statcoffee

1. We have not been given any orientation specifically. Generally, it's call the hospital police, or get the doctor to order restraints. HP usually does nothing, and the staff must be put in harms way to point restraint someone. 2. Belongings were ticketed in admitting but when the patients come to our unit we usually receive their belongings so they may transfer with their property. Due to the design of the unit there are no lockers or areas where personal items can be safely secured unless we put them under our desk by our feet. I am highly uncomfortable with this as belongings are constantly being left on the unit long after patients are transferred or discharged. I gave the patient the phone because I foolishly thought it would help calm him down. I realize now he was testing the waters. When I gave the CNA the patient's property and told them not to give him his clothes, I also realize this was a horrible mistake. 3. He had PNA and COPD exacerbation. Sat's were in the 80's, RR into the 40's, Tachy. He was getting IV abx. I was going to d/c the IV after his meds were done but I didn't get the chance as my other patient started up. The unit is unfortunately just not physically set up for patients like this. The lack of prosec devices or lockable passage ways and easy access to multiple exits is just a formula for disaster. Thank you for responding.

He was on observation for lack of insight, nothing about self harm or violence. I would have surely not given the CNA any of his belongings if that were the case. He was AOx3, alert and even stated multiple times he would stay for length of treatment. Seems he just wanted to feed his habit more than he wanted to be cared for I suppose. Going forward, I decided I will halt any admit on observation with possibility of elopement and try to redirect the patient to a floor with secure patient lockers and a functioning prosec system.

I tried but the patient only spoke a dialect of Slovakian. There were no interpreters at the hospital who spoke the language, and the phone interpreter I found was unable to communicate with the patient due to the patient's hearing deficit. There are no teaching materials available in that particular language from the hospital. The teaching I provided was directed towards the patients family members when they came to pick him up and were actually the only ones who could communicate with him. Patient education was given for DVT and coumadin but unfortunately only the DVT portion was documented as given.

I work on a bit of Hellish unit. 10 bed holding area, patient acuity levels vary greatly, and also do a massive amount of admissions/discharges/transfers. This past week I ended up with two patients (out of 5) on watch. A 2 to 1 by psych for unpredictable behavior, and the other a psych 1 to 1 with PNA and a raging Heroin addiction who was also actively withdrawing. The 2 to 1 had been on the unit for several days and had been well behaved, directable and while he made the other staff and patients nervous we had a good relationship. The 1 to 1 on the other was a new admit, very nervous, diaphoretic, yawning, etc - withdrawing. The morning was unremarkable, however the 1 to 1 had become increasingly agitated and wanted his cell phone to call his family. I got his property from property office and gave it to the CNA doing the watch telling him he was allowed to have his phone but do not give him his clothing. The rooms do not have lockers, and there are no secure areas on the unit to lock up a patients property unless we put it under the desk but honestly I don't like doing that in case something were to go missing. Right about dinner time, the 2 to 1 goes off the handle, screaming about how he demands to be discharged and takes off into the hallway (this unit has no prosec system or doors which lock) we try talking him down and reasoning with him for about 45 minutes, his doctor shows up during this time, he threatens his doctor and myself with serious bodily harm, I get in between the two of them to try and talking him down. When it finally seems to reach a lull, out of nowhere I see the 1 to 1 patient sprint from his room into the hallway and jets off to the elevator. It was almost like he could see his opening to flee due to the chaos being caused on the unit by the other patient. The CNA followed him but due to the fact that he was 6ft tall 200+lbs and desperate - she did not get on the elevator with him. Smart move on her part, because if she did catch him, she could have put herself in serious physical harm. I could not take off after him, due to my current patient's excited state and my concern for his safety as well as the other patient's on the unit (this guy was 6'5" and in excess of 250lbs). So I immediately called Hospital police, the primary team, my supervisor and filled out an incident report. The patient who eloped , had done so with his medlock intact (at least I assume so, seeing as I did not take it out personally). So 911 was also called. Unfortunately the patient was not found, and I was just made aware that there was going to be a root cause analysis performed and the staff questioned individually to determine what and why this happened, and if this is sentinel event worthy. If you have read this far, I thank you. Here are my questions: - The CNA at no point alarmed me or the other nurse that the patient was dressing. I feel if I had at least been made aware of this, I could have removed the patient's medlock and called hospital police. To what degree would you say I am at fault? - Are nurses allowed to hold a patient's property from them if the patient is AOx3 and alert? I thought giving him his phone would help calm him down and provide comfort so he could speak to his family. I did not think the CNA would have allowed him to get his clothes. - Has anyone else had a situation like this occur and how did you handle it? Thank you for any input. I understand that this really isn't in anyone's control as addiction in such a horrible disease and the unit itself has nearly no way to keep a patient from eloping if they chose to do so. Honestly, I am distraught over this and very worried that I could be terminated as a result.

This is a long one, forgive me...I was recently called into my supervisor's office and was told that there had a been fall out regarding a patient I discharged sometime in December. I was told I did not perform Coumadin teaching for a patient who was new to the drug, and now the hospital will not be getting paid for the patient's stay as the chart had come under review by medicaid. Now, I know, without a doubt in my mind, I had given the patient's family (patient was basically stone deaf and only spoke a rare eastern euro dialect - I had to communicate with him by drawing pictures and use of hand gestures) teaching regarding his diagnosis, risk of bleeding, dietary restrictions and need for follow up appointments. Coumadin teaching was also documented on previous tour as given by the night shift. However, because there was no copy/proof of the teaching in the patient's chart it is going down that patient was discharged improperly. Seeing as it was too late to go back and put in a note, I had to just take it on the chin even though I truly feel I did the best I could considering the situation and the resources I had available. I work on a very busy, understaffed unit that has every kind of patient you can think of from near death to psych to walkie talkies. 2 RN's typically due 5-6 admits, 5-6 discharges, and numerous transfers daily, all without help from CNAs or even a clerk usually. It's a very difficult and dangerous place to work. My question is, seeing that a note could make all the difference in proving if one had actually done the teaching they said they did - would it be unethical to go back and check the discharges I had done in the past couple of months to make sure everything is as it should be? Ever since the sit down, I have changed my style and I am over compensating in the amount of teaching and documentation I perform but I can't see any other way around it. As a new nurse, I'd appreciate any input, thank you.