 1 mg q 12 for withdrawal, isn't it more of a tapering process then an actual withdrawal assessment process? If someone is only requiring up to 2 mg of Ativan in a 24 hour period a week after they were admitted, to me, they are no longerbeing monitored on the WAS (since the policy states VS q 2-4 hours with meds q 2-4 hours as needed) maybe getting the med more for anxiety at that point. But the docs never change the PRN indication to anxiety, they leave it as withdrawal. I guess my point is, it just seems silly to leave a PRN Ativan 1 mg q 12 hr order for the indication of "withdrawal".....does anyone see/agree with my point? How does your facility handle this?

For pts on meds like invega sustenna, when the pt is discharged, do you give the script for this med directly to the patient, with instructions to take the med to their outpatient appointment to be administered there on the date it is due? Or do you have another system, such as faxing the script to the outpatient provider? just curious on how other people handle this, thanks

thanks everyone for your responses!

He was not going to be given a script for ativan at discharge